Bridging Gaps: Medical-Dental Integration for Veterans in Family Medicine Training

Advancing medical-dental integration, with a particular focus and priority on innovative solutions that link behavioral health and oral health for veterans.

 Project Completed: Performance Improvement Pilot 

We are proud to announce the successful completion of the Medical-Dental Integration for Veterans in Family Medicine Training Performance Improvement Pilot Project. This initiative, made possible through the generous support of the CareQuest Institute for Oral Health, explored how family medicine residency programs can better integrate oral health care for veterans—a population disproportionately affected by dental disease, trauma, and behavioral health challenges.

Through faculty interviews, curriculum development, and implementation of a pilot project across family medicine residency programs, the project identified and addressed key categories of barriers to oral health care—specifically for veterans, but also to support physicians in improving oral health care for all patients. Twenty-one faculty and residents at six family medicine residencies pilot tested the quality improvement (QI) curriculum, implementing oral health assessments, enhancing data collection through electronic medical records (EMRs), and evaluating screening practices, identification of veteran status, oral health challenges, and referral processes.

Resources from the Pilot Project

 A key milestone of this initiative was the development of a new curriculum for family medicine residency programs. We invite you to explore and incorporate these materials into your residency training or use them for personal education. The curriculum includes a recorded webinar available on YouTube, along with downloadable resources housed in a dedicated Online Folder. These materials include the full PowerPoint presentation with presenter notes, a reference sheet, and a curated set of implementation tools—such as oral health screening forms and conversation guides tailored for engaging veterans.

Designed to support trauma-informed care, interdisciplinary collaboration, and practical integration of oral health into primary care, these resources offer a valuable foundation for clinical education. We are also working with Smiles for Life to make this curriculum available within their downloadable course offerings, and we encourage you to explore their broader library of oral health training materials.

FMEC Veteran Oral Health & Medical-Dental Integration in Family Medicine Training Course Structure

1. Burden of Oral Disease Among Veterans
• Veterans have higher rates of dental caries (56% vs. 37%) and periodontal disease (42% vs. 27%) compared to nonveterans.
• 41% rate their oral health as fair/poor; 2.5 million had unmet dental needs in the past year.
2. Oral-Systemic Health Connections
• Oral diseases are linked to systemic conditions like diabetes, cardiovascular disease, COPD, and mental health disorders.
• Periodontal treatment improves chronic disease outcomes.
3. Military Subpopulations & Access to Dental Care
• Only active-duty members receive comprehensive dental care.
• Just 15% of VA-enrolled veterans qualify for dental care; only 34% of those eligible use it.
• Recruits and marginalized groups (e.g., LGBTQIA+, older adults, homeless veterans) face significant barriers.
4. Trauma-Informed Care
• 87% of veterans report exposure to traumatic events.
• Dental settings can trigger trauma responses; providers should implement trauma-informed principles like safety, trust, and empowerment.
5. Dental Problem Identification in Primary Care
• PCPs can screen for common issues like TMD, caries, and oral cancer.
• Guidance on pain management, antibiotic prescribing, and referral pathways is provided.
6. Policy & Advocacy
• Highlights systemic gaps in veteran dental care.
• Encourages providers to engage in advocacy and leverage state/national coalitions to improve access.

Webinar Recording: Veteran Oral Health & Medical-Dental Integration in Family Medicine Training. Originally aired May 13, 2025- Watch on YouTube

PICME Project Highlights

The 2025 pilot project engaged family physician providers through structured learning sessions and collaborative discussions. Participants completed QI training, implemented practice-based activities, and earned:

• 20.00 Performance Improvement AAFP Prescribed Credits (AAFP Activity ID: 106152)
• FMEC Annual Meeting registrations for participating residencies
• Opportunities for scholarly activity and regional/national recognition

Project Advisors and Reviewers

This initiative was guided by a multidisciplinary team of experts in family medicine, dentistry, public health, and education.

• Elizabeth Alpert, DDS, MPH, Instructor, Part time | Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
• Maya Bass, MD, MA, Program Director, Cooper Family Medicine Residency/Cooper Medical School of Rowan University
• Roxanne Bavarian, DMD, DMSc - Instructor | Oral and Maxillofacial Surgery, Harvard School of Dental Medicine
• Alec S. Eidelman, DMD, MPH, MMedEd, Lecturer, Oral Health Policy & Epidemiology – Harvard School of Dental Medicine
• Britt Gayle, MD, MedStar Health
• Janet F. Hale PhD, RN, FNP, Professor Emeritus, Tan Chingfen Graduate School of Nursing, Univ of Massachusetts Medical School
• Robert Motley, MD, MHCDS, Vice Chair, Community Medicine and Ellen M. & Dale W. Garber Professor in Family Medicine, Thomas Jefferson University
• Hugh Silk, MD, MPH, Professor, Dept. of Family Medicine and Community Health, Univ of Massachusetts Medical School
• Robert Smethers, RDH, MSDH, Dental Hygiene Assistant Professor, Forsyth School of Dental Hygiene, Massachusetts College of Pharmacy and Health Sciences
• Lisa Thompson DMD, Program Director, Geriatric Dentistry, Harvard School of Dental Medicine

Stay Connected

We are grateful to all who participated and contributed to this important work. If you are interested in future projects or would like to explore how these resources can support your own initiatives, we welcome your feedback and interest in future collaborations. Please contact Rebecca Bouck, Manager, Education and QI Projects at [email protected].