Three dental clinics and two dental hygienists serve the 40,000 Lakota Sioux residents of the Pine Ridge Indian Reservation in North Dakota, an area the size of Connecticut. By comparison, at a typical private dental clinic, there is one hygienist for every 2,000 people, writes Maxine Brings Him Back-Janis in the Narrative Matters section of the October Health Affairs issue. The three clinics set aside only a few hours a month to schedule appointments by phone; anyone who misses this window or calls after all the appointment slots are filled must try again the next month, and anyone without the resources to travel the often large distance to a clinic is out of luck.

Janis, a Lakota Sioux and a dental hygienist herself, was part of a study team documenting oral health conditions on the Pine Ridge Reservation, one of the poorest areas of the country. In her essay, she describes in vivid and tragic detail the consequences of the lack of access to dental care for the area’s residents. Approximately 90 percent of the study participants had at least one decayed tooth. About 50 percent of the adult participants had twenty-seven or fewer teeth, compared to the normal complement of 32 (28 excluding wisdom teeth), and a full 10 percent of the adults had fewer than sixteen teeth remaining. Many of the children in the study had received little or no dental care.

Janis calls for more resources for the chronically underfunded Indian Health Service, but she emphasizes even more the need for education opportunities that “train and nurture many more tribal members to deliver oral health care services to the people of their home communities.” She approvingly cites several models for using mid-level dental providers to provide care previously provided only by dentists and writes that “dental hygienists and dental health aide therapists are better positioned than dentists (who often are not even available) to meet the needs of communities in rural and remote areas.”

You can read or listen to Janis’ essay, and you can hear her discuss her work at the release event for the October issue of Health Affairs, a theme issue on disparities in health and health care. You can also read a related op-ed by Terry Batliner, a dentist and Janis’s partner in the Pine Ridge study.