The Path to Improving Oral Health Care for Veterans

When Bosco Jerez returned from Iraq, he was diagnosed with post-traumatic stress disorder (PTSD) and dental care wasn’t his top priority.

“During that time, I didn’t take care of my teeth like I should have been because I had other things on my mind,” says Jerez, a veteran from Virginia. “And of course, I didn’t have dental insurance to take care of it.”

In the 10 years it took him to seek care for his teeth, Jerez’s oral health was up and down. Although he didn’t have any major oral health issues during that time, he also couldn’t afford preventive care. Luckily, he was able to connect with Dr. Kathleen Mullaney, DDS, who runs a clinic where she provides free dental care to veterans in the Alexandria, Virginia, and D.C. areas.

“I am a veteran, I served for six years,” says Dr. Mullaney. “I feel so grateful to be able to give a little bit back and honor people who’ve given so much.” 

Jerez knows he’s lucky to have “just one cavity so far,” but the same isn’t true for many veterans. Thousands of men and women who fought to defend our country have oral health problems like gum disease, tooth pain, tooth abscess, and other dental issues — many of which develop due to a lack of dental coverage. While many providers like Dr. Mullaney and other organizations have stepped up to help fill this unmet need, there needs to be a more comprehensive solution. 

To help, CareQuest Institute and the American Institute of Dental Public Health (AIDPH) recently entered into a new partnership to explore solutions to veteran oral health care, increase accessibility to care, and stimulate rural oral health innovation. The partnership will focus on studying the current state of veteran oral health and access to care and then developing data-driven recommendations informed by the veteran community. 

The partnership’s first output is a new white paper — Veteran Oral Health: Expanding Access and Equity — focused on the need to better understand the significant deficits surrounding veteran oral health. The goal of the paper, which includes several strategic recommendations to improve access and quality of care, is to catalyze oral health professionals and policymakers toward advancing health equity for veterans.

The Reality Veterans Face

Ongoing research provides a glimpse into the reality veterans are facing. 

According to the VA, out of the 9.2 million veterans enrolled in VA health care, only about 1.4 million are eligible for comprehensive dental care. The VA reports that 33% of eligible veterans (463,000) received a total of more than 3.6 million dental procedures during 1.3 million visits in 2020. The VA notes “significant potential for growth”
among dental utilization rates for veterans.

In the National Survey of Veterans, close to half of veterans (41%) described their oral health as “fair” or “poor,” and these veterans were more likely to report having a self-identified disability than veterans with better self-reported oral health. More than half (56%) of veterans had seen a dentist in the past 12 months, with the majority of those individuals paying out of pocket or through other payment sources, such as employer-based dental insurance. 

A survey of nearly 200 veterans in Michigan found that while most (80%) were not eligible for dental benefits through the VA, over half of the respondents who were ineligible had been seen by a dentist in the previous six months. Survey respondents who were not eligible for dental benefits through the VA reported that cost was a significant barrier to seeking out dental care.

This reality exists because our government requires veterans to meet specific eligibility requirements. Essentially, veterans do not qualify for dental care from the VA unless they have a preexisting dental condition, a disability, or were a prisoner of war. This lack of coverage for our veterans is compounded by the fact that Medicare only pays for certain dental services patients receive in the hospital and Medicaid provides limited or no adult dental benefits in many states. Meanwhile, more research is demonstrating that poor oral health has a direct tie to poor overall health, particularly among veterans. 

The Connection Between Oral Health and Overall Health 

Roughly 19 million veterans live in the United States, comprising about 6% of the total population. Those veterans are more likely to experience worse oral health outcomes — higher rates of tooth decay, higher rates of gum disease, and an increased need for restorative dental care — compared to nonveterans.

Lack of coverage and care for those veterans has led to significant health problems for them. Veterans are at greater risk of oral health issues than most populations and, overall, 41% of veterans report a negative oral health perception. 

Veterans are exposed to physical injuries that frequently lead to jaw fractures and tooth loss, and many confront PTSD — like Jerez — and other mental illnesses that affect their teeth as well. According to one study, 61% of veterans with serious mental illness (SMI) self-reported fair to poor dental health, and 34.1% reported that oral health problems made it difficult for them to eat. 

Hope for the Future

The partnership between CareQuest Institute and AIDPH aims to uncover more of these issues.

“Now more than ever, veterans need innovative, whole-person approaches to care in an integrated system that they have a voice in designing,” says Annaliese Cothron, AIDPH executive director. “We have been listening to the veteran community, stakeholders, and veteran-run organizations to set the priorities for our joint work.”

There’s hope on the policy front, too. One recent piece of legislation, the Veterans Dental Care Eligibility Expansion and Enhancement Act of 2021, proposed by Senator Bernie Sanders, would specifically expand and improve comprehensive health care for veterans by expanding eligibility to all veterans receiving VA health care.

Editor’s note: To learn more about veteran oral health, read the white paper.