Dental care should be overseen by Fort Peck Tribes – not IHS

The Indian Health Service (IHS) is a federal agency responsible for providing health care to federally recognized tribes. The agency has long been criticized for underfunding and understaffing, and in 2020, the National Congress of American Indians said that IHS health care “is largely provided in Third World conditions”.

Until recently, the IHS oversaw dental services on the reservation. However, tribes were able to take control of these services through a process commonly called “638.” Enacted in 1975, Public Law 93-638 (Indian Self-Determination and Educational Assistance Act) gave tribes the authority to contract directly with the federal government to operate programs serving its members.

Now, federal money that used to go toward IHS dental services must go directly to tribes to receive those services. However, experts say tribes are often given less money to operate the programs they undertake using the 638 process.

Adriann Ricker, director of dental operations within the tribal health department, said the move to oversee dental services “allows us to have more autonomy as a tribe.”

“The Self-Determination Act was created so that sovereign nations can determine for themselves the best course of action for health and education needs,” she said. “Instead of focusing on different outcomes, we can focus on how we can provide culturally safe oral care for our people.”

The movement for tribes to oversee oral health care services has long been underway. In 2021, the Fort Peck tribes declared a state of emergency due to the chronic lack of dental care on the reservation, and various oral health outcomes have been documented.

In a 2019 report by the National Indian Health Board, Fort Peck elders said there was high turnover among IHS dental staff, so they often saw a new provider each visit. Data shows that people who are more satisfied with their provider are more likely to visit the dentist and therefore more likely to have better health outcomes. Elders also spoke about the unnecessary extraction of teeth, while younger community members noted the lack of cultural dental care on the reservation.

A 2016 Fort Peck Community Health Assessment found that 32% of youth living on the Fort Peck Reservation did not visit a dentist in the past year – compared to 25% of youth in Montana. And in Roosevelt County, there were about 2,266 people for every dentist, according to the report. Meanwhile in Montana, which is experiencing a shortage of dental health professionals, there are 1,477 people per dentist.

Ricker said the tribes have ambitious goals for dental care, but changes won’t necessarily happen overnight. Dental services will continue to be offered at the same IHS locations in Wolf Point and Poplar – just under different leadership. Current staff will have the option to keep their jobs under the new leadership, and according to Ricker, a top priority will be recruiting more staff. In a few weeks, Ricker said the tribes will have three dentists on staff and seven or eight dental assistants.

She also hopes to explore alternative solutions for referral care. Because IHS does not offer most specialty services, people who need advanced dental care will often travel four hours one way to Billings.

“That trip costs a lot of money,” Ricker said. “We want to find ways to bring in specialists to provide care locally.”

Longer term, Ricker hopes tribal oversight of oral care can inspire community members to pursue careers in dentistry. She wants to create partnerships with tribal colleges and other institutions to provide relevant training and opportunities to interested students.

Improving dental care, Ricker said, is critical to improving overall health outcomes. An individual who is missing teeth may also struggle with eating, for example, or someone with diabetes may be more likely to suffer from gum disease.

“Oral health is a really important aspect of overall health,” she said. “We’re really trying to see our patients as whole people.”