Inside Dental Care in a Rural Tribal Community

A conversation with Dr. Pond, DDS, an oral surgeon and locum tenens provider currently serving a rural tribal community in the Southwest.

In a rural tribal community in the Southwest, access to dental care can be shaped by geography, workforce shortages, and longstanding barriers to care. It is a setting where extraordinary need is met by extraordinary dedication.

Dr. Pond came to this assignment because the work is among the most meaningful in his field, and because rural communities like this one have been asking for clinicians willing to show up for a long time. What he found — in the patients, the colleagues, and the work itself — is a story that says something important about what healthcare access actually means in tribal and rural communities that have been asked to wait too long.

We sat down with Dr. Pond for a candid conversation about practicing where the gap between need and access is most visible.

Tell us a little about your current locum tenens assignment in a rural tribal community. What drew you to this opportunity?

“To serve the people is always the mission. Helping people get out of pain is its own reward.”

For clincians drawn to Indian Health Service settings, the motivation is rarely conventional. The schedules are demanding and the patient complexity is high. What draws providers like Dr. Pond is both the setting and the purpose embedded in it — a place where the relationship between clinical skill and community impact is impossible to miss.

The clinicians who make this kind of care possible are not only the locum professionals who rotate through. Permanent staff provide the continuity, local knowledge, and relationships that keep care moving.

Before arriving, what expectations did you have about practicing in such a rural setting?

Coming from rural Montana, Dr. Pond already understood something about distance. But practicing in a remote tribal community brings its own realities. Long travel distances, limited nearby resources, and geography can all shape how patients access care and how healthcare teams operate.

Dr. Pond arrived with rural roots and realistic expectations, and still found himself struck by something he didn’t anticipate: the people working alongside him. In rural tribal healthcare settings, the clinical culture can be deeply collaborative and mission-driven, shaped by geography and shared purpose in equal measure. Permanent staff bring continuity, institutional knowledge, and relationships built over years.

For dentists who have never worked in an Indian Health Service or tribal community setting, how would you describe the experience?

“Very rewarding. Also, challenging. The level of care, skill, and judgment required is very high.”

By the time some patients in rural and underserved communities present for care, their conditions may have progressed significantly. Untreated decay becomes an infection. Infection becomes surgical intervention. What might have been a filling in a well-resourced community becomes an extraction — or worse.

A note on context: Oral health disparities in Native American and Alaska Native communities are among the most severe in the country — not by chance, but as a documented consequence of decades of federal underfunding, forced displacement, and broken treaty commitments around healthcare access. Native American children experience tooth decay at rates two to three times the national average. These are not inevitable outcomes. They are the result of policy choices that are still being reckoned with.

What makes dentistry in this environment different from a more traditional private practice or urban clinic setting?

“There is no selling. All chairside services are covered — due to treaty rights. So it creates a freedom to do what is best for your patient.”

This might be the most striking distinction Dr. Pond raises, and one that resonates far beyond Indian Health Service settings.

In private practice, dentistry operates within a production model. Treatment plans are shaped not only by clinical need but by what patients can afford, what insurance will cover, and what the practice needs to generate to stay open. Providers often find themselves navigating the uncomfortable space between optimal care and financially accessible care.

In Dr. Pond’s current setting, that tension largely disappears. Services are covered. The treatment plan is the treatment plan. And the provider’s job is simply to deliver the best possible care.

It reflects what patients in every community deserve: a treatment plan driven entirely by clinical need.

What types of patient needs do you see most often?

“Anything and everything. Mostly surgery. Occasionally a denture adjustment or crown adjustment. An added bonus is our ability to utilize expanded function dental assistants — they are trained and skilled with doing fillings. It’s unique to the federal government to help with the significant need.”

The surgical caseload Dr. Pond encounters reflects the broader reality of deferred care. When access is limited for years or decades, the cases that eventually present are complex. Oral surgeons in these settings encounter complex cases early and often — a direct reflection of how long patients have gone without access to earlier intervention.

The expanded function dental assistant (EFDA) model Dr. Pond references is worth noting. EFDAs are trained dental assistants authorized to perform certain restorative procedures, like placing fillings,  under the supervision of a licensed dentist. In federal and IHS settings, this model has become an important tool for extending capacity without proportionally expanding provider headcount. It is a creative, practical response to a workforce shortage that shows no signs of resolving itself quickly.

Have there been moments where the lack of access to dental care in rural communities became especially real to you?

“Every day. You see it every day. It is readily apparent. They need our help.”

There is no dramatic anecdote here, because reality doesn’t need one.

The absence of consistent dental care isn’t experienced as a single defining moment in rural and underserved communities. It accumulates. It becomes visible in the severity of what walks through the door, in the age of patients presenting with conditions that should have been addressed years earlier, in the quiet matter-of-factness with which providers describe what they see.

It is, as Dr. Pond says, just every day.

What skills or personality traits do you think help dentists succeed in this kind of environment?

“Cultural and emotional competence. Again — care, skill, and judgment.”

Cultural competence in healthcare is often discussed in abstract terms. In IHS and tribal settings, it is concrete and essential. Understanding the history, values, and lived experience of the community being served, including the complex relationship between tribal communities and federal healthcare systems, can shape everything from how a clinician builds trust with a patient to how they navigate conversations about treatment.

Emotional competence is equally non-negotiable. Providers working in high-need, high-complexity environments without the operational buffers of large systems must be able to hold the weight of the work, to absorb what they see without becoming numb to it, and without being undone by it.

What has stood out to you most about the people you’ve cared for during this assignment?

“The sincere appreciation for our help. After a long, difficult surgery, they often say, ‘Thank you — for being here to help our people.'”

It’s hard to imagine a more clarifying moment in a clinical career.

After a complex extraction, after hours in the operatory, after the kind of work that tests technical skill and emotional endurance equally — a patient looks at their provider and says thank you for showing up.

That moment says something important about what care access means in communities where it has historically been uncertain. And it says something about why providers like Dr. Pond keep coming back.

Why This Story Matters

The Indian Health Service serves approximately 2.6 million American Indians and Alaska Natives across 574 federally recognized tribes. Dental provider vacancies in IHS facilities consistently run among the highest of any federal healthcare system. The gap between need and capacity is not new — but it is widening.

Locum tenens dentists and oral surgeons play a meaningful role in bridging that gap. Providers like Dr. Pond bring high-level surgical skill to communities that need it, often filling coverage that would otherwise simply not exist.

But beyond the logistics of coverage, Dr. Pond’s experience illustrates something harder to quantify: the relationship between clinician presence and community trust. When clinicians show up consistently, skillfully, and with cultural humility, they can contribute to the trust that is essential to delivering care in communities that have experienced longstanding barriers to healthcare access.

That is not a staffing story. That is a public health story.

Interested in locum tenens opportunities with Indian Health Service or tribal healthcare organizations? Click here to learn more about current assignments.