By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

Each Veterans Day, many dental schools and some private dental offices open their doors to veterans and honor their service by providing free dental care. These acts of generosity are welcome and impactful, but they point to a shameful reality: For too many veterans, access to dental care is often a matter of charity and chance.

Roughly 15% of veterans are eligible for dental benefits through the Veterans Administration (VA), and many of the ineligible veterans can’t afford to pay for care on their own. This gap in care has persisted for decades, despite the fact that veterans have higher rates of dental caries (56% versus 37%) and periodontal disease (42% versus 27%) than their civilian counterparts.

“They sacrifice. Their families sacrifice. They shouldn’t have to struggle to get dental care,” says Gabriela Gonzalez, MPA, director of the VOCARE (Veterans Oral Care Access Resource) program at NYU Dentistry. The VOCARE initiative provides free dental care to U.S. military veterans from the five boroughs of New York City who are registered with the VA and are not eligible for dental benefits through the VA. Enrollment in VOCARE is based on referrals received from providers at the VA New York Harbor Healthcare System, the VA Bronx Health Care, and the Leukemia & Lymphoma Society.

Since its inception in 2021, VOCARE has made a significant dent in the access to dental care problem for veterans living in our region. Between July 1, 2021, and June 30, 2024, 3,253 veterans received care in our clinics. Over the course of 29,473 visits, 58,040 procedures were performed. The program currently gets about 20 to 25 referrals each day.

“VOCARE is having an impact in New York City and New York State,” says Michael O’Connor, EdD, MPA, who serves as executive vice dean and oversees the VOCARE program. He says the NYC VA directors are “thrilled” that they now have a place to refer their patients for free dental care. So are VA leaders in Washington. During a visit to NYU earlier this year, U.S. Secretary of Veterans Affairs Denis McDonough presented Gabriela with a military challenge coin in recognition of the VOCARE program.

On the Policy Front

As we celebrate VOCARE’s success, we are acutely aware that beyond our immediate region, millions of veterans still struggle to receive dental care. According to a June article in Military Times, only 1.8 million of the nation’s 9 million veterans were eligible for dental care through the VA in 2023. To qualify, veterans must demonstrate their oral health needs are either connected to their military service or medically necessary to prepare the veteran for a covered hospital admission. Routine dental care is not a covered benefit.

The VA also provides dental care for veterans who are considered 100% disabled as a result of service injuries. The 2022 PACT Act, which created health benefits for veterans exposed to burn pit smoke and other toxins, has made it easier to qualify for the 100% rating. This should increase the number of veterans eligible for dental benefits, but shouldn’t all veterans have access to dental care, whether or not they have a service-related disability?

Some in Congress think so, and they have introduced legislation that would expand access to dental care for millions of veterans. The Dental Care for Veterans Act, introduced in 2023, has garnered 68 co-sponsors. It would eliminate the current eligibility restrictions for VA dental care. A separate bill introduced the same year would provide dental care to veterans diagnosed with diabetes and ischemic heart disease. With only 14 cosponsors, its chances of immediate passage are less promising.

Nevertheless, Michael believes momentum in favor of expanding veterans’ oral health benefits is building. “Will it be full oral health care? Not this round,” he says. “But will there be some enhancement to current plans? I think so. One idea is to have a voucher system in which each living veteran receives $1,000 to $2,000 a year to spend on dental care, and they decide how best to spend it,” he suggests.

Each spring, we take 20-25 students to Washington, D.C., in conjunction with our Global Health Care Leaders program. As part of this leadership experience, our students have been able to speak on behalf of pending legislation related to oral health priorities in meetings at our Congressional representatives’ offices on Capitol Hill. During one such encounter, a member of the New Jersey delegation asked one of our students, Anthony Allison, DDS (a 2024 NYU Dentistry grad), if he would serve as an advisor on veterans’ oral health policy. As an active-duty member of the U.S. Army, Anthony was only too happy to oblige. With such committed and knowledgeable advocates, the momentum Michael has observed can only grow.

A Role for the Private Sector

The success of VOCARE would not be possible without NYU Dentistry’s in-kind contributions and additional donations to cover the cost of care. A generous donation from the United Concordia Dental Charitable Fund helped us launch the program, and the Leukemia & Lymphoma Society, which underwrites dental care for veterans with blood cancers, soon followed suit. Subsequently, support arrived from the New York State Assembly, the New York State Senate, and the New York City Council.

Faculty, students, and alumni at NYU Dentistry have also been moved to contribute. Of special note is a $1 million donation announced earlier this week, from NYU dental alumni Dr. Nazish Jafri and Dr. Noel Liu. Their gift will sustain the program and allow us to expand the dental services the college provides to deserving veterans. The Chicago-based couple are talking with other area alumni about ways to support veterans’ oral health, and we hope their example will spur alumni all over the country to think about serving veterans in their locales.

So does Dianne Sefo, RDH, MEd, who chairs our Dental Hygiene & Dental Assisting Department. Dianne is also the daughter of a veteran and a VOCARE donor. She introduced everyone to the Wounded Veterans Relief Fund, which provides financial assistance and dental care to wounded veterans in Florida. A burgeoning relationship has formed.

“My hope is that the relationship will raise more awareness and get more Florida alumni involved, whether it’s volunteering their work or providing monetary support,” she says. As she points out, NYU graduates 10% of all dentists in the country, so the impact our alumni could have in this one area is vast.

Of course, dentists do not need to be NYU Dentistry graduates to join in providing veterans with free or reduced cost dental care. Michael is particularly eager to see how the American Dental Association (ADA) Foundation’s Give Veterans A Smile program, launched last month, impacts veterans’ care. “As advocates for veterans to get more oral health care, they have the capacity and the influence to make a major difference across the country,” he believes. I hope the organization will use that clout with their members and with lawmakers.

As someone who has worked with the Veterans Administration Outpatient Clinic in Boston and served as a technical expert to the VA on veterans’ oral health care, I’m heartened to see policy moving in the right direction. Veterans and their families sacrifice a lot to serve this country. We shouldn’t be leaving their dental care to chance.