Careers in Dentistry
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.
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.
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. See the American Dental Education Association’s website.
Researchers help generate new knowledge. Some researchers are faculty members at universities. Others work in in private industry or in federal facilities, such as the National Institutes of Health.
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.)