Veterans Oral Health Initiative
Helping Veterans Receive the Oral Healthcare They Deserve
Student doctors Arthur Shinder and Darren Gunness provide care for a U.S. veteran.
Letisha Azizah, 50, had served in the United States Marine Corps as a supply administration specialist for four years, all the while receiving regular dental care. But when she retired in 2016, she learned that dental care is not a guaranteed benefit for veterans of the U.S. Military. She also discovered how complicated and frustrating it can be to navigate the system to find out which, if any, dental services she was eligible for.
While the U.S. Department of Veterans Affairs (VA) provides some dental services, veterans must meet strict criteria for their outpatient dental care to be covered under the VA Benefits Package. For example, veterans with a service-connected compensable dental disability, such as a combat injury to the head/neck, or those who are considered 100 percent disabled as a result of service, are eligible for full dental care. Non-disabled veterans who have recently served are only entitled to a one-time course of free dental care, provided that they apply within 180 days of discharge and that they are honorably discharged. This leaves nearly 85 percent of veterans ineligible for dental care through the VA, and their access to oral health services is thus subject to their ability to pay out-of-pocket or purchase private or employer-sponsored dental insurance. So, like many veterans without dental insurance, Letisha just gave up the search, leaving her without any dental care.
Many groups with an interest in veterans’ health have attempted to address the lack of access to dental care. One notable initiative got underway in 2013, when the American Dental Association introduced “Veterans Smile Day,” a program whereby private dentists volunteer their services to provide free care in their practices to veterans who otherwise do not have access. This annual initiative now includes hundreds of dentists across the country. Aspen Dental also provides an annual day of free dental care for veterans and encourages its dentists to provide ongoing free preventive maintenance care. But commendable as such efforts are, the one-day-per-year programs are not able to sustain improvements in veterans’ oral health or access to care.
Some dental schools have also begun to address the gap in access to care for this vulnerable population. The University at Buffalo School of Dental Medicine hosts an annual "Dentistry Smiles on Veterans Day," whereby veterans are eligible for one day of free dental services at the school’s clinics. The University of Colorado School of Dental Medicine in Denver opened the CU Heroes Clinic, which provides free dental care to degree-seeking student veterans in Colorado colleges/universities and one-time free or discounted dental treatment to low-income veterans and those not covered by VA benefits.
In a 2017 case study published by the VA’s Office of Rural Health, the dental outpatient team for Grand Island VAMC in Nebraska worked with the University of Nebraska Medical Center College of Dentistry and other community dental clinics to try to get veterans into dental homes, but was ultimately unable to sustain the effort. The study recommended that facilities considering establishing or implementing a dental referral program to formalize community partnerships, identify dedicated staff, document
processes and procedures, and collect data.
The New York State Dental Foundation (NYSDF) invited NYU Dentistry to join its Veterans Access to Care Initiative and supplement nationwide efforts on Veterans Smile Day (the Friday closest to Veterans Day) by providing a day of free dental care to veterans in need. Recognizing, however, that such an initiative would not close the critical gap in access to sustainable oral health services for this vulnerable population, a small group of committed individuals from NYSDF and NYU Dentistry collaborated with colleagues inside the VA New York Harbor Healthcare System to design a program that would extend beyond the one-day service approach. This collaboration led to NYU Dentistry launching the Veterans Oral Health Initiative (VOHI) in March 2019, a program that includes comprehensive care at no out-of-pocket cost to the veteran, with the ultimate goal of connecting the veteran with a dental home in his/her community for access to ongoing, affordable care. Treatment for veterans living in and around New York City is provided at the College on Saturdays by a group of dedicated dental student and faculty volunteers. The NYSDF has provided a grant of $15,000 per year for two years to help fund the program.
Letisha learned about the VOHI during a primary care visit to the Manhattan VA Medical Center. "I noticed a flyer announcing the program at NYU," she recalls, "and I made an appointment right away."
"Finding the program at NYU was a great thing for me. And I’m glad that they are trying to find volunteer dentists in my neighborhood to help me continue to receive care."
– Letisha Azizah, U.S. veteran
Another veteran who became a patient, Peggy Godette, also heard about the program through her physician at the Manhattan VA Medical Center. She told the doctor that she was having trouble with her mouth and teeth and he gave her the number of NYU Dentistry’s VOHI. "I couldn’t dial the number fast enough," she said.
Peggy had spent time in the U.S. Army studying Korean at the Defense Language Institute in Monterey, California, but didn’t complete the program. Once she separated from the Army, she learned that she wasn’t eligible for any dental care at all, not even a one-time course of free care, and, as a result, hadn’t seen a dentist in two years before enrolling in NYU Dentistry’s VOHI. She is currently in treatment and couldn’t be more pleased.
"I’d like everybody to get these services," she says. "Dental care is very important for older people like me in order to be able to get the nutrition we need. This program is giving veterans a chance to have a better quality of life. There’s a lot of shame around not having good teeth. A smile is very important to everyone; it’s important for a good social life. And it makes me very happy that now I’m going to have a good smile."
