ADA cites Indian Health Service sealant, fluoride 'advances'
The House Appropriations subcommittee on interior, environment and related agencies asked the Association to comment on whether the panel's actions have helped make a measurable reduction in the disease disparity rates between American Indians and Alaska Natives and all other populations and to offer recommendations on future actions the subcommittee should consider taking "within this constrained funding environment."
The appropriations subcommittee takes the initial steps toward annual appropriations for the Indian Health Service with hearings and invited testimony, and the Association has been testifying before this panel since the 1990s. The IHS dental budget has grown over that period from $65 million to more than $159 million.
"We are very grateful to the committee for responding to the oral health needs of American Indians and Alaska Natives and we have seen advances that we believe will lead to improvement in the oral health of American Indians and Alaska Natives," Dr. Henry Fields testified. "But we also know there is still much more that needs to be done," he told the subcommittee hearing chaired by one of two dentist members of Congress, Rep. Mike Simpson (R-Idaho). Representing the Association, Dr. Fields chairs the ADA Council on Government Affairs.
According to the most recent data from the IHS Division of Oral Health, dentists are making advances in these areas, Dr. Fields said:
• in 2011, the IHS placed 276,893 dental sealants, 19,632 sealants more than the goal;
• IHS dentists reported treating 28 percent of the patients who needed care, which is 5 percent more than they serviced in the 1990s;
• the IHS reported that 161,461 American Indian/Alaska Native students had received at least one topical fluoride treatment, which was 25,857 applications over the goal.
"The ADA believes that a key factor for these accomplishments and taking further steps to reduce disparity for disease is having a sufficient workforce," Dr. Fields testified. "In 2009, the IHS reported needing 140 dentists. Today, the vacancies are down to 40. These numbers reflect the vacancies reported by the Division of Oral Health and tribes that choose to notify headquarters of their openings for dentists. Because tribes are not required to report their workforce needs, the vacancy figures might be understated. Nonetheless, this data shows a substantial improvement."
The Association offered recruitment and retention recommendations and urged the committee to "encourage" the Indian Health Service to release data gathered more than two years ago on its early childhood caries initiative to promote prevention and early intervention of tooth decay in young children.
"Thank you for allowing the ADA to testify and highlight the needs and successes of the IHS dental program," Dr. Fields said. "The ADA is committed to working with you, the IHS and the tribes to aggressively reduce the disparity of oral disease and care that currently exists in Indian country. We know oral disease is preventable – provided that appropriate oral health literacy programs, prevention programs and an adequate workforce are in place."
Dentist/Rep. Simpson said total Indian Health Service funding from 2000 to 2012 increased from $2.4 billion to nearly $4.4 billion "before sequestration," which several witnesses said will hit hard in Indian country. "No doubt some of that increase was an attempt to keep pace with the nationwide problem of rising medical care costs, but my hope is that the rest of the increase has made a positive difference in people's lives," the congressman said.