Donald R. Dexter Jr., DMD, was the first in his family to attend college. As an enrolled Modoc member of the Klamath Tribes of Southern Oregon (a federally recognized Native American Nation that includes the Klamath, Modoc and Yahooskin tribes and is headquartered in Chiloquin), Dexter was also the first member of a federally recognized Oregon tribe to become a dentist. He shared his story with AGD Impact and spoke about the different roads he took on his dental journey, eventually leading to a private practice in Eugene, Oregon. 

Dentistry is something I wanted to do from a young age for no known reason. My great-grandmother tells how, when I was 4 or 5, I would just tell her, “Grandma, when I grow up, I’m going to be a dentist.” Then, when I was around the age of 10, I was treated very badly by a dentist. The dentist did six fillings on me without anesthesia — by today’s standards, that would be considered abuse and assault. I remember at that time feeling shame that I had allowed that, but I also felt an unusual amount of empathy. The experience became my reason for wanting to be a dentist, because I would never treat anyone that way. 

After dental school, I started with the Indian Health Service (IHS), intending to stay there for my career. As a doctor, you can impact individuals, but, at the policy level, you can impact communities. I went into IHS with the thought that I would work with individuals in communities, but I could also effect policy change from the inside. 

I was involved during the time of transition in the early 1990s when tribes began taking over management of the care themselves. Back then, the politics of being Indian within IHS were extreme, because there was a preference toward hiring those who were Indian, but there was a hierarchy within that group. Opportunity was unequal. There were people who came into the service who had never identified as Indian and had never needed to because they could always pass as white, so they grew up without that strong Indian identity and without the adversity. Then, somewhere along the line in college or dental school, these people realized there are opportunities in utilizing that identity. These doctors were able to come in and, because they were more like the status quo and the establishment in terms of their values and identity, they were also more likely to get ahead. Meanwhile, to the status quo, those of us with strong Indian identities working in IHS were considered the “threatening Indians” because our allegiance was to the communities we were working in, not the system. 

The other problem with IHS was that members of the communities had grown a lot of resentment toward the commissioned corps because they had experienced so many people just passing through who had no investment or commitment to the community. For many dentists, IHS stints were self-serving in that they were going to work there for a little while to build experience and then move on, so the questions from community members whenever someone new would start were always, “How long are you going to be here?” and “How much do you care?” 

After I resigned my commission with IHS, I went back to my tribe in Klamath County, Oregon, and the politics were amplified. It hurt to go back and get politically chewed up more — not by the system like with IHS, but by my own tribe. Now that tribes have moved toward self-governance within the IHS, we’re running our programs, and the failure to serve our communities is on our shoulders. It’s up to us to improve the systems we’ve inherited, and there are some tribes that have been very successful and have established good leadership and consistency of care. I wanted to make change because it was needed, but I was resisted because they didn’t want to change, and that was very painful for me. 

Oftentimes after you leave your tribe as an Indian, you can go home again, but you can’t stay. You can’t be a benefit to your own people. I found myself alienated. When you go back, there’s initially pride because you’re a tribal member and you’ve been successful, but there’s also resentment because you’ve changed. You are part this and part that, and you try to fit into both. When I was struggling to fit in at my liberal arts undergraduate school, a Native American friend with a PhD in psychology told me, “Don, you can be an Indian, and it makes you no less of a doctor. And you can be a doctor, and it makes you no less of an Indian. But you’re the only one who has to reconcile that.” You’re not going to be accepted by everyone, but you have to accept yourself.

I left Klamath after almost three years to move into the Willamette Valley and into private practice. I chose Eugene because it’s a college town — big enough for opportunity, yet small enough that it’s still town-like. Coming from public health and IHS, I didn’t have a strong understanding of private practice when looking for a practice to purchase. I wanted to find a practice where I felt my clinical values aligned with the doctor I was buying from to better transition the patient base, so I found a dentist to purchase from whom I felt was an outstanding clinician. I found out later that, even though clinical skills are important in private practice, personal values are what bring people to you, and my personal values were not at all aligned with the person whose practice I bought. I experienced white flight when I bought the practice — within five months, I lost 70% of the patient base. People who hadn’t come in for an appointment since I bought the practice went to other dentists without even meeting me. 

I had to build a new patient base on my own personal values. We retained enough patients to have a foundation, and then we built from there. My Native values serve me, guide me and form the foundation of how I practice. My logo is a medicine wheel, which, in its simplest form, means that your life is not linear. Life is a circle that has no end, and what goes around comes around. 

The beauty of dentistry is that it allows us to practice traditional medicine, which emphasizes maintaining wellness and preventing disease. Within traditional medicine, the role of the doctor is not healer, but teacher. I put a lot of emphasis into educating my patients about their conditions and their responsibilities. My team and I do what we’re responsible for as far as fixing things, but we’re really looking to build a partnership and long-term relationship of establishing and maintaining a position of wellness for each patient. 

Everything I’ve done has been as the first, whether it’s being the first in my family to go to college or the first person from my tribe to go to dental school, and every step along the way has been without a mentor. I have learned a lot of things through trial by fire, and I feel complicit that no others have come behind me yet. That’s a unique burden for Native communities that members of other communities might not have or realize exists. Few others feel responsible for making sure others follow after them. Now, I want to help young people who are coming up the way I did avoid some of the mistakes I made, and I want to help facilitate their success. Being the first is about hopefully not being the last.