ANCHORAGE, ALASKA-On November 16th, PBS News Hour aired the second of a two-part series on the dental needs of rural Alaska. Their report comes on the heels of a report done by Reuters in September of this year. That report by Reuters pointed out that tooth decay in the rural areas of Alaska are four times the rate of decay in other parts of the nation.

The blame for this high rate of decay was found to be inadequate sources of drinking water in the communities. They also cited the high cost of commercially bottled water in communities where local water was in short supply.

According to Dr Ward Hurlburt, with the Alaska Department of Health and Social Services, currently Alaska’s top public health official, sugar is the main culprit in the tooth decay problems in rural Alaska, he stated on News Hour, “The people in the village, the children in the village drink a lot of soda pop. There is often not good water. A can a pop may cost less than a bottle of water. They will — babies will be fed things like Jell-O water. And so the kids get a lot of cavities in their teeth. They lose a lot of the teeth, the baby teeth. It goes on into the permanent teeth or the adult teeth. So there are huge problems.”

The show continued discussing how rural Alaska can overcome this high rate of decay and how they can gain greater access to care.

Betty Ann Bowser, News Hour health correspondent pointed out that for the last six years some areas of rural Alaska has access to an unconventional mode of dentistry found nowhere else in the nation. This program, the Alaska Dental Health Aide therapist Program, run by the Alaska Native Medical Health Consortium, trains therapists in a two-year program, the trainee must have graduated high school. The training program, for the first year focuses on textbook training and learning basic sciences. They also begin training on mannequins. In the second year, they begin their clinic clerkship, where they see and assist with patients every day.

These therapists primarily focus on prevention of tooth decay, preferring to deal with the subject of cavities before they develop, but they also perform basic dental procedures such as simple extractions, cleanings and fillings. Prior to any dental procedure, the therapist is required to contact and discuss the case with a dentist. But, they can perform routine procedures without direct supervision.

The program in Alaska, at its beginnings was highly controversial, and several dentists in the state came out against the program. Again, as the program is being looked at as a viable alternative for the rural areas of the lower 48, the same concerns are being aired.

One such opponent of the program, Dr William Calnon of the American Dental Association, says “I cringe when I hear the terms it’s just a routine filling or it’s a routine extraction. There is no such thing as routine, because they’re on a patient. There’s no such thing as a routine patient. Every patient is different.” He would go on to say, “I have had patients in my chair have heart attacks. I have had people have strokes. I have had people that have allergic reactions, life-threatening allergic reactions, to medications they took before they came in this office. You do not have a lot of time to think when you react to that.”

When he was asked if there have ever been any reports, examples or evidence of things going wrong as a result of procedures done by the therapists, Dr. Calnon replied, “To my knowledge, there is no documentation at this point, but we are dealing with so few people. There are not that many people in the program in Alaska.”

Supporters of the program say that perhaps it isn’t just safety issues that are driving dentists to oppose the program, but the fact that someone else is able to come in and do the same procedures that have been traditionally been in the realm of dentistry for so many years.

Dr Mary Williard, of the Alaska Dental Health Aide Therapist Program said, “I think they are afraid of the unknown. They are afraid of change. They are afraid of losing control. You know, dentistry has been the dentist for purview for years. And now we have a new provider that’s coming in and being able to do some of those things that only dentists could do before. I think they’re afraid of it coming down into their area. That’s the biggest fear.”

Time will tell if this program started for the benefit of rural Alaskan Natives will grab hold and move beyond the state’s borders to other states in the lower 48. “The idea is gaining some traction because the federal government has identified more than 4,500 areas in all 50 states where it says there are critical shortages of dentists,” said PBS correspondent Betty Ann Boswer.