American Indian and Alaska Native people experience more oral disease and are more likely to have unmet oral health needs than the general US population. These disparities may be attributed to limited access to and use of the dental care delivery system plus a high prevalence of disease risk factors such as social inequities, diet and infant-feeding practices, smoking, and oral hygiene behaviors. This review provides information on the use of and effectiveness of strategies designed to increase access, prevent oral disease, and change systems. To address the oral health crisis in Indian Country, a multi-modal approach which engages the individual, family, community, tribal leadership, plus health and social service providers must be developed, implemented, and sustained. This multi-modal approach should combine primary, secondary, and tertiary prevention strategies layered with strategies to increase access and system changes to reduce the consequences of social inequities.