Five Oral Health Challenges Facing American Indian/Alaska Native Communities

The oral health disparities American Indian (AI) and Alaska Native (AN) communities face can be traced back to the 15th century — when European settlers arrived in North America.

Fast forward several hundred years, and AI/AN communities continue to battle striking inequities.

A new white paper — a collaboration between CareQuest Institute for Oral Health, the Society of American Indian Dentists, and the National Indian Health Board — details those disparities, highlighting several troubling statistics about access to care and health outcomes. “American Indian and Alaska Native Communities Face a ‘Disproportionate Burden of Oral Disease’: Reversing Inequities Involves Challenges and Opportunities” presents data from the State of Oral Health Equity in America survey, the largest nationally representative survey focused exclusively on adults’ knowledge, attitudes, experiences, and behaviors related to oral health.

When collecting the data, CareQuest Institute researchers purposefully oversampled AI/AN communities to try to shine a light on the oral health challenges they face. Tamanna Tiwari, BDS, MDS, MPH, a coauthor on the paper and assistant professor in the Department of Community Dentistry and Population Health at the University of Colorado School of Dental Medicine, reflected on those challenges.

“They’re not just neglected from an access perspective from oral health, but also overall health,” says Tiwari. “If you look at life expectancy, mortality numbers for American Indian populations, you’ll see a difference.”

Here are five urgent oral health challenges facing AI/AN communities:

1. Fewer AI/AN adults reported seeing an oral health care provider (69%) than non-AI/AN individuals (79%) in the last year. Fewer also reported having dental insurance and having a place they go for dental services on a regular basis (dental home).
   
   The white paper includes a quote from one dentist who explains, through personal experiences, some of the issues facing AI/AN communities. In part of a quote from the white paper, the dentist says, “I see it daily . . . the history of dental trauma and having no steady provider that you can form a relationship with, or somebody coming in who isn’t culturally safe . . . ”
   
   On top of those barriers, AI/AN adults often have more difficulty getting transportation to the dentist, which leads to delayed care and missed appointments.
    
2. Three and a half times as many people who identified as AI/AN reported going to the emergency department (ED) for dental care or mouth pain in the last year, compared to non-AI/AN adults. In addition, 39% of AI/AN adults said getting care from a dentist would be difficult based on where they live, compared to 24% of non-AI/AN individuals.
   
   What does that data mean? It suggests that when AI/AN adults have dental pain, getting to a dentist is difficult and they are likely to try to endure it or go to the ED for treatment.
    
3. More than one in four (28%) AI/AN individuals rated their oral health as “fair,” compared to about 18% of non-AI/AN individuals. On the other hand, only one in five (20%) of AI/AN individuals rated their oral health as “very good” (31% for non-AI/AN adults). AI/AN adults were more likely to have at least one oral health symptom in the past year. They were also more likely to feel self-conscious because of their teeth in the past year.
    
4. More than half of AI/AN individuals say they have been denied health care or oral health care at some point because of discrimination. A larger proportion of AI/AN individuals identified race/ethnicity, age, physical appearance, sexual orientation, and language as sources of discrimination they have faced, compared to non-AI/AN individuals.
    
5. The number of AI/AN students applying to dental school nationally has decreased dramatically in the past decade, according to the American Dental Education Association, with a record high of 92 in 2005, record lows of 16 in 2019, and 19 in 2021. A lack of AI/AN students applying to dental school reduces the likelihood that AI/AN people will be able to receive care from AI/AN dentists. There are also many barriers AI/AN communities face that make the process of qualifying for, applying for, and attending dental school difficult for prospective AI/AN dentists.
   
   In the white paper, the dentist was asked about the college and dental school journey. The response: “I just didn’t know how to navigate . . . academia. My parents had no idea. They pretty much discouraged me from anything past undergrad just because taking out student loans freaked them out. They couldn’t financially help me in any way.”

What can we do about these challenges? The white paper provides strategic recommendations, calls to action, and potential solutions to respond to these issues. One important step, say the authors, is to listen.

“Do not assume what they want. Talk to them. Partner with them,” Tiwari says. “That’s how you will actually develop trust with that community and be able to work alongside them and really make a difference.”