In South Dakota, about 30,000 people live on the Pine Ridge Indian Reservation, an area the size of Connecticut that is framed by rolling hills, pine trees and the majestic Badlands.

But the physical beauty is fractured by small villages with modest houses and some decrepit structures that pose as homes for 10 or even 20 people at a time. Unemployment hovers around 80 percent, and the counties making up this “third-world” corner of America are among the poorest in the nation.

A year ago, Maxine Brings Him Back-Janis and I, both American Indians who have provided dental care on the Pine Ridge Indian Reservation in the past, went there to assess oral health conditions.

The shocking details of what we encountered are reported in the just-released October issue of Health Affairs: 90 percent of adults and children had active decay, a percentage three times that typically found in the United States. About half were missing teeth — front teeth that were not replaced with bridges, dentures or implants — or had no teeth at all. A large percentage of the people we saw had emergent problems, active infections and wrenching pain.

Many of the kids we surveyed said they had never met a dentist before, and their dental condition corroborated the story: much decay and multiple teeth that were causing pain.

There are too few dentists on the reservation, and the distances are too great to ensure these kids can regularly get basic dental services. Ten dentists work in three locations to serve 30,000 people. In the summer, it can be an hour drive to a dentist. In the winter, the weather can make it impossible to get to one of the dental clinics.

To put it bluntly, oral disease is rampant at Pine Ridge, and access to dental care is a cruel joke. But Pine Ridge is not alone when it comes to dental access problems. Virtually every state in the country has a dental shortage area, and close to 50 million people can’t get dental care in their own communities.

What can be done? We need to expand the dental workforce and look at adding new providers to the dental team. It is our best hope of increasing access.

Alaska has done just that. The Alaska Native Tribal Health Consortium developed a program where local Native people are hired and trained to provide basic dental care in villages around Alaska. The therapists work under the supervision of dentists at distant locations. Some procedures can be done without consultation, and others require a discussion with the supervisor before proceeding.

Now, instead of seeing a dentist once every couple of years, many people can get routine care when they need it, not just when the dentist flies into the village.

This approach is desperately needed in Native communities and others throughout the country. However, there is a big and ugly roadblock to progress. The American Dental Association is fighting tooth and nail to keep this from happening. The idea that only a dentist can treat dental disease is archaic and was proved ridiculous long ago when the profession of dental hygiene emerged.

Dental therapists have worked in Alaska for years. The idea has worked in other countries for decades, and it can work in the United States.

It is my hope that someday, people on the Pine Ridge Indian Reservation, in downtown Detroit or in any other location that has a hard time attracting and retaining dentists can get the preventive care that they need to avoid big problems and the basic dental care that they need to keep routine disease from becoming an emergency.

Terry Batliner, D.D.S., previously worked for the Indian Health Service on the Pine Ridge Indian Reservation.