The mission of the Native Dental Therapy Initiative is to connect tribal communities with innovative approaches to address AI/AN oral health disparities, to remove barriers impeding the creation of efficient, high quality, modern dental teams and to provide opportunities for AI/AN people to become oral health providers. According to the IHS 2014 Oral Health Survey, the majority of American Indians and Alaska Natives (AI/AN) children have tooth decay, most adults have lost teeth because of dental disease, periodontal disease is a significant problem for adults, and there is limited access to both preventive and restorative dental care. There is a tremendous opportunity to increase access to oral health care and improve oral health outcomes by training and employing Dental Health Aide Therapists (DHATs). DHATs are highly-trained mid-level providers, much like Physician’s Assistants.  Part of a dentist-led team, they have a narrow scope of practice, focusing on routine and preventive services.  They are recruited from their communities and go back to serve their communities.  Tribes deserve the reliable, culturally relevant care that DHATs offer. The Native Dental Therapy Initiative is working to ensure this solution is available to all Tribes.  Read our newsletter to find out more about our current projects and campaigns!

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See why Swinomish is using DHATs to improve oral health!

DHAT Daniel Kennedy seeing his first patient at the Swinomish Dental Clinic
DHAT Daniel Kennedy seeing his first patient at the Swinomish Dental Clinic
Naomi Petrie, a student from the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians at the ANTHC DHAT Education Program.
Naomi Petrie, a student from the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians at the ANTHC DHAT Education Program.

Dental Health Aide Therapists (DHATs) are part of a dentist-led team. Dental therapists were first introduced to the United States over 10 years ago by a consortium of Alaska Native tribal health organizations.  Thanks to their leadership and courage, over 40,000 Native Alaskans now have access to regular dental care for the first time. DHATs are recruited from their communities and go back to serve their communities.  DHAT training includes:

  • Comprehensive and rigorous coursework
  • 3,000 hours of clinical training
  • 400 hour dentist-supervised preceptorship
  • Mastery of 46 procedures in 2 years. Dentists learn 500+ procedures in 4 years of dental school

Dental Health Aide Therapists:

  • Educate patients about oral health and prevention
  • Perform dental evaluations
  • Give fluoride treatments
  • Place sealants
  • Clean teeth
  • Place fillings
  • Perform simple extractions

Tribal communities need the reliable, culturally competent care DHATs offer:

  • DHATs expand access to consistent,  routine, high quality oral health care
  • Grow the number of AI/AN oral health care providers available to tribal communities
  • Create a more efficient and effective oral health team that brings care where it is needed most
  • Establish cost effective solutions to oral health challenges into tribal communities

Download our DHAT Factsheet Here

Early in the 20th Century, dental disease among American Indians and Alaska Natives (AI/AN) was extremely rare. That is not the case today. Chronic pain, missing teeth, infections, and even life-threatening oral health emergencies are realities for citizens of tribal nations. NPAIHB works hand-in-hand with our member tribes to improve oral health outcomes through our Northwest Tribal Dental Support Center and our Native Dental Therapy Initiative. Despite the slow and steady improvements in the Portland Area, profound disparities continue to exist between AI/AN and non-AI/AN populations. It is clear that AI/AN people carry a disproportionate burden of oral disease, and lack of access to consistent, routine and preventive care stands in the way to improving oral health outcomes:

  • Despite the trend toward a reduction in tooth loss in the U.S. population, 25% of AI/AN people aged 35 to 44 years have fewer than 20 of their natural teeth, and 68% had untreated decay in 1999, the most recent year for which nationwide data are available.1
  • According to the 2014 IHS Oral Health Survey, the majority of AI/AN children have tooth decay. In fact, by 5 years of age, 76% have experienced dental decay.2
  • Historically, access to dental care in IHS, tribal, and urban programs has been lower than the general U.S. population. An estimated 44.5% of persons aged 2 years and older had a dental visit in the past year in the United States, while only 28.8% of American Indians and Alaska Natives accessed dental care in 2014. This low access rate was despite the fewest number of dentist vacancies in the IHS in the past decade.3
  • The U.S. Indian Health Service spent an average of only $99 per person on dental care in 2009, compared with average per capita spending of $272 nationwide.4
  • Over 2.4 million AI/ANs – one third of which are youth up to age 18 – live in counties with dental health care professional shortages, and half of AI/AN youth live in dental care shortage areas.5

Download the Portland Area 2014 IHS Oral Health Survey National, Area and Clinic Level Results here.

Download our Oral Health in Indian County factsheet here

Download the Data Brief IHS 2016 Adult Oral Health Survey here

Download NDTI Fact Sheets:

Native Dental Therapy Facts

Oral Health in Indian Country

DHATs: Good for Tribal Economies


Additional Fact Sheets, Reports and Studies:

Community Catalyst, 2017. A Sample Dental Therapy Curriculum for Community Colleges

Indian Health Service, 2016. Data Brief IHS 2016 Adult Oral Health Survey

Building Momentum for Dental Therapists Map, WKKF June 2016

Journal of Health Care for the Poor and Underserved, January 2016. American Indian and Alaska Native Access to Oral Health Care: A Potential Solution (Terrence C. Batliner DDS, MBA)

Indian Health Service, 2015. The Oral Health of American Indian and Alaska Native Children Aged 1-5 Years: Results of the 2014 IHS Oral Health Survey

Pew Charitable Trusts, November 2015. Improving Dental Care Access in Rural America

American Journal of Public Health, September 2015. Safety Net Care and Midlevel Dental Practitioners: A Case Study of the Portion of Care That Might Be Performed Under Various Setting and Scope-of-Practice Assumptions, 

Pew Charitable Trusts, June 2014. Expanding the Dental Team: Increasing Access to Care in Public Settings

Pew Charitable Trusts, February 2014. Expanding the Dental Team: Studies of Two Private Practices

Community Catalyst, May 2013. Economic Viability of Dental Therapists.

W.K. Kellogg Foundation, October 2010. Alaska Dental Therapist Program: RTI Evaluation Report


Find out more from our partners!

Swinomish Indian Tribal Community

Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians

Coquille Indian Tribe

Alaska Native Tribal Health Consortium DHAT Education Program

W.K. Kellogg Foundation

Pew Charitable Trusts

Community Catalyst

Oregon Health Authority Dental Pilot Program

Please contact us directly or use the form below.  We look forward to your questions and comments! Christina Peters, Project Director Email: cpeters@npaihb.org Phone: (206) 349-4364 Pam Johnson, Project Specialist Email: pjohnson@npaihb.org Phone: (206) 755-4309