Careers in Dentistry
The Challenge
Oral health is more than healthy teeth. The health of the
mouth, face and jaw is basic to overall health. Tooth
decay, gum disease, infections, chronic facial pain, birth
defects and oral cancers can be distressing and lead to
other conditions. Some problems can even be life
threatening. Quite correctly, the mouth is sometimes
referred to as a mirror for general health and
well-being.
In
the past half century, the oral health of Americans has
improved greatly. Most middle-aged and younger American can
expect to keep their natural teeth throughout their life.
However, profound disparities affect people without the
resources or knowledge to achieve good oral care. Poor
Americans, especially children and the elderly, suffer the
worst oral health. American Indians, Native Alaskans and
other minority groups have disproportionate levels of oral
health problems. Also people with disabilities and complex
health conditions are at greater risk for oral health
problems. More than 100 million Americans lack dental
insurance. Most older workers lose their dental insurance
when they retire.
Oral Health and American Indians and Native
Alaskans
The American
Indian/Alaskan Native (AI/AN) population has the highest
tooth decay rate of any population cohort in the United
States: 5 times the U.S. average for children 2 to 4 years
old. Sixty-eight percent of AI/AN children have untreated
dental caries. One-third of AI/AN school children report
missing school because of dental pain; 25% report avoid
laughing or smiling because of the way their teeth look.
According to the Alaska Native Tribal Consortium, Alaska
Natives suffer rates of dental decay that are 2.5 times
greater than the national rate. In addition an oral health
survey by the Indian Health Service in 1999 revealed the
most adults had lost teeth because of dental disease, and
periodontal disease was a significant problem for adults.
Insufficient funding for healthcare; the isolation of
tribal populations, particularly in Alaska; and the
difficulty in attracting and keeping dentists in the Indian
Health Service (IHS) or tribal health facilities in rural
areas are all factors that contribute to the disparities in
oral health that exist today. Currently there is roughly a
34% vacancy rate of dentists in the Indian Health Service.
In outlying parts of Alaska almost half of the positions
for dentists are not filled. There is one dentist for every
2800 individuals in the IHS and tribal health clinics
compared with one dentist for every 1500 individuals in the
general population.
In addition, some older people might avoid dental care
because of their literally painful history with dental
care. Dr. George Blue Spruce
Jr. of the
Pueblo Tribe (Laguna /Ohkay-Owingeh), the first American
Indian dentist, says, "Prior to 1955, the funding for
dental care was far less than it is now. Dentists
visited reservations only once or twice a year. With few
supplies and no opportunities for follow-up, dentists
extracted problematic teeth, typically without
anesthesia.
Opportunities
Clearly there
is a great need for dentists in American Indian and Alaska
Native country. Blue Spruce says that American Indian and
Native Alaskan dentists are needed to shape health care
policy. Indigenous people, he explains, are more likely to
provide effective care that takes into account historical
and cultural factors. Blue Spruce thinks that indigenous
dentists are also more likely to continue caring for their
people even when any payback periods are
over.
Darrell Pratt,
who has been recruiting health care professionals for IHS
for 30 years says, “There’s no question that AI/AN
providers bring important perspectives and understandings
to their work. They also have something in the way of
built-in credibility. Even though they may be working
with a tribe whose culture is very different from their
own, the fact that they are Indian gives them something
that non-Indian providers may never achieve, even after
years of working in a particular facility. Their
status as role models for AI/AN people cannot be
overestimated.
Pratt continues: “If the provider [AI/AN dentist] is
willing to “exploit” this (by going to schools to talk
about their work and what they had to do to get to their
current position, by talking with parents of students who
might be interested in a health career, by being active in
their professional organizations, by being available to
students with questions and serving as a mentor to those
who elect to pursue professional careers), the communities
in which they work and their children will be even better
served and there will be even more AI/AN health care
providers as a result of their efforts. If they
become involved in the communities they serve, they can
help tribal members to understand health issues more
clearly, help to bring additional funding to the community
through grants, etc., and help the community to develop
plans for dealing with many issues important to them,
whether or not they are specific health issues.”
Opportunities for a successful, satisfying career are also
available in the wider U.S. population. Large numbers of
dentists are likely to retire in the next 20 years. New
dentists will be needed to take their places. Advances in
technology, such as digital radiography and laser systems,
are making it possible for dentists to provide more
effective care. An increasing number of people are seeking
cosmetic services from their dentists.
Because of the shortage of minority dentists, minority
students are being actively recruited. A growing number of
women are now entering dental school. They represent more
than 40% of the students enrolled in U.S. schools of
dentistry.
Career
Options
Private patient care is the major
focus for most dentists. These clinicians diagnose and
treat diseases, injuries and malformations of the teeth,
tongue, gums, lips and jaw. Sometimes they are the first
ones to diagnose oral and pharyngeal cancers as well as
systemic conditions that show up first in the mouth.
Dentists can help patients improve their appearance by
doing various cosmetic dental procedures. Dentists and
their staff educate patients on how to best take care of
their teeth. Dental specialists perform such surgical
procedures as extractions, implants, and tissue grafts.
Typically dentists who work primarily as clinicians have
their own private practice or work in partnership with
other.
Public
health dentistry focus on
community settings but includes the care of individuals.
Public health dentists promote dental health, develop
health policy, and prevent disease. The U.S. Public Health
Service offers dentists an opportunity to provide dental
care in such settings as reservations and military
establishments.
The Indian Health Service, which is a part of the U.S.
Public Health Service, provides health care to over 1.9
million American Indians and Alaska Natives living on or
near reservations in both rural and urban areas. Public
health dentists assist in planning comprehensive prevention
and treatment programs that are tailored to the unique
needs of each tribe. General dentistry is offered at all
dental sites. Dental specialists consult on difficult
cases.
Prevention is emphasized both for communities and
individuals. For example, public health dentists might work
with their community on water fluoridation and tobacco
cessation programs. They might urge dentists and hygienists
to use dental sealants and look for cancers. In addition,
they might have campaigns to encourage daily oral hygiene
habits, such as brushing with a fluoride toothpaste
flossing and having a healthy diet.
For more information, see the American Association of Public Health
Dentistry.
Academic
dentists educate future
dentists and hygienists at schools of dentistry. They
usually also do research, patient care and community
service.
Researchers help generate
new knowledge. Some researchers are faculty members at
universities. Others work in federal facilities, such as
the National Institutes of Health
or in
private industry.
Hospital
dentists work with
physicians and other health professionals in caring for
hospitalized patients. Typically they have a strong
interest in medicine and collaborative care.
Dentists involved in
international health care typically work
for such organizations as the World Health Organization.
Some are private practitioners who volunteer their
services.
This
article was originally published in the Spring 2007
issue of
Winds of Change. (The cover
artist is Buffalo Gouge, Creek and Cherokee.)