Letter #1
Donald R. Moeller, DDS, MA, MD
Lieutenant Colonel, US Army Dental Corps (Retired)
Diplomate, ABOMS
Dr David Capelli
American Institute of Dental Public Health January 26,2024
University of Nevada Las Vegas
Dear Dr. Capelli,
The interest of the AIDPH in the area of Veteran’s Oral Health Care is admirable. As a retired US Army Oral and Maxillofacial Surgeon who has treated well over a thousand Veterans in my office in Columbus, Georgia, it is heartwarming to learn of others who also share my concerns.
I had hoped to develop a dialogue with your organization in an effort to help the two million Veterans with PTSD associated with Stomatognathic problems. My letter suggests that the problem of PTSD associated with Oral Health problems has been inadequately addressed by the Veterans Affairs. Last Friday, I flew to Washington DC to meet with staff members of the House Committee on Veterans Health Affairs and discuss this issue with them. Unfortunately, it was necessary for me to inform them that, in my professional opinion, the VA’s current position on this matter borders on Vicarious Negligence or Malpractice.
To provide a fair and balanced position on this matter, I would appreciate your response to my understanding of this situation. I will be presenting this information at numerous National Veterans Conventions this year.
Very Respectfully
Donald R Moeller DDS MA MD
Lieutenant Colonel US Army Dental Corps (ret)
Columbus Georgia
Letter #2
Donald R. Moeller, DDS, MA, MD
Lieutenant Colonel, US Army Dental Corps (Retired)
Diplomate, ABOMS
Hi,
Since I failed to connect with your office telephonically after several attempts, I am using your suggested email alternative.
It is wonderful to see the actions which AIDPH is taking to improve Veterans’ dental care as an essential component of their Whole Health Care.
As a neuroscience researcher in the area of PTSD associated with Stomatognathic pathologies, I am having great difficulty in understanding why the AIDPH seemingly has assumed that the Stomatognathic System falls exclusively under the umbrella of “Dental Care”. There seems to be no mention that PTSD is a disorder which affects millions of Veterans and exerts devastating effects on the Stomatognathic system and dental structures. Maybe it is an oversight on my part, but I would expect that given the prevalence of this problem, Stomatognathic and its associated head and neck pain would be issues listed among the top priorities of Veteran care and the AIDPH.
The ADA approved Board Specialties of Oral Medicine and Orofacial Pain testify to the necessity of incorporating a broad scope of Health Care Professionals in the treatment of a Veteran’s Stomatognathic System pathologies. Dental specialties are certainly an essential component of Stomatognathic care.
Post Traumatic Stress Disorder exerts significant effects on the Stomatognathic System as well as the Cardiovascular system, immune system, endocrine system, and musculo-skeletal system, to mention but a few. The VA allows secondary disability rating eligibility for these many somatic systems but excludes the Stomatognathic System. There are over four dozen published research papers which indicate that PTSD affects the Stomatognathic system in addition to subordinate “dental structures”. Craniofacial pain and Orofacial Pain are prevalent in Veterans with PTSD associated Stomatognathic pathologies.
The VA makes the illogical, unscientific and myopic assumption that “Dental Care” is semantically equivalent to “Stomatognathic System” care and then by association conveniently mandates that unless a Veteran has a 100% disability, they are not eligible for “Dental Care”.
Stomatognathic System care is not now, and never has been the exclusive domain of Dentistry. General Surgeons, ENT Surgeons and Plastic Surgeons have been research pioneers and practitioners in this specialty of medicine and dentistry for decades. Current research mandates that nebulous boundaries involving dental and medical treatment must be identified in order to develop integrated Oral Health care for Veterans.
For example, women who suffer Military Sexual trauma and receive less than a 100% Disability rating are not eligible for VA care for their teeth which are destroyed by bruxing. The chronic cranio-facial, orofacial, and dental pain caused by bruxing during nightmares is excluded from treatment by the VA Dental Service. The VA Handbook (1130.01) states that VA Dentists will have the final authority to determine a Veteran’s “nexus” eligibility for “dental care”.
Since I will be meeting with House Congressional staff in the next month to explain this pervasive “epidemic” of Stomatognathic injuries in Veterans with PTSD, I would like to have the AIDPH position on this problem. I know that AIDPH has a history of having a heart for Veterans Health Care, so I want to make sure that I provide you an opportunity to have your position represented.
Thanks again for your help
Donald R Moeller DDS MA MD
LTC US Army Dental Corps (ret)
Diplomate ABOMS