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By Guest Contributor Christina Peters

Last year, Gov. Jay Inslee signed into law a bill aimed at improving oral health for Native people on tribal lands. Senate Bill 5079, the first to pass during the 2017 legislative session, recognizes tribes’ sovereign right to determine how best to meet the needs of their community and allows tribes to access federal money for the use of oral health primary care providers referred to as dental health aide therapists (DHATs).

A year after the passage of SB 5079, DHATs in Washington’s Native communities are helping improve oral health and overall wellbeing through expanded access to care, using a model started in Alaska.

Dr. Rachael Hogan, Dental Director for the Swinomish Tribe, knows how valuable DHATs are in the clinic and for the community: “Native American communities in Washington state experience a number of barriers to accessing much-needed dental care, including historical trauma and insufficient access to culturally appropriate providers. DHATs are an affordable, effective, and efficient way to provide oral health care for our community.”

A recent University of Washington study that found that Alaska Native children and adults living in villages with DHATs “had more preventive care and fewer extractions, cutting down on one of the worst outcomes in dentistry.”

Tooth decay is the most common chronic childhood disease, disproportionately impacting Native American children. Preschool-aged Native American children are four times more likely to have untreated tooth decay than white children. American Indian and Alaska Native (AI/AN) adults also experience higher rates of untreated tooth decay than almost any other racial or ethnic group in the United States.

DHATs are not mini dentists; they are primary oral health care professionals trained to perform specific procedures like filling cavities, non-surgical tooth extractions, X-rays, and cleanings under the supervision of a dentist, as part of the clinical team. Under the Alaska model, DHATs are required to be recertified every two years, through which supervising dentists confirm competency in the entire DHAT scope of practice.

Tooth decay is the most common chronic childhood disease, disproportionately impacting Native American children.

Many of the DHATs working in tribal settings are tribal members living in the community, providing culturally competent care for children and adults. In Alaska, for example, some DHATs speak to their patients in their tribe’s native language, providing patient-centric, community-based care. This is so important: it is an entirely different experience for the patient when they can receive dental care from a person who looks like they do and is a member of their community. Oral health care is the most often avoided service by individuals that have experienced trauma or communities that have a history of intergenerational trauma. Having access to culturally humble providers that understand historical trauma is an important tool for Tribes to bring community members back into care.

Arcora Foundation is currently partnering with tribes to support the DHAT model. These efforts include working with other organizations and educational institutions to establish DHAT training programs in Washington state. Arcora Foundation also is working with the Swinomish Tribe to evaluate the tribe’s DHAT program to determine how care has changed. The assessment is scheduled to be completed this year.

DHAT training is only available in Alaska at this time. Five Washington state-based DHAT students from Colville, Lummi Nation and Swinomish tribes are on track to graduate next year.


Christina Peters is the Native Dental Therapy Initiative Project Director for the Northwest Portland Area Indian Health Board.

Arcora Foundation
400 Fairview Avenue North, Suite 800
Seattle, WA 98109
Oral Health Watch does not provide dental care and cannot provide direct referrals. To find dental care in your area, please visit our resources page. Please contact Oral Health Watch for more information about our programs and oral health in Washington State