Oral Care For Native Health

More than 140,000 Native Americans from over 200 recognized nations and tribes call Los Angeles County home, creating California’s largest urban Indigenous community. There is only one health center that exclusively serves that community: United American Indian Involvement, Inc. (UAII). Trust is a basic component of health care, and for many years UAII has been the only place many American Indians and Native Alaskans trust.

In almost 50 years, UAII has grown from a small self-empowerment community center into a multi-million dollar holistic clinic that treats physical, mental and behavioral health, addiction recovery as well as classes and activities for women, elders and youth. And soon, oral health.

The importance of oral health for Native American communities is masked by other health concerns, notably diabetes and kidney disease. Native Americans are at a greater risk of diabetes than any other group in the United States, according to the Centers for Disease Control and Prevention. Dental care is a key element of diabetes treatment; high blood sugar can cause tooth decay, cavities and gum disease. In addition, national research shows tooth decay among Indigenous children is as much as five times that of their peers. Tooth decay and gum disease “influence overall childhood health and well-being.”

A new office

The decision to build a dental office inside UAII headquarters in Los Angeles’ Echo Park was informed by research and driven by need. While UAII doctors and counselors had been referring patients to dentists in Los Angeles, staff began hearing from the IHS, or Indian Health Service, clinics in Santa Barbara and San Diego. The IHS is a federal agency tasked with providing health care to American Indians and Native Alaskans, and their staff was surprised by the distance traveled, especially for patients who rely on public transit. Though the clinics were 100 miles away either north or south, treatment in an office familiar with Indigenous people was preferred.

“American Indian and Alaskan Natives have a higher prevalence of diabetes than any other demographic group in the United States. Part of the diabetic protocol is to provide a dental examination,” explains Jeffrey Rosenburg, chief medical officer for UAII’s community clinic. “The goal is to meet the needs of our clients and bring it in house.”

Rather than sending away people who had traveled a long distance, UAII decided to make the long-term investment in a dental clinic.

Why someone would travel 100 miles for dental services when there’s a closer office nearby is hard to understand. Why Native Americans would travel 100 miles for health care from someone they trust should be easy to understand. But both require reminders.

“Federal policies have always been detrimental to Natives,” begins UAII’s Interim CEO Joseph Quintana. Though Quintana is Kewa, a Pueblo community thousands of years old located between Albuquerque and Santa Fe in New Mexico, he grew up shuffling between residential hotels in Los Angeles’ skid row, sharing a single room with his siblings, grandparents and great-grandmother. He casually mentions living in the Rosslyn and Alexandria, once notorious SROs and now cornerstones of downtown Los Angeles’ redevelopment.

His family’s story is not unlike that of the many Native Americans who came to Los Angeles in the 1950s as part of a federal relocation plan. Given a one-way bus ticket off the reservation but otherwise unsupported and unprepared for a totally different lifestyle in a city, many Native Americans experienced housing instability, which led to diseases including addiction. Originally located at 118 Winston St., along what non-Natives nicknamed “Indian Alley,” United American Indian Involvement Inc. was created in 1974 to serve these needs. Quintana can recall the smell of the alley while dismissing any notion of growth through poverty.

“Once you got inside, you felt safe,” Quintana recalls of UAII. “You were taken care of.”

That safety sounded like Native Americans speaking their own language: Havasupai-Hualapai, Meskwaki-Sauk, Lakota, Ojibwa. Safety was the food lines that kept them fed and Native Santa distributing gifts at Christmastime. Safety looked like the murals that welcomed them into 118 Winston and now hang inside the new headquarters just a couple miles away at 1453 W. Temple.

“As much as we talk about oral care or health care, we first start by building relationships,” said Quintana.

'The People's Home'

Today, when you enter UAII, you are greeted by a banner featuring a portrait of three people embracing at the original location. The banner states: “Welcome to the People’s Home” and directs clients and patients to check in.

Dental hygienist Travis Tramel examines 4-year-old Leo Quintana during a children’s health event at the UAII community center on April 15, 2022.

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Photo courtesy UAII.

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UAII is the last self-help community clinic of its size and scope for Natives in Los Angeles, notes Quintana, adding that the dentist’s office in a southeast suburb that patients once frequented is gone. The mutual aid organizations that focused on voting, behavioral health and education have shuttered.

“For complete, whole-person, holistic care, UAII has taken on the primary responsibility,” Quintana said.

Many clinics and hospitals deal in volume of patients to offset cost of federally subsidized care, but Quintana says UAII takes a different approach. Of the more than 3,000 regular clients, 95% are low-income and most visit UAII an average of 2.5 times a year. Visits that begin as routine checkups often lead to other referrals — such as for addiction treatment, mental health care and oral health care.

“We don’t know when we’ll see them again, so we try to spend as much time as possible,” Quintana said.

Awaiting safety inspections

The entrance to the new dental clinic is in the back of the beige and brown trimmed former warehouse, through the parking lot adjacent to the 101 Highway. There are three bays for patients. Each bay is equipped with reclining chairs still in their plastic wrap. There’s a computer monitor for the doctor as well as a wall-mounted screen for patients: television for children and images, like x-rays and camera views, for adults. On hand is a digital scanner to create crowns. The rooms are clean, modern and well lit.

What’s missing are the patients: The dental lab is waiting on final safety inspections. Dental Director Davis Hong is confident in the clinic’s ability to address patient needs, though he has been warned to anticipate overflow. In that case, there are two additional offices, meant for Hong and an office manager, that they are prepared to transform to expand treatment.

This is the second dental clinic Hong has helped open, after launching a dentist’s office within a hospital in Boyle Heights, a Chicano neighborhood just east of the Los Angeles River.

Impressed with the layout of the UAII clinic and the equipment, Hong is familiarizing himself with the medical history of the community to which he will be attending. Hong notes his surprise to learn about higher cavity rates among Native Americans, the prevalence of diabetes and barriers to treatment. He heard directly from the IHS staff in San Diego and Santa Barbara who explained why clients traveled so far.

“It could be naive thinking, but everyone just wants to be treated with respect,” said Hong matter of factly.

When he was interviewed for the job, Hong was asked about restraining youth, especially common for low-income children whose families cannot afford sedation. It’s not something he would do. The question underscores a common experience and a stark reminder that in addition to a lack of access, harmful experiences are a barrier to dental care.

Hong is still learning about the culture of his new workplace. He notes the respect afforded elders and the treatment of patients like family. With the overlap of services and events at UAII, he has realized this clinic will be different. Hong will be seeing patients more often than in a typical office.

“Dentistry is dentistry, but when I see the patient before and after I need to build more of a relationship,” he explains. “It’s not like, ‘Open your mouth’ and get to work. That isn’t going to work here.”