Number of Native American dental program applicants plummets as community faces oral health crisis

The first time Rudy Oxendine visited a dentist, he was in middle school. In the poor rural community he’d grown up in as a member of the Lumbee Tribe of North Carolina, the notion that everyone was destined to end up with dentures was pretty much a given, he said.

Oxendine, who was raised by his grandfather, was surprised to learn the procedure wasn’t so bad. At the time, it didn't occur to him that becoming a dentist was a possibility.

“It just was not something we grew up with – the idea that this was something we could do,” he said.

This summer, Oxendine, will start his career in pediatric dentistry after completing his residency at East Carolina University’s School of Dental Medicine.

That makes him a rarity: According to the American Dental Education Association, the number of Native American dental school applicants has plummeted from a 2006 high of 92 to just 16 in 2019 and 19 in 2021 – a decline the Society of American Dentists calls "unacceptable" and that far reduces opportunities for Native American communities to get care from culturally competent providers.

“We all know there’s some comfort in having the person who’s taking care of you look like you, being someone who understands your culture,” said Oxendine, a former police officer who lives in the Greenville area with his wife and two kids. “You’re going to be more comfortable in the chair and more willing to accept guidance given by that person.”

A 'disproportionate burden' of oral health disease

The shortage was cited in a report released earlier this year describing the “disproportionate burden” of oral health disease faced by American Indians and Native Alaskans in the U.S. from childhood onward, a crisis it said was rooted in structural racism and exacerbated by a lack of access to healthy food and stable housing.

The report was compiled by Boston nonprofit CareQuest Institute for Oral Health in collaboration with the National Indian Health Board, Society of American Indian Dentists and Southern Plains Tribal Health Board.

“The lack of representation is significant because the importance of cultural competency cannot be overstated,” said Myechia Minter-Jordan, CareQuest’s president and CEO. “There’s a level of connection and credibility.”

Among other things, the report found that rates of early childhood tooth decay are three times higher among American Indian/Native Alaskan children than in white children and that American Indian/Native Alaskan adults are twice as likely to have untreated decay than the general population.

Growing up in North Carolina’s Robeson County, Oxendine recalled, he and his siblings weren’t taught basic oral hygiene; they knew they needed to brush their teeth at night but didn’t understand that they shouldn’t eat before bedtime. They had horses, cultivated their own food and wore hand-me-down clothes.

“There’s great tradition there, but it really is like you’ve gone to another country,” he said.

As a young high school graduate, Oxendine said he not only lacked the guidance to consider a medical career; he lacked the maturity. He would gradually learn discipline in 14 years as a Greenville police officer, but the idea of pursuing dentistry entered his mind when East Carolina University opened its school of dental medicine in 2011. He started in 2018.

The importance of guidance and mentoring

Tamana “Bunny” Begay, clinical program director for the Gallup Indian Medical Center in New Mexico, said pathway programs can offer opportunities for students to exchange information and learn about resources, “like how to study for the dental exam. A lot of students who are first-generation may not know how to navigate the systems and the coursework.”

But many such programs, she said, have been lost to defunding and that, along with rising dental school costs, discourage many prospective students from even applying.

Begay said some Native students who've struggled to maintain good grades because of family obligations tell her they don’t feel taken seriously when they inform college counselors of their dental program interests.

“They feel like the counselor has already made their mind up,” she said.

Begay cared for siblings while in school and earned money cleaning houses as she worked her way through community college, inspired to pursue dentistry by a female dentist she met while traveling in Guatemala.

“Until I met that doctor, I had only seen men in that role,” she said. “At Indian health centers, the dental assistants, the front desk workers were all Natives and all women – but to be a doctor, I didn’t understand that. They were all older white men.”

That’s why, when Begay worked at the Indian Health Center in Phoenix, she invited a number of Navajo students at Arizona State University to shadow her at the dental clinic through a mentor program. Nearly all, she said, decided to pursue dentistry.

“It’s important that Native students have that connection,” she said.

Such connections are important for Native communities too: Begay said her patients see her not only in the clinic but participating in powwows. She hopes it lets them know that their options are open, “that they can choose to be a doctor. They don’t have to choose to just be an assistant because that’s what someone told them or because that’s all they see.”

Joseph Churchill, a non-Native dentist who’s served tribes in Washington state and Nebraska, said that in the communities he’s served, medical providers – whether doctors, dentists, or hygienists – don’t stick around for long. When one considers that, along with historical trauma and unpleasant Native dental experiences at the hands of previous providers, “you can imagine why many people living in tribal communities avoid going to the dentist at all costs.”

When a community knows its provider and feels understood, it can make a big difference, Churchill said. The hygienist he works with is well known and loved in the community, he said, regularly participating in tribal events that have nothing to do with dentistry.

“While not a tribal member herself, she grew up in the area – which counts for a lot in a rural community,” he said.

'People will judge you'

Oxendine said addressing the shortage of dental students means, in part, reaching kids when they’re young and making them believe that the medical profession is an attainable goal.

“We haven’t had the nurturing and have difficulty viewing ourselves as candidates,” he said. “There’s that imposter syndrome, of when you step into a professional setting, you see no one else who looks like you, where no one in your family has had the opportunity to attain that. That’s a mental thing.”

Oxendine said he hopes not only to be a role model but to make sure poor oral health doesn’t prevent kids from reaching their potential, whatever that might be. Aside from hampering a child’s academic focus, he said, poor oral health can be aesthetically displeasing, affecting one’s confidence and limiting opportunities.

“People will judge you,” he said. “There’s a portion of the population who will not understand or who just have cold hearts. They’ve never experienced poverty and have no sympathy.”

When Oxendine graduated in 2021, he said he made sure that his teen nieces and nephews, who are growing up on the same plot of land that he did, were present at the ceremony.

“I wanted them to see,” he said, “that this is something that is attainable.”

This article originally appeared on USA TODAY: Native Americans: With oral health in crisis, dental students decline