When she completed dental school at the University of Pennsylvania, Amanda Gaynor Ashley was firmly committed to practicing dentistry in a rural community. The Indian Health Service directed her to Barrow, Alaska, where there are no roads leading in or out of the town and few dentists cared to practice. The Barrow, Alaska, dental clinic had earned a reputation as the “extraction clinic.” So Ashley decided that’s where she would go—for one year.
Ten years later, Ashley is on her way to transforming the oral health of an entire generation. “In the first three months, it became clear to me that this community had seen so many health care providers come and go. If I wanted to make a difference, I would need to stick around.”
Ashley knew that engaging the community would be a crucial element in improving the population’s oral health. She created a dental assistant training program to empower local residents to take care of their own oral health. “That is how we transformed the clinic. It is no longer a group of outsiders. We have empowered the local residents to take charge of their own teeth.”
The next step in improving the community’s oral health was convincing patients to visit the clinic for preventative care. “The clinic had become the place you would go when you couldn’t stand the pain anymore. I’ve been able to change the mindset, so that people want to come in and get their teeth checked.”
The first step in making the dental clinic a welcome destination was making the clinic child-friendly. “We spend money on prizes and toys and stickers to make the clinic a place that kids will beg their parents to come to.”
With the dental clinic as part of the local hospital, Ashley is able to coordinate comprehensive care. “If there is something going wrong in the mouth, we treat that and then also plug them into the hospital pipeline to address anything else that’s wrong.”
“There is a huge correlation between your oral health and the rest of your body,” says Ashley.
Some circumstances unique to the region make oral health a particular challenge. For example, the calcium in milk is essential to the healthy development of a child’s teeth and bones, yet in Barrow, Ashley says, milk can cost as much as $14 a gallon. “Given the price of milk here, it’s not easy to talk to parents about giving their children milk rather than soda,” she says.
In addition to the challenges inherent in her work, Ashley—a native of Utica, N.Y.—had to learn to cope with the Alaska climate. The sun doesn’t rise for close to three months each winter. While traveling home from work one day when she was six months pregnant, Ashley was trapped in a snowdrift—not an uncommon occurrence in the outer banks of Alaska.
She managed to alert the local authorities, and a Barrow resident who was listening to his police scanner came to her rescue. “This guy had been listening to the police scanner and drove up in one of those huge trucks. He said, ‘I know you’re pregnant and there is no way I was going to let you be stranded out here.’”
Ashley believes that current national health reform efforts have ignored oral health. “Every child should have a dental check up by age 1. Adults already have cavities and missing teeth, but with a pediatric population, you have the most hope for success. But the family has to be able to afford treatment. Parents should be able to bring their children in without worrying about the cost.”