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Letters: Dental care and veterans’ health

July 09, 2020

Marjorie Jeffcoat, D.M.D.

The article on the Orlando VA Healthcare System’s dental clinic in the Feb. 3 ADA News, “It’s Very Rewarding When Dentists Can Treat Veterans,” struck a special chord with me. My parents — veterans both — always praised the care they received at their Florida VA Medical Center. But they asked a question that their daughter the dentist couldn’t answer: Why couldn’t they go there for their dental care too?

I think I could now explain the rules, if not the reasons, that make most veterans ineligible for care in VA dental clinics.

On the other hand, what we’re learning about oral-systemic health links makes it worth reexamining the traditional wall between dentistry and other medical fields. Nowhere is this more important than in veterans’ affairs, whose responsibility extends to the total health of the millions of veterans in the system. If basic dental care could mitigate the effects of, say, diabetes (a major problem among this group), wouldn’t it make sense to include dentistry in the health care equation?

Now, I’m not suggesting that the VA should change its policies overnight and certainly not that private care should be excluded from the mix. Any changes to such an enormous system will have to be approached with caution to assure that they’re effective and affordable. In particular, we need to make sure that research results pay off for the real, specific needs of our veterans.

Florida Rep. Gus Bilirakis, together with bipartisan cosponsors, has introduced a bill (HR-2628, “VETCARE”), to apply this new knowledge to help veterans live healthier lives and save taxpayer dollars. VETCARE authorizes a limited but meticulous pilot program to determine whether periodontal treatment can really make a difference to veterans’ systemic health, and consequently to their medical costs. The bill wisely doesn’t try to dictate scientific details — it’s left to an independent steering committee to design the study and assure that high scientific and ethical standards are maintained. Maybe the previous findings will be borne out, maybe not, but either way we need to know the answer.  

Like any legislation, the future of Mr. Bilirakis’s bill is uncertain, though it appears to be moving forward with enthusiastic support from veterans’ groups.  In any case, I hope that we as individuals, and through our collective voice in the ADA, will advocate for this and other initiatives that help us understand how dental health contributes to general health. Endless heel-dragging at this stage is simply unconscionable. Our veterans, and all our patients, deserve better from us.

Marjorie Jeffcoat, D.M.D.
Professor and dean emeritus, University of Pennsylvania School of Dental Medicine
Philadelphia

Editor’s note from Drs. Chad P. Gehani, ADA president; Mia Geisinger, chair of the ADA Council on Scientific Affairs; Philip Fijal, chair of the ADA Council on Government Affairs; and Kathleen T. O’Loughlin, ADA executive director: The “VETCARE” bill (HR 2628) is a unique mechanism to conduct an interventional study within the veterans’ population. We at the ADA are concerned, however, about the construct of this bill, its feasibility, and the potential precedent for the politicization of scientific inquiry, which should be held in the highest standard of impartiality.
 
Briefly, our concerns regarding feasibility focus on the timeline and regulatory aspects of the bill, which omits some details of the scientific process and appoints an oversight committee to establish those details. However, the bill does contain a timeline for initiation of recruitment of 180 days from passage. This timeframe seems truncated for the development of a protocol, the peer-review of such a protocol through a grant review or similar process, and the establishment of sufficient institutional review oversight. If the protocol within the bill is unable to be carried out, we — as a dental community — jeopardize future research and healthcare delivery funding and our critical relationships with key members of the US Congress.

 Furthermore, grant monies that support research endeavors are in almost all instances vetted through a rigorous, competitive, peer-reviewed application process. Whether those grants are funded through the National Institutes of Health, the Department of Defense, or the Department of Health and Human Services, an established process is in place to allow for content experts to critique and, thus, improve overall study protocols. The study embedded within HR 2628 has not been vetted in such a way. The current grant-review process has been established to allow for the best use of taxpayer funds to yield meaningful results that can then the applied to wider programs to impact public health. To conduct research without such vetting and peer-review has the potential to waste taxpayer funds and/or provide incomplete data.

 For these reasons, the leadership of the ADA feels that it cannot support the bill as currently written.