Dental care inadequacies gnaw at Reserve and National Guard readiness

An army’s power is often framed in terms of its “tooth-to-tail” ratio: the proportion of combat elements, such as infantry or fighter jets to logistical and support functions, such as maintenance and transportation. While it’s true that the “teeth” do the lion’s share of fighting, it’s the “tail” that wags the canine.

And it is canines — and molars and incisors and wisdom teeth — that do some potent wagging when it comes to Reserve Component combat readiness. Back in 1990, dental unreadiness took a bite out of troop strength able to muster, as the U.S. military surged for potential war in the Persian Gulf. 

A 1992 Industrial College of the Armed Forces study reports “compelling evidence” that Reserve and National Guard soldiers have “significant dental health problems. A total of 21.9 percent were found to be in dental class 3” (the non-deployable class with dental problems that, if left untreated, are likely to cause an emergency within 12 months). The study cited cases where the teeth of some soldiers fell from their jaws at “the touch of a dental instrument.”

The military’s dental affairs have measurably improved since that war, but in the war just concluded, evidence persists that the dental health — and thus, readiness — of the Reserve Components of the U.S. military still lag the readiness of the active force.  

An Army-approved study, “The Incidence of Dental Disease Nonbattle Injuries in Deployed U.S. Army Personnel,” published in the June 2014 issue of Military Medicine, indicated, for example, that the Army Reserve rate of dental disease and non-battle injury per 1,000 soldiers was 128 percent of the active force. Further, the study found that both the Army Reserve and National Guard, despite some progress, “still lagged behind their (active duty) counterparts.”

The active force gets free health care 24/7. They live on or near a base that has medical and dental facilities. They get free dental checkups, cleanings, X-rays, and other toothsome benefits. Their preventative care is served up on a platter.

In the Reserve and National Guard, it’s very different. While on active-duty orders, these citizen-warriors have access to care, and for limited periods upon demobilization. Otherwise, they are on their own. Civilian-sponsored employer dental plans can help, but most have co-pays, deductibles and annual maximums. Additionally, many service members do not have dental insurance through their employers. 

Even the care they get while mobilized may be incomplete and can leave them vulnerable to high out-of-pocket expenses. The impact of this inequitable burden on readiness was discussed on March 2 at a Reserve Education Forum hosted by the Reserve Organization of America (ROA).

The forum, “How Teeth Impact Military Readiness for the Reserve and Guard,” was moderated by one author — ROA’s health services officer, retired Army Maj. Gen. Peggy Wilmoth, Ph.D., R.N., interim dean and professor at the University of North Carolina. Panelists included two other authors — Col. Scott Blum, an Air National Guard dentist assigned to the National Guard Bureau Office of the Joint Surgeon General, who holds a doctor of dental medicine from New Jersey Dental School and has a private practice in New Jersey; and Col. Diana Zschaschel, an Army Reserve dentist who holds a doctor of dental surgery from the University of California and has a private practice in Los Angeles. Joining them was ROA’s director of legislation and military policy, Jonathan Sih. 

The panelists discussed inequities with regard to access to dental care and examinations, as well as within the Reserve Health Readiness Program (RHRP) that provides a modicum of urgent care and limited examinations to the Reserve Components. Many Reserve and Guard service members face difficulties in simply finding a provider who will accept patients under this program’s “onerous” and “cumbersome” policies.

Once a provider is found, the RHRP will cover only an exam and only limited urgent care for Army components. If a complex problem is found, a specialist must be seen, lengthening the process. One reservist needed several tooth extractions, and had missing teeth and extensive cavities needing root canals. A year has gone by without RHRP approval to see a dentist.

A root canal and crown can easily run $2,000 to $3,000 or more. Many service members can’t or won’t spend that kind of money. The least costly solution would be to extract the tooth. If such a problem occurs during a deployment, often because of a lack of preventative care at home, the costs escalate. It can cost $200,000 to fly a soldier out of the area of operations to get dental care, and that takes the soldier out of action for days, weeks or longer — so, it’s a readiness issue. Dental health increases readiness.  

Bipartisan legislation in Congress, H.R. 3512, Healthcare for Our Troops Act of 2021, endorsed by ROA, would “eliminate certain health care charges for members of the Selected Reserve eligible for TRICARE Reserve Select, and for other purposes.” This bill’s passage would help ensure the Reserve Components “private health care” coverage that would reduce factors now preventing them from getting preventative and corrective care.

The Army has a regulation titled, “Holistic Health and Fitness,” and we contend that dental fitness is health fitness. That equals military readiness.

Maj. Gen. Peggy Wilmoth, U.S. Army (Ret.), PhD, RN, is the chair of the ROA Health Services Committee. She is interim dean and a professor at the University of North Carolina. 

Col. Scott Blum, Air National Guard, is an Air National Guard dentist who holds a Doctor of Dental Medicine and has a private practice in New Jersey.

Col. Diana Zschaschel, U.S. Army Reserve, is an Army dentist who holds a Doctor of Dental Surgery from the University of California and has a private practice in Los Angeles.

Maj. Gen. Jeffrey E. Phillips, U.S. Army (Ret.), is chief executive officer of the Reserve Organization of America.