Academic journal article Generations

Dental Care for Older Veterans and the VA's Leadership Roles in Dental Geriatrics

Academic journal article Generations

Dental Care for Older Veterans and the VA's Leadership Roles in Dental Geriatrics

Article excerpt

The demographics of the VA's target population have resulted in VA dentistry having a heightened focus on dental conditions that predominantly impact older veterans.

Dental care has been a component of the palette of services the nation has made available to its veterans for nearly a century. As such, many of the same forces and circumstances that led to the Department of Veteran Affairs' (VA) prominent role in the emergence of medical geriatrics-strong ties to medical schools, medical research, physician education, and the disproportionate increase in number and proportion of elders within the veteran population during the past three decades-also positioned the VA to play a prominent and analogous role during the past thirty years in its contributions to clinical, research, and educational advances affecting dental care for older veterans. Many survivors of mid-century American wars have aged into and beyond their seventh decades.

At the same time, a great deal of the educational, clinical, and research effort and accomplishments that benefited older veterans' dental care has not explicitly had a "geriatrics" brand- something that can also be said for other health disciplines. Yet the demographics of the VA's target population has of necessity resulted in VA dentistry having a heightened focus on, and therefore strong contributions to, the knowledge and management of dental and oral diseases and conditions that predominantly impact older veterans. Historically, the mission of the Veterans Health Administration (VHA) has been provision of patient care, education of healthcare professionals, biomedical and health services research, and a clinical backup role to the Department of Defense. Using the first three of these four missions, we can look at the role of VA dentistry in the care of older adults.

Clinical Dental Care for Older Veterans

Because dental pain has the potential for being so severely debilitating, the United States armed services have historically included professionals skilled in the diagnosis, treatment, and prevention of dental diseases, largely out of necessity for preserving the efficacy of the fighting force. As such, the continued provision of healthcare for veterans, many of whom had no contact with any such resources prior to enlistment, has included dental care for more than 100 years. The first national program for addressing veterans' needs, the Veterans Bureau, initially relied on the services and resources of the Public Health Service (PHS), and, to a lesser extent, services purchased from private dentists to provide dental care for beneficiaries (Director, United States Veterans Bureau, 1923).

In 1923, the Bureau began to open its own set of health facilities across the country and specified the inclusion of dental personnel in all of them (Director, United States Veterans Bureau, 1922). This ended the VA's reliance on the PHS for many dental needs, but arrangements with private dentists continued (Director, United States Veterans Bureau, 1923). When the Veterans Bureau became the VA in 1930, dental was among the range of services made available for veterans under the new system (Committee on Veterans Affairs, 1967).

For the next fifty years there were no explicit restrictions placed on veterans' access to VA dental services other than those posed by mismatches between supply and demand. Each of the more than 130 VA medical centers had a dental clinic staffed with a mix of generalist, specialist, trainee dentists, dental assistants and dental hygienists, and, in many cases, dental laboratory technicians who fabricated dental prostheses. Dental clinics ranged in size from a single provider plus support staff to more than 100 employees and trainees.

Beginning in the early 1980s, wait times for dental care became so excessive system-wide that a priority system was introduced, under which veterans with the most severe servicerelated disabilities and those who had been incarcerated for more than 90 days as prisoners of war were given the highest priority for care. …

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