1. Addressing Oral Health Disparities in Tribal and Rural Communities in North Dakota GRETCHEN DOBERVICH BSW LSW AMERICAN INDIAN PUBLIC HEALTH RESOURCE CENTER NDSU DEPARTMENT OF PUBLIC HEALTH

2. Disclaimer  I am here as a public health advocate and as a concerned citizen of the State of North Dakota  My perspective is my own and does not reflect an official stance on these issues by any institution

3. The Problem  47% of ND dentists do not accept Medicaid patients, according to a 2011-12 survey  70% of ND children enrolled in Medicaid did not see a dentist in 2013  Native American children in ND had more than twice the need for treatment than their non-Native peers  Rural third-graders in ND have significantly worse oral health than their urban peers  One-third of all ND seniors have dental problems, far more than any other group Source: University of North Dakota, Center for Rural Health, (2014)

4. How Did We Get Here  28 of North Dakota’s 53 counties have federally-recognized dentist shortage areas.  40% of counties have only one dentist or none at all — 12 counties have 0 dentists; 9 have only 1  More than one-third of dentists plan to retire in the next 13 years  Nearly half of ND dentists don’t accept Medicaid, according to a 2011-12 survey Source: University of North Dakota, Center for Rural Health, (2014)

6. Solutions  Need to increase the number of dentists in rural and tribal communities.  Need to increase the number of dentists accepting Medicaid patients.  Need to increase the number of oral health providers available to meet the needs of the aforementioned special populations. This may or may not be a need for dentists.  Need for more dental assistants in the state, especially in the Western half of the state where the patient population and needed dental care have changed and increased as the result of the recent oil boom.

7. Need to use dental hygienists at their full scope of work, allowing more dental hygienists to work under general supervision of a dentist, providing preventive care and education in communities with high need. Need for oral surgeons, specifically, those who will accept Medicaid patients – in both rural and urban communities. Source: University of North Dakota, Center for Rural Health, (2014)

8. The Voice of Change  Share your story with tribal leadership and encourage them to participate in the upcoming ND Oral Health Summit and support legislation that would increase access to care for Native Americans  Share your story with the state legislators who represent you  Encourage family and friends in tribal communities to share their story with tribal leadership and state legislators

9. ND Oral Health Summit  May 18, 2016  Best Western Plus Ramkota Hotel in Bismarck, ND  Funded by the Pew Charitable Trust

10. Contact Information  Gretchen Dobervich BSW LSW Gretchen.Dobervich@ndsu.edu 701.231.6248