By Cecile A. Feldman
No matter the era, equipment, or technology, our army’s strength has always passed through oral health. This might sound unexpected to some people but take the Iraq War as an example. At the height of combat in 2008, about 50% of the Army Reserve and National Guard were non-deployable overseas because of dental issues.
Since then, few steps have been taken to improve the oral health of our troops. But a vital bill is now before the House of Representatives.
On June 16, Rep. Andy Kim (D-NJ) and Trent Kelly (R-MS) introduced two bipartisan bills, one of which was the Dental Care for Our Troops Act. Their legislation proposes to provide National Guard and Army Reserve members — almost half of all our armed forces — access to no-fee dental care in the same way that active personnel does even when they are not on active status. This would provide care to 800,000 people, roughly 130,000 of whom are currently without private health insurance.
That’s why for me, this is a public health issue as much as it involves national security.
There are several criteria for overseas deployment, one being dental readiness. The Department of Defense essentially has a ranking system for determining dental readiness. While classes one and two deem one as deployable, classes three and four mean staying back home. Class three has more than a 75% chance of a dental emergency within a year. For class four, the odds are much higher.
Although active personnel receives government support to maintain good oral health on and off deployment, the National Guard and Army Reserves face financial barriers to access. They neither have federal coverage nor preventative care. Their only option is private insurance, which only a few can afford.
I’m not a military expert but as a dentist, I know the harms of lack of dental care and what kind of health problems it can cause. The Reserves and National Guard may need to be deployed anywhere in the world at any moment. Though they’re ready to hug goodbye to their loved ones any minute, we fail to provide them with the same day-to-day commitment to their dental health.
Our soldiers must go abroad with the best possible health, including oral health. While the existing criteria are essential to ensure that the missing link here is helping them meet those standards. This bill can bridge that gap.
For centuries, big and small regulatory changes occurred as oral health proved its importance from one war to the next. The need for good oral health at war times surfaced in the 18th century when soldiers had to have strong front teeth to open wooden gunpowder tubes and set off grenade fuses.
During the Civil War, people without front teeth weren’t allowed to serve on the front lines because they couldn’t open the cartridge with gunpowder and bullets. Sailors also needed strong teeth to climb up to the sails and hold tools. The term “4F,” shorthand for missing 4 front teeth, originated in this period.
In 1911, the Dental Corps was founded to admit and treat soldiers with dental issues pre-deployment. For combat in World War I, soldiers needed to have at least four molar teeth, two above and two below. When World War II broke out, the Army initially required some recruits to have 12 teeth — a high bar later eased to meet the need.
Fast-forward to post-Vietnam War, the Army realized the importance of oral health not only during war but during peace times, as well. It created regulations to maintain the fitness and readiness of soldiers’ oral health. Others followed.
But all regulations failed to provide adequate dental care to the National Guard and Reserves.
As a result, a substantial number of them underwent last-minute dental work to be deployed during the Gulf War. Later in the Iraq War, a large percentage of reservists could not be activated again because of oral health needs.
This delay weakened our national security.
Thus, there was a 2008 hearing in the House of Representatives, where Colonel David Sproat, chief surgeon in the National Guard, said: “Few Army National Guard guardsmen have private dental insurance, and only seven percent participate in the TRICARE Reserve Dental Program. Truly Herculean efforts must be applied by the states once a unit is alerted to achieve full dental readiness.”
The same Herculean efforts were needed for Reservists. Between 1990 to 2008, the Army Reserve Component had less than 50% dental readiness.
In 2009, the Army Selected Reserve Dental Readiness System was established, and dental readiness increased from 50% to 81%. But that still meant that over 20% of Guards and Reserves were non-deployable post-9/11. Moreover, during deployment, 15% were removed from duty due to dental problems.
Deployment after deployment, war after war, history showed us that oral health is a key factor in national security. Yet, we’re still unable to deliver the basic care our troops need. It is time that dental coverage is provided to our troops.
I thank Representatives Andy Kim and Trent Kelly for introducing the Dental Care for Our Troops Act and am grateful the House of Representatives has included it as part of the larger National Defense Authorization Act for Fiscal Year 2023. I urge Congress to approve this important bill so it can be signed into law this year. It’s the least we can do for National Guard members’ and reservists’ service and commitment to our nation.
But our work won’t end there. Because lack of dental care continues to pose challenges from recruits to veterans.
Cecile A. Feldman, DMD, MBA, is the dean of Rutgers School of Dental Medicine in Newark.
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