Dental care provision to UK military personnel serving on Operation Herrick in Afghanistan. Part 2: aetiology and management.

Aims: To evaluate the nature of tooth-related morbidity in military personnel deployed on Operation Herrick and to compare the management of dental emergencies to that in non-deployed personnel. Method: Data were collected prospectively for UK Service personnel on Operation Herrick (OpH) during an 18-month period and measured against prospectively collected 'home base' (HB) control data. Results: Molar teeth were responsible for 64.1% (2,089/3,259) of presentations on OpH and 69.5% (323/467) at HB, causing 81.4% (622/764) of cases of pain lasting for >60 minutes and/or waking the patient on OpH and 86.0% (129/150) at HB. Third molars were responsible for 48.3% and 43.3% of such cases, respectively, and first molars 20.7% and 26.7%. The ratio of temporary to definitive restorations was 0.42 at HB compared with 0.18 on OpH (P <0.001). Antibiotics were prescribed in 5.7% of all cases of pulpitis /periapical infection on OpH and 7.9% at HB. A third molar causing pericoronitis was 2.4 times more likely to be extracted on OpH than at HB (27.4% cf 11.6%). Conclusions: A more definitive approach to management is evident on deployment, reflecting the effort to conclusively treat immediately. To maintain this standard of care it is vital that military dental surgeons continue to be skilled in minor oral surgery.

Dental care provision to UK military personnel serving on Operation Herrick in Afghanistan. Part 1: access to dental care.

Aims: To assess factors influencing access to dental care and to determine the true level of dental morbidity experienced by UK military personnel serving on Operation Herrick. Methods: Data on dental emergencies were collected prospectively over an 18-month period. Deployed personnel were divided into those co-located with a dental centre and those not co-located. Personnel were separately surveyed on return from Operation Herrick; individuals who had suffered an oral/dental problem whilst deployed were asked to complete a questionnaire. Results: There were 4,017 dental emergency attendances by 3,355 UK military personnel (282/1,000 man years at risk). A total of 278 non-co-located patients were transported with the sole purpose of seeing a dental officer, 79% by helicopter; a median of 24 hours was lost from their operational role (vs one hour for those co-located). In the cohort surveyed after their return from Afghanistan, 37/118 (31.4%) patients who had wanted to see a dentist whilst deployed did not manage to. Conclusions: Dental morbidity is common and can affect operational effectiveness, but this risk is reduced by co-location with a dental centre. There is a substantial component of 'hidden' dental morbidity in deployed personnel. Evaluating dental morbidity using dental centre attendees likely underestimates the true levels by approximately a third.

The efficacy of supplementary sonic irrigation using the EndoActivator® system determined by removal of a collagen film from an ex vivo model.

AIM: To evaluate the efficacy of sonic irrigation (EndoActivator® ) using various polymer tips and power settings in a stained collagen ex vivo model. METHODOLOGY: The root canals of fifty human, straight single-rooted extracted teeth were prepared to size 40, .08 taper. The roots were split longitudinally; stained collagen applied to the canal surfaces, photographed and re-assembled. The canals were subjected to syringe without supplementary (group 1, n = 10) or with supplementary sonic (groups 2-5, n = 10) irrigation. EndoActivator® tip sizes (size 15, .02 taper for groups 2 and 3; size 35, .04 taper for groups 4 and 5) and power settings (low for groups 2 and 4; high for groups 3 and 5) were tested. After irrigation, the canals were re-photographed and the area of residual stained collagen was quantified using the UTHSCA Image Tool program (Version 3.0). The data were analysed using Wilcoxon signed rank test and general linear mixed models. RESULTS: Supplementary sonic irrigation using EndoActivator® resulted in significantly (P < 0.0001) less residual collagen compared with syringe irrigation only. Agitation of irrigant using the large EndoActivator® tip with high power resulted in significantly less (22.4% - 29.5%) residual collagen compared to other combinations (large tip/low power P = 0.001; small tip/low power P = 0.01; small tip/high power P = 0.04). There was no significant difference amongst the latter three groups (P > 0.5). CONCLUSIONS: Supplementary sonic irrigation using the EndoActivator® system was significantly more effective in removing stained collagen from the canal surface than syringe irrigation alone. EndoActivator® used with large tip (size 35, .04 taper) and high power setting in size 40, .08 taper canals was more effective than other combinations.

Vitamin D deficiency as a suspected causative factor in the failure of an immediately placed dental implant: a case report.

AIM: To discuss the influence of Vitamin D deficