Kenneth Mumford smiled into the mirror and saw a full set of pearly white teeth for the first time in years.
He was sitting in a chair at the University of Maryland School of Dentistry, where he was being fitted for free dentures last month. The 59-year-old Air Force veteran got his full set of teeth courtesy of the Department of Veterans Affairs, which has been stepping up a dental care program for homeless vets.
The idea, VA officials say, is to alleviate pain, improve health and boost self-esteem. That could bolster job prospects, not to mention put a decent meal within reach.
"Ever try and eat corn on the cob without teeth?" asked Mumford, who left the military in the late 1970s and has had trouble in recent years finding a job in his native Salisbury or a steady place to stay. "This will change my look and my eating habits."
The dentistry program for homeless veterans was launched almost 20 years ago, but the need has been so great recently in the region that officials at the VA Maryland Health Care System reached out to the Maryland dental school for help. Since late 2006, students, residents and faculty have answered 1,110 referrals for vets, or close to half of the total treated through the program locally.
The Baltimore-area budget for the dental program has jumped to $300,000 this year, more than tripling from the time the partnership began. The growth has been similar nationally, with the VA spending $26.5 million this year on dental services for homeless vets.
The program is part of a larger effort by Veterans Affairs to end homelessness among vets. The agency is spending $4.3 billion in 2011 on a range of services including housing assistance and job training as well as medical and dental care.
VA officials say dentistry was included in its efforts after surveys ranked it as one of the top three unmet needs of the homeless, along with permanent housing and child care. Pain and missing teeth were considered barriers to employment. After getting care, the vets reported improvements in perceived health and self-esteem.
Oral health problems have been a distraction for Mumford, who for the past year has been staying at the Maryland Center for Veterans Education and Training, a Baltimore-based nonprofit organization.
Mumford said he had a tooth knocked loose during a football game years ago. Eventually he lost it and others began to come loose, too. With a bit of medical training from the military, he began extracting them himself.
He said it didn't hurt too much but left him with some gaps in his smile and some challenges. He had to switch from eating apples to bananas and make other dietary adjustments. Though he enjoys a good joke, he found he wasn't smiling as much. His friends started calling him "Mumbles."
When Maryland dentist Yemisi Akinrefon began seeing him a few months ago, Mumford had a lot of periodontal disease. She said he needed all but four teeth extracted, and even those four remaining needed work. They were kept to anchor his new set of teeth, which are being made and fitted over six visits, scheduled about three weeks apart. He's halfway through the process.
"It takes a while to fit them and to adjust to them," Akinrefon said about the dentures. "He'll have to relearn how to speak, and for some people that takes a long time. It's a process. But it's a good thing."
Akinrefon and others working in the program say the vets seem to be especially appreciative. And the dentists feel good about providing the care, which the VA gets at about a 40 percent discount from the school.
Jeffrey A. Rajaski, a faculty instructor at Maryland, said the dental school doesn't provide the vets with regular cleanings or preventive care beyond advice. The dentists assess problems and make a one-time plan for fixing them, such as pulling problem teeth or fixing decay. After years of neglect, many require dentures.
Dentists there are used to seeing such problems. In addition to treating faculty, students and the public, serving the homeless is part of the school's mission, said Douglas M. Barnes, a professor and director of the Advanced Education in General Dentistry Program, where the veterans are treated. So when a colleague who splits his time at the VA and Maryland asked if the school might help the homeless vets, Barnes agreed.
The vets started coming within a few weeks, making the collaboration one of just a handful that VA offices have with dental schools around the country. And Barnes believes the treatments make a big difference.
"Surveys show the first thing people look at is your smile," he said. "It's what we use for communication. It's how we make our first impressions."
Sharon Chenowith, the dental office manager, said the work is also especially gratifying because everyone wants to help repay the service members, who now make up about 10 percent of the practice's patients.
She said the vets' lack of self-esteem is obvious when they first visit. Many put their hands over their mouths when they talk because they don't want anyone to see their teeth. It's the same for everyone — they're in their 30s, 40s, 50s and even 60s, mostly men but a few women. Some acknowledge not having brushed in a year.
Once the work is done, Chenowith said, "They're all smiles. They feel good about the way they look."
That confidence, as well as other services, can help pull some vets out of the downward spiral that often results from addiction, mental health issues and medical problems, as well as homelessness, said Patricia Lane, acting homeless clinical manager for the VA Maryland Health Care System.
The VA estimates there are more than 107,000 homeless vets on any given night nationwide, roughly a third of all homeless Americans. More than a half-million more are at risk, according to veterans' groups.
In the Baltimore region, there are an estimated 3,000 homeless veterans. The goal is to find them all stable places to live, and so far locally 300 have been placed in permanent housing and another 450 are in temporary housing. Vets must be in temporary housing for 60 days to be eligible for dental care.
Lane said the Baltimore area has seen an uptick in veterans receiving dental care because officials have been more aggressive about recruiting them, and the collaboration with Maryland allows the VA to see more patients in a timely manner. The VA also runs two local dental clinics.
"The needs continue to be demonstrated," Lane said. "And the gentlemen look so different when they get their teeth fixed. It's delightful. Now they have a sense of pride. They no longer are embarrassed, and they are better prepared for employment."
Mumford thinks so. He's hoping to get a job and go back to school. He'd like to become a certified nursing assistant. For now, he's looking forward to something simpler.
"I'd really like to have an apple," he said. "And peanuts."