How the program works
NYU Dentistry’s VOHI includes a two-step approach to increasing access to oral healthcare for New York City’s veterans. First, each patient receives a treatment plan, and second, when treatment is completed, NYU Dentistry connects each veteran with a dentist in his/her community whose practice will become the veteran’s dental home and maintain the patient’s oral health on an ongoing basis.
The 24 currently enrolled patients are veterans of World War II, and of the Korean, Vietnam, and Iraq Wars. More than 85 are on a waitlist. Five to 10 patients are scheduled for each Saturday; after being screened, they immediately enter treatment. When a treatment plan is completed and a patient is put into recall/preventive maintenance status, a new patient is invited to join the program. In the program’s first three months, it has provided over $30,000 in uncompensated care. The patients range in age from 31 to 93 years, with the average age 62.5 years.
Leveraging community providers
NYU Dentistry has an extensive network of faculty and alumni who practice dentistry in and around New York City, and the College is actively recruiting these dentists to become the permanent dental homes of veterans who transition out of care from the VOHI. The NYSDF has also issued a call to action for its members to participate as dental homes, so that as many veterans as possible can find routine dental maintenance following completion of their treatment at NYU.
Of the 11 third-year dental student volunteers, about half are service members or veterans of the U.S. military, including several who are military scholarship recipients.
Alan Ostrovsky is one of the recipients of a Health Professions Scholarship, which enables members of the U.S. Army, Navy, and Air Force to attend medical and dental school with full coverage of tuition, as well as reimbursement of health insurance costs and other related school expenses. After graduation, Ostrovsky will fulfill his four-year service obligation in the Army as an active duty dentist at the rank of second lieutenant, while pursuing specialty training in oral and maxillofacial surgery.
Ostrovsky, who is president of the Tri-service Military Dental Club at NYU, says, "Given my interest in the military and my status as a Health Professions Scholarship recipient, it felt perfectly natural to volunteer for the VOHI as a way of giving back to the community. I think that all the students who volunteer feel honored to be a part of this program and to be able to show our respect for our veterans, whose need for dental care is so great."
Student doctor Arthur Shinder served in the Navy on a destroyer for four years, deploying three times — to Africa and South America — where he was involved in counter-smuggling operations. After that, he was attached to a special reconnaissance team and deployed to Afghanistan for six months, where he witnessed a Navy dentist being flown in by helicopter to provide care for the sailors and was very impressed.
"Veterans’ access to dental care is incredibly restricted," says Shinder. "After graduation, I plan to pursue specialty training in oral and maxillofacial surgery and to continue my commitment to provide free care to our veterans by becoming an alumni volunteer with the VOHI."
Each two-hour Saturday session is also staffed by faculty volunteers. Dr. Kay Oen, clinical assistant professor of cariology and comprehensive care, is present at every session.
"Patients are very appreciative," says Dr. Oen. "They understand the value of the care they are receiving, and the students are unbelievable. On Saturdays, most students sleep until noon, but our student volunteers give up their Saturday mornings to provide care. Some of the cases are very medically complex, but the fact that we have a direct link to the Manhattan VA Medical Center across the street means that our patients’ medical issues can be addressed promptly, allowing us to proceed with care in a very efficient manner. Also, our students benefit from this interprofessional approach to care."
In addition to the learning that takes place, student volunteers deeply value the interpersonal experiences the program provides. "I am truly blessed and fortunate to be able to participate in this program," says student doctor Rebecca Renelus. "Being able to spend time getting to know the veterans within New York City has been rewarding. Whether talking to them about their time in the service, hearing their life stories, or being able to provide care and address their dental concerns, every interaction has been meaningful. Having NYU College of Dentistry start this program to meet a present need for an underserved population shows a commitment to improving access to care and to the New York City community."
"The response to the program from veterans who don’t have access to dental care has been overwhelming," says Joseph Pellicciari, the VOHI program coordinator. "And then having the opportunity to provide them with much needed care has been extremely rewarding for every member of our team."
Dr. Stuart Hirsch, the vice dean for international initiatives, who heads the clinical portion of the VOHI, emphasizes the support of the community partners. "Dr. Gayle Miranda, the chief of dental services at the VA, is playing a vital role in helping to inform veterans of this new program," he says, "and Dr. Maria Maranga and Laura Leon, of the New York State Dental Foundation, are responsible for promoting and obtaining the two-year, $15,000 grants to help fund the program. In addition, three NYU Dentistry alumni have donated $5,000 each to support the program, and the Jason Kim Laboratory is providing all the needed laboratory work at no cost."
According to Dr. Hirsch, "Our next step is to recruit alumni and faculty throughout New York City to volunteer their services and become permanent dental homes for the patients who have completed care at NYU."
Having completed her treatment, Letisha says that she is very happy with the outcome and with the fact that her student doctor provided her with information to help her maintain her oral health. "Finding the program at NYU was a great thing for me," she says. "And I’m glad that they are trying to find volunteer dentists in my neighborhood to help me continue to receive care."
If you are an NYU Dentistry alumnus/a or faculty member who wishes to volunteer for the VOHI, please contact Dr. Stuart Hirsch at email@example.com.