A new study has found that 40% of children and nearly 60% of adults on the Pine Ridge Indian Reservation in South Dakota suffer from moderate to urgent dental needs, including infections and other problems that could be life-threatening. The findings of the study—the first in 12 years on the state of oral health on this reservation—were recently presented at the 68th annual National Congress of American Indians, held in Portland, Ore.

Investigators examined 20 communities on the reservation and recruited 292 adults and children. Each participant received a dental exam that identified any decay or other problems, and was then offered recommendations for treatment. The study found that residents of Pine Ridge had significantly higher numbers of decayed teeth and lower numbers of treated or filled teeth than reported by previous studies.

The study, funded by the W.K. Kellogg Foundation, found that 90% of participants showed signs of active decay, a rate three times that typically found in the United States. The researchers discovered that 84% of children in the study and 97% of adults had ongoing decay.

The findings also showed that 68% of the adult participants had evidence of gum disease and 16% showed signs of an advanced problem. According to the study, the high prevalence of decay and gum disease suggests that many participants had chronic pain that could interfere with daily activities.

“Many of the Pine Ridge residents suffer daily from wrenching dental pain yet they face huge barriers to getting routine care,” said Terry Batliner, DDS, who is the study’s lead author and a member of the Cherokee Nation of Oklahoma. “A severe shortage of dentists willing to practice in isolated areas has left many Americans, including American Indians, with ongoing dental problems that threaten their overall health.”

“All Americans, including those living in Pine Ridge, should have access to affordable dental care,” said Sterling K. Speirn, president and CEO of the W.K. Kellogg Foundation. “It is time to expand the reach of dentists by employing a new type of dental practitioner to provide routine care.” The Foundation is currently working with five states—Ohio, Kansas, New Mexico, Washington, and Vermont—to consider dental therapists as part of an overall approach to expand care to underserved populations. Alaska and Minnesota already allow dental therapists to practice.

Other approaches identified by this study’s authors to address the care shortage include allowing hygienists to serve as dental therapists in federally designated shortage areas. The authors also recommended that the tribe could take federal dollars now used to provide dental care on the reservation and use the money to create their own oral health care system. Currently, only 10 dentists work in three locations, providing care to the tribe’s population of 30,000 in an area roughly the size of Connecticut.