It’s just before 8 a.m. and Catherine Rayburn is walking to Tufts University School of Dentistry, where she is a third-year student in clinic training. About 10 minutes before getting there, she makes a detour to the New England Center and Home for Veterans, where her first patient of the day is waiting for her in the lobby.
Rayburn calls an Uber for his patient, whose medical condition prevents him from traveling alone to the dental school building on One Kneeland Street. As the Uber sinks into Boston’s morning traffic, Rayburn continues his walk down Washington Street, arriving just in time to meet the Uber and take his patient upstairs. When the date is over, they start over, in reverse.
The patient came to Tufts through Service With a Smile (SWAS), a program that provides free dental care to veterans who would likely otherwise go without. Like Rayburn, dental students and Tufts professors who volunteer for SWAS quickly discover that there are many reasons veterans in need could go years without a cleaning or checkup, and the old “fear of the dentist” is hardly at the top of the list.
Just as important as going to the veterans’ center and interviewing those who want dental care “to make sure there are no barriers,” says Kathryn Dolan, assistant professor of public health and community service at dental school. These barriers can include lack of insurance, transportation, or even a phone number to confirm or schedule appointments. And it’s a situation that often falls under the radar.
“There is a misconception that the VA will cover everything. But that’s not the case,” says Yoon Na Choi, D23, a SWAS volunteer who is herself an army veteran. Of the 9 million people registered with the federal Department of Veterans Affairs health care system nationwide, only about 500,000 are eligible for dental benefits. And while Massachusetts’ Medicaid program, MassHealth, covers some adult dental procedures — many state Medicaid programs do not — a veteran cannot qualify for MassHealth while receiving VA medical benefits.
Also, government benefits can be confusing. A veteran, for example, came to his first appointment with a MassHealth card, but it had expired. A volunteer is working with them to try to reactivate coverage, but there is no guarantee that will happen, which would limit their care to the $2,000 that SWAS can allocate annually per patient.
These student volunteers, Dolan says, face the difficult realities of accessing oral health care in the United States and go the extra mile to help their patients.
“Maybe it shouldn’t be part of the dental student’s responsibilities, but it’s not a bad thing to learn the barriers and obstacles,” she says. “It’s not as simple as, ‘Here’s an address and here’s a meeting time.’ ”
Dolan coordinates SWAS with Professor Gerard Kugel, D85, MSD93, and Student Liaison Russell Smith, D22. The program was started by two former Tufts dental students, Brent Mullen and Keith Nguyen, both D20s and Army veterans. The effort has survived — with some tweaks — over the past two years of evolving pandemic protocols, and now serves veterans at two facilities in Boston: the Downtown Veterans Shelter and Brighton Marine, a center housing and resources for veterans of all branches. of the Army.
Since its inception, SWAS has received about $71,000 in donations and grants, Dolan says. But with hundreds of homeless veterans across Massachusetts, the need is great, and SWAS is working to get that money to go as far as possible, she says, whether it’s billing MassHealth or a other insurance or by using the services of non-profit groups like Soldier On, which can arrange transportation for some veterans.
When the program started, dental students were able to do screenings that involved looking into people’s mouths, right at the veterans center. COVID put a stop to that. Now, Tufts students and faculty use interviews and questionnaires to determine if a referral to the clinic is necessary. This is almost always the case, but not everyone follows. “For every 10 we screen, maybe five will follow to schedule an appointment. And two of them are going to miss this date,” Dolan said. But she attributes this to the nature of poverty and homelessness: “They live in transient living conditions. They might not even be at the veteran center next month.
Rayburn’s patient is the one who held on. “They’re so friendly,” she said. “Being at the dentist’s office isn’t the most fun place, but they’re so willing to come. They show up on time, every time. And they’re willing to do whatever it takes to get what they want and need, which is a new smile and functioning teeth to chew and talk.
Helene Ragovin can be reached at [email protected].