Addressing the Mental-Oral Health Link for Veterans

Lack of access to dental care is a problem for many Americans–over 68 million, or nearly 26%, of American adults do not have dental insurance.¹ While that number is shocking, the problem is even more pronounced in the veteran population. Eighty-five percent of veterans are ineligible for dental coverage through the Veterans Affairs (VA), making lack of access to dental care a significant and devastatingly common issue for those who have served our country.¹

When veterans can access dental care, they often have unique needs. Mental health conditions that are prevalent among veterans, such as post-traumatic stress disorder (PTSD), can have oral health ramifications that dental professionals should be aware of as they design treatment plans.

I am a veteran myself, having served in the United States Air Force. I care deeply about providing the highest level of care for all my patients, and I recognize the importance of being attuned to the specific oral health needs of veterans.

Veterans Have Poorer Oral Health than Nonveterans

On average, veterans have poorer oral health than the nonveteran population. In a recent study, over half (56%) of veterans had a higher than average Decayed, Missing, Filled Teeth score–compared to 37% of nonveterans in the study. Additionally, approximately 42% of veterans experienced periodontal conditions such as gum issues or bone loss, compared to 27% of nonveterans.¹ Further, when asked to describe their oral health, 40% of veterans answered ‘fair’ or ‘poor.’²

In my practice, I’ve seen the disparity between veteran and nonveteran oral health firsthand. Many veterans who come to my practice suffer from inflammation of the gums, tooth decay, and severe plaque buildup due to lack of oral health care access.

One patient, who I’ll call John, provides a shocking example of the consequences of lack of dental care access for veterans. John sought treatment at a VA clinic, and the care providers removed John’s teeth so he could have dentures made. After having his teeth removed, he was told to wait 6 months, then come back to the clinic to have his dentures produced and fit. During those 6 months, the funding for the VA was cut, and by the time John was supposed to have his dentures made, he was told he was no longer eligible to receive them. John came into our practice on our Day of Service, during which we treat veteran patients free of charge, and we were flabbergasted that he’d had to endure six months of no teeth, only to find out he could not receive the dentures he was promised. We were able to make him a set of dentures on the spot, which dramatically improved his oral health and gave him his smile back.

Although John’s story has a happy ending, what happened to him is an unfortunately common occurrence for veterans seeking dental care within the VA.

Mental Health Plays a Role in Oral Health

In addition to compounded oral health problems due to lack of access to care, veterans have another factor affecting their overall well-being: mental health.

During their service, veterans face a litany of terrifying and life-threatening situations that can lead to PTSD. A recent study found that the prevalence of PTSD among veterans at some point in their lives differs by service era. World War II and Korean War veterans had the lowest prevalence at 3%, while Operations Iraqi Freedom and Enduring Freedom veterans had the highest, at 29%.³

There is a strong but often overlooked relationship between mental and oral health.⁴ Poor mental health can lead to neglect of regular dental care, which can lead to tooth decay, periodontal disease, and oral pain. Additionally, the state of your teeth can give clues about your mental health, revealing factors such as your anxiety levels or any eating issues.

PTSD has Specific Effects on Dental Health

For veterans dealing with PTSD, there are specific oral health problems that can arise, including a higher likelihood of orofacial pain as well as difficulty with chewing.⁵ Further, PTSD can lead to bruxism, which is involuntary teeth grinding. Grinding the teeth can cause enamel wear and additional jaw pain. Finally, PTSD can increase susceptibility to gingivitis, tooth plaque, and gum disease.

If a patient is managing his or her PTSD with antidepressants or other medications, there are additional factors to consider. Medications like these can lead to dry mouth as a side effect. This can be especially detrimental to oral health because saliva is necessary for flushing out food particles, aiding in swallowing, and delivering tooth-strengthening minerals like phosphate and calcium. As a result, dry mouth, which can seem innocuous, can have considerable consequences, from tooth decay to fungal infections.⁶

Providing the Highest Quality Care to Veterans

So many veterans who come into one of my offices suffer from severe dental health issues that arise from the lack of access to proper care. Short of increasing care access, which would have the biggest impact on veterans’ oral health, there are several issues I address with my veteran patients to improve their dental health. Firstly, I always encourage daily brushing and flossing for all patients, but it’s especially important for those who can’t regularly visit a dentist. Secondly, I discuss my patients’ medications, such as antidepressants, which could be causing dry mouth and leading to other oral issues. Finally, I try to address the connection between mental and oral health, because I want to be sure I am providing the most comprehensive care for my patients.

As a veteran, I try to be especially sensitive to the oral health needs of my fellow servicemen and women. Across my 7 Aspen Dental® offices, nearly every staff member participates in our annual Day of Service, during which we provide free, comprehensive care to veterans. This Day has become something we all look forward to, because everybody feels it’s very important to be able to give back to their communities and take care of the veterans who served our country.

References

1. The American Institute of Dental Public Health and CareQuest Institute for Oral Health. Veteran Oral Health: Expanding Access and Equity. Boston, MA: December 2021. doi;10.35565/CQI.2021.2041

2. Vetsmile Experience. VA Center for Care and Payment Innovation. Accessed May 29, 2024. www.innovation.va.gov/careandpayment/VETSmile/veteran-need.html#:~:text=42%25%20of%20Veterans%20reported%20having,health%20as%20fair%20or%20poor

3. How Common Is PTSD in Veterans? U.S. Department of Veterans Affairs. Published July 24, 2028. Accessed May 29, 2024. www.ptsd.va.gov/understand/common/common_veterans.asp#:~:text=These%20types%20of%20events%20can,have%20PTSD%20in%20their%20lifetime

4. Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosom Med. 2015;77(1):83-92. doi:10.1097/PSY.0000000000000135

5. De Oliveira S, Ana C, et al. “Impact of post-traumatic stress disorder on oral health.” Journal of Affective Disorders, vol. 219, Sept. 2017, pp. 126–132. doi:10.1016/j.jad.2017.05.033

6. Dry Mouth. National Institute of Dental and Craniofacial Research. U.S. Department of Health and Human Services. Published November 2023. Accessed May 29, 2024. www.nidcr.nih.gov/health-info/dry-mouth#:~:text=Dry%20mouth%20can%20happen%20to,keep%20harmful%20germs%20in%20check