By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management
“Having a healthy mouth means everything.”
Those are Leonard’s words, not mine. He’s a patient at NYU Dentistry and one of the millions of U.S. military veterans who are not eligible to receive dental care through the U.S. Department of Veterans Affairs (VA).
Leonard says he looked everywhere for help with his teeth but couldn’t find it until the VA referred him to VOCARE (Veterans Oral Care Access Resource) at NYU Dentistry. The program serves veterans who are not eligible to receive oral health care through the VA. In its first year alone, VOCARE provided more than 10,000 dental procedures — free of charge — to 1,022 veterans.
That pent-up demand stems from the nature of VA health coverage. Nine million veterans get their health care through the VA, but only 1.4 million of them are eligible to receive dental care at the VA’s expense. To qualify, veterans’ oral health needs must be connected to their military service or be medically necessary to prepare the veteran for a covered hospital admission. Just as in traditional Medicare and many private plans, routine dental care is not a covered benefit.
Michael O’Connor, co-director with me at the Center for Oral Health Policy and Management and executive vice dean of NYU Dentistry, also co-directs VOCARE, and he’s passionate about serving this population. He vividly recalls a decades-old encounter with his father, a veteran of World War II. He didn’t look well, and knowing of his struggles with alcoholism, Michael feared his father had scurvy.
Michael took him to the VA, where the reception they got was far from welcoming. When the staff tried to release his father without providing care, Michael took down names and made it clear he would hold the staff responsible if his father’s condition worsened. They agreed to keep him overnight and soon learned he did have scurvy, one of many debilitating conditions (including cancer, heart disease, vision problems, diabetes, and a stroke), which Michael would help him manage over the next two decades.
At every VA facility where his father sought care, Michael fought the system and was able to secure great health care for his father. “I kept him alive for 20 years,” but Michael was unable to get his father treatment for one critical concern: his broken and missing teeth.
“I wonder what would have happened to my father if I was able to get him teeth. Would that have changed his life? Would he have no longer been a recluse, ashamed to go out? Would he have gone back to work? Would he have tried to turn himself around? Those questions will never be answered,” Michael says.
VOCARE is part of a VA pilot program, VETSmile, which aims to fill the gap in veterans’ access to dental care by connecting them with dentists in their communities. In July 2021, the VA selected NYU Dentistry to pilot the program in an urban setting. I sit on a technical expert panel advising VETSmile, and in my role at NYU Dentistry, I’m delighted that VOCARE resides within the Center for Oral Health Policy and Management. That connection forces us to also think about policies that can further extend veterans’ access to oral health care.
Although VETSmile is a VA initiative, pilot sites such as NYU Dentistry are responsible for funding the care. To date, the College has raised $900,000 from a mix of public and private sources. The New York State Assembly and New York City Council have allocated funds, and charitable donations have come in from the United Concordia Dental Charitable Fund and the Leukemia & Lymphoma Society, which provides funding specifically for dental care for veterans with blood cancer. Faculty and students at NYU Dentistry have also been moved to contribute.
VOCARE co-director Gabriela Gonzalez, MPA, shares their passion for providing care to former members of the nation’s military services. As the younger sister of a veteran who served in Iraq and Afghanistan, her compassion for this population is rooted in her personal experience as well as her patriotism. She’s been attending national meetings on veterans’ oral health, including the American Dental Association’s Give Veterans A Smile Summit in May. She told me the willingness to treat veterans at no cost is growing, but no one is committing resources on the scale of VOCARE.
According to Gabriela, “Some dental practices set aside part of a day each week to provide pro bono care to veterans, but more often, including at dental schools, it’s one day a year, usually Veterans Day. After a recent presentation at which I spoke about VOCARE, everybody thanked us for providing free dental care to veterans year-round.”
The veterans we’ve treated have also shown their gratitude. “I am so grateful that Brooklyn VA Hospital [connected me to] NYU Dentistry,” Leonard told us. “Coming here, just meeting the staff, was breathtaking, and they guarantee me that they can help me, and they are helping me.” He’s confident many others in his community will benefit as well.
Michael shares his conviction that VOCARE will improve the oral health — and the lives — of today’s veterans. Thinking back on his father’s situation, Michael observes, “One thing I know is, no one feels good about themselves if they can’t smile. No one gets a job if they don’t have teeth. There is a stigma associated with people missing or having no teeth. VOCARE will help in this regard.”
NYU has a five-year partnership with the VA to continue VOCARE, and Michael and Gabriela are now looking at ways to help other dental schools and federally qualified health centers adopt the model. Making more charitable care available is a step in the right direction, but with his background in public health policy, Michael won’t be satisfied until he sees government action to address the root of the problem: the lack of a universal dental benefit for veterans. He is looking forward to a day when he and VA representatives testify before Congress, explaining the importance of dental treatment and preventive care to veterans’ oral, mental, and overall health.
“This care shouldn’t be at the largesse of private institutions like the NYU College of Dentistry. It should be a taxpayer-funded benefit appropriated by Congress,” Michael insists. “Our goal is for Congress to fund dental care at all the VAs across the country, so that these veterans get the care that they deserve — simple as that.”
I couldn’t agree more.
