First tribe in the Lower 48 to use dental therapists

Monday, January 4, 2016

Swinomish become first tribe in the Lower 48 to use dental therapists to address oral health crisis in Indian Country

FIDALGO ISLAND, Washington – Leading the effort to address the oral health crisis in Indian Country, the Swinomish Indian Tribal Community on Monday became the first tribe in the Lower 48 states to employ a dental therapist to provide basic oral health services.

“There are too few dentists in Indian Country,” said Brian Cladoosby, Chairman of the Swinomish Indian Tribal Community. “We cannot stand by any longer and allow Native people to continue to suffer tooth decay at a rate three times the national average. We have developed a tribal approach to solve a tribal issue. This solution will help our people immediately address their oral health needs in ways that have not been possible until today.”

Supported by a W.K. Kellogg Foundation grant in partnership with the Northwest Portland Area Indian Health Board, the Swinomish Indian Tribal Community program is modeled on a successful oral healthcare delivery model used by Alaska Native communities for over 10 years.

Although dental therapists – known as dental health aide therapists (DHATs) in the Alaska Native program – are banned from providing many basic dental services in Washington and most other states, the Swinomish Tribe has licensed and employed a dental therapist on the Tribe’s reservation as an exercise of their inherent tribal sovereignty. With too many Swinomish Tribal members – particularly children – suffering unnecessarily and potentially facing life-threatening conditions because they lack access to dental care, dental therapist Daniel Kennedy joined the Swinomish Dental Clinic team to help ensure that all Tribal members have access to reliable, high-quality and culturally competent dental care.

Similar to nurse practitioners and physician assistants, dental therapists are highly trained mid-level dental providers who expand the capacity of dentists by delivering a number of routine and preventive dental services, including fillings and simple extractions.

“Today we stand with the Swinomish Indian Tribal Community,” said Joe Finkbonner, Executive Director of the Northwest Portland Area Indian Health Board. “We applaud the leadership, dedication and courage that has resulted in this historic occasion, and we look forward to continued partnership turning the tide on oral health disparities in this community and throughout the Portland Area.”

Oral health research shows that historical traumas have caused Indians to lead the nation in oral disease rates. By age five, 75 percent of American Indians and Alaska Natives experience tooth decay. Recent Federal statistics for Washington, Oregon and Idaho show that Indian children suffer tooth decay at three times the national average. Low-dentist-to-patient ratios in Indian Country mean that many Indians lack access to regular dental treatment and prevention services. Turnover among providers in Indian Country interrupts continuity of care and inhibits the delivery of culturally competent services.

DHATs were first certified to practice in Alaska more than 10 years ago by the Alaska Native Tribal Health Consortium. The program today has expanded care to more than 45,000 Alaska Natives in need of preventive and restorative care. Dental therapists were also authorized to practice in Minnesota in 2011 and in Maine last year. Attempts to authorize them in Washington have failed repeatedly because of political opposition from organized dentistry.

In June, the Swinomish Indian Tribal Community began working in partnership with the Northwest Portland Area Indian Health Board to bring this new and innovative dental resource into the Pacific Northwest. This past summer, a Swinomish Tribal member was sent to Alaska to begin her two year dental health aide therapy training.


The Swinomish Indian Tribal Community is a federally recognized Indian Tribe organized pursuant to Section 16 of the Indian Reorganization Act of 1934, 25 U.S.C. § 476, that occupies the Swinomish Indian Reservation on Puget Sound in Washington State. The Tribe is a present day political successor-in-interest to certain of the tribes and bands that signed the Treaty of Point Elliott, 12 Stat. 927 (1855), that established the Swinomish Reservation on Fidalgo Island.

The Northwest Portland Area Indian Health Board is a non-profit tribal advisory organization serving the forty-three federally recognized tribes of Oregon, Washington, and Idaho with a mission to eliminate health disparities and improve the quality of life of American Indians and Alaska Natives by supporting Northwest Tribes in their delivery of culturally appropriate, high quality healthcare.

First tribe in the Lower 48 to use dental therapists

Video_icon_sm WATCH: Bringing Dental Care into the 21st Century, Swinomish Chairman Brian Cladoosby and Dental Clinic team make the case for expanding care for our community.


David Richey, Swinomish Indian Tribal Community
(206) 282-1990

Pam Johnson, Northwest Portland Area Indian Health Board
(206) 755-4309