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Development of Dental Services in Alaska

Following the acquisition of Alaska from Russia in 1867, medical care was sporadically provided by ship’s surgeons who were assigned to the Revenue Cutter Service and who occasionally provided treatment to Alaska Natives when making landfall during their summer cruises in the coastal waters of the Bay of Alaska and the Bering Sea. Beginning in 1885, the Department of the Interior’s Bureau of Education operated a series of village schools in Alaska. By 1907, because of the high prevalence of illness among school children, the Bureau of Education began to hire physicians and nurses directly and to support a program of hospital construction in Juneau, Akiak, and Noorvik. In 1916, a Commissioned Officer of the Public Health Service traveled by cutter to villages in the Aleutians, where he reported that the dental health of Alaska Natives was extremely poor and warranted an annual visit by a government dentist. In 1931 the Bureau of Indian Affairs assumed responsibilities for health programs from the Bureau of Education and embarked on a hospital construction program while expanding dental and nursing services. Nonetheless, during the ensuing two decades, provision of health services, including dental services, was limited—particularly during World War II when many health professionals were drafted to assist in the war effort. In 1954, Congress directed the Division of Indian Health (renamed the Indian Health Service in 1969) to take over health care provision for American Indians and Alaska Natives. During the 1950s and 1960s, the number of Commissioned Officers of the Public Health Service who were assigned to the Division of Indian Health grew in Alaska. Nearly all of the dentists, who were primarily assigned to either Anchorage or field hospitals, were Commissioned Officers. Each of seven hospitals located throughout the state had a dental unit administered by a Commissioned Officer. In the early 1960s, with transfer of all health care responsibilities to the Division of Indian Health, the concept of field visits by medical and dental teams became established as a basic model for providing care to residents of remote villages. Under this model, teams of providers would visit distant sites for brief periods of time—typically 1 to 2 weeks—and work long hours to accommodate as many patients as possible. The focus was on addressing acute need through extractions and restorative care. Although transportation, particularly access to air travel, has improved dramatically during the past 50 years, this model of itinerant care by dental