It is well documented that American Indians and Alaska Natives (AI/AN) carry a disproportionate burden of oral disease. According to the IHS 1999 Oral Health Survey, the majority of AI/AN children have tooth decay, most adults have lost teeth because of dental disease, periodontal disease is a significant problem for adults, and there is limited access to both preventive and restorative dental care. Profound health disparities exist between the oral health status of AI/ANs in the Pacific Northwest compared to non-AI/ANs in the same area.  These differences result from multiple etiologies, but one clearly identifiable factor is the loss of dental public health infrastructure by the Indian Health Service over the last decade.  The Indian Health Service (IHS) has made additional funds available to create dental support centers with the goal to improve the oral health of AI/AN people. The Northwest Tribal Dental Support Center (NTDSC) is currently in its twenty-first  year of operation.