Service With a Smile pairs student dentists with former service members who have been left behind by the health system
It’s a little before 8 a.m., and Catherine Rayburn is walking to Tufts University School of Dental Medicine, where she’s a third-year student training in the clinic. About 10 minutes before she gets there, she makes a detour at 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 her patient, whose health prevents them from making the trip to the dental school building at One Kneeland Street on their own. As the Uber inches into Boston’s morning-rush traffic, Rayburn continues her walk down Washington Street, arriving just in time to meet the Uber and bring her patient upstairs. When the appointment is over, they do it again, in reverse.
The patient has come to Tufts through Service With a Smile (SWAS), a program that provides free dental care for veterans who would likely otherwise go without. Like Rayburn, Tufts dental students and faculty who volunteer for SWAS soon discover there are many reasons veterans in need might go years without a cleaning or a 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 “is making sure there are no roadblocks,” says Kathryn Dolan, assistant professor of public health and community service at the dental school. Those roadblocks 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 so,” says Yoon Na Choi, D23, a SWAS volunteer who is herself an Army veteran. Of the 9 million people enrolled in the federal Department of Veterans Affairs health system nationally, only about 500,000 qualify for dental benefits. And while Massachusetts’ Medicaid program, MassHealth, covers some dental procedures for adults—many states’ Medicaid programs don’t—a veteran cannot qualify for MassHealth while also receiving VA medical benefits.
Plus, government benefits can be confusing. One veteran, for example, came to their first appointment with a MassHealth card—but it was expired. A volunteer is working with them to try and reactivate the coverage, but there’s no guarantee that will happen, which would limit their care to the $2,000 SWAS can allocate each year per patient.
These student volunteers, Dolan says, are confronting the difficult realities of access to oral care in the United States, and going the extra mile to help their patients.
“Maybe this shouldn’t be in the scope of the dental student’s responsibilities, but it’s not a bad thing to be learning about the barriers and hurdles,” she says. “It’s not as easy as, ‘Here’s an address and here’s an appointment time.’ ”
Dolan coordinates SWAS along 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 D20, and both Army veterans. The effort has survived—with a few adjustments—through the past two years of evolving pandemic protocols, and now serves veterans from two facilities in Boston: the downtown veterans’ shelter, and Brighton Marine, a housing and resource center for veterans from all branches of the military.
Since its start, SWAS has received about $71,000 in donations and grants, says Dolan. But with hundreds of homeless veterans throughout Massachusetts, the need is great, and SWAS works to make that money go as far as it can, she says, whether through billing MassHealth or other insurance or using services from nonprofit groups like Soldier On, which can arrange transportation for some veterans.
When the program started, the dental students were able to do screenings that involved looking into people’s mouths, right out at the veterans’ center. COVID put a stop to that. Now, the Tufts students and faculty use interviews and questionnaires to determine if a referral to the clinic is needed. It almost always is—but not everyone follows up. “For every 10 that we screen, maybe five will follow through to schedule an appointment. And two of them are going to miss that appointment,” Dolan says. But she attributes that to the nature of poverty and homelessness: “They are in transient living conditions. They might not even be at the veterans’ center next month.”
Rayburn’s patient has been one who stuck it out. “They’re so gracious,” she says. “Being at the dentist’s office is not the most fun place to be, but they are so willing to come. They show up on time, every time. And they’re willing to do whatever is necessary to get what they want and what they need—which is a new smile, and functional teeth for chewing and talking.”
Helene Ragovin can be reached at firstname.lastname@example.org.