The Swinomish Indian Tribal Community has had a difficult history when it comes to receiving dental services.

In the 1970s, traveling dentists staffed a small trailer provided by Indian Health Services. Tribal elders tell Rachael Hogan, director of the Swinomish Dental Clinic, stories of hearing patients screaming from inside the trailer and dentists in bloody aprons.

“If they didn’t experience the pain, they could at least hear the noises, and that’s their story about how dentistry was delivered,” Hogan said.

To help repair the relationship between tribal members and dental professionals, Skagit Valley College’s Dental Therapy Education Program and the Swinomish tribe are jointly launching the first program in the state to train dental therapists.

The therapists serve as midlevel dental providers, performing procedures such as fillings and simple extractions. Whereas a dentist is trained to perform about 500 procedures, a dental therapist is capable of performing roughly 50, Hogan said.

The dәxwxayәbus-Dental Therapy Education Program will require 28 months of tightly condensed curriculum that Hogan says the dental therapists at the Swinomish clinic call “dental boot camp.”


Across the country, Native American communities face challenges to accessing quality and consistent oral health care.

A study examining the prevalence of tooth decay among American Indian and Alaskan Native children ages 2 to 5 found rates of decay three times the U.S. average, according to a data brief by Kathy Phipps and Timothy Ricks.

Before hiring dental therapists to work at the Swinomish Dental Clinic, tribal members waited between two to three months for appointments, Tribal Senate member Brian Wilbur said.

With the addition of three dental therapists to the clinic’s staff, wait times are down to a week, Wilbur said.

Dental therapists have helped free up time for dentists to perform more complex procedures, Hogan said.

“Instead of doing cleanings and fillings, I can do crowns and bridges, partials and dentures, and extractions and root canals, because there’s still a ton of dentistry out there to do or be done,” Hogan said.


Additionally, within the Swinomish tribe, dental therapists work alongside hygienists to conduct community outreach and education. Once a week, dental therapists and hygienists from the Swinomish clinic visit the Swinomish Youth Center to talk to kids about brushing their teeth and to perform visual exams.

The dəxʷx̌ayəbus-Dental Therapy Education Program will allow the tribe to train providers from the community to serve the community, providing culturally appropriate health care, Wilbur said.

“When you have a community member working on their own community members, they understand what they’ve gone through. There’s understanding what they’ve experienced and why their teeth or oral health might be what it is,” Wilbur said.

Swinomish tribal members have traveled to Alaska in the past to receive dental therapy training at Iḷisaġvik Tribal College — an expensive and difficult endeavor for students, with a number dropping out due to the length of time it required them to be away from home, Wilbur said.

Already having a relationship with Skagit Valley College, the tribe asked the college to explore the potential of building a dental therapy program closer to home, said Darren Greeno, executive dean for instruction at Skagit Valley College.

“This very much was a workforce training opportunity for the college to be engaged in where we would be helping to produce dental therapists,” Greeno said. “I would say, a coequal incentive was the fact that we would be helping to ameliorate oral health disparities.”


The journey from first conversations to the program’s accreditation took 10 years, Greeno said. It will be able to support 12 students per year, with six expected when the fall quarter begins Sept. 20.

The program’s state-of-the-art facilities include simulation pods with mannequin heads for hands-on practice, a preclinical space for students to practice infection control and for sterilizing tools and a lab space for students to work on operating lab machinery.

Students will also transition to gaining real-world experience at the Swinomish Dental Clinic in year two of the program; in the last quarter, they will work for 14 weeks under the supervision of a dentist.

“Once they’re done with that and they graduate, they’re ready to hit the ground running and be billable providers,” Hogan said.

— Reporter Benjamin Leung:, 360-416-2156, Twitter: @goskagit