The IHS dental program--a historical perspective.

The federal government provides health services for American Indians and Alaska Natives based on treaties with tribes, legislation, and executive orders. These services began in the late 1700s, when they were the responsibility of the Department of War. This responsibility was later transferred to the Bureau of Indian Affairs and in 1955 the Indian Health Service was established within the United States Public Health Service. This paper describes the development and mission of the Indian Health Service dental program. During the 1950s, Public Health Service officers were assigned to the dental program, dental assistant training centers were established, and clinical prevention programs were implemented. Increased dentist recruitment, the implementation of four-handed dentistry, and the development of an automated information system were the highlights of the 1960s. Considerable effort was placed on work force development during the 1970s, while expansions of both treatment and prevention services were the highlights of the 1980s. Unfortunately, decreases in administrative staffing and a decline in clinical services have been noted during the last decade. The main reasons for the decline were initiatives to reduce the size of federal government and inability to recruit and retain dentists in clinical positions. Also, many tribes have elected to manage their own programs and have requested and received their share of IHS administrative funds to use in their programs. Recent pay and budget legislation along with changes in program management should reverse this trend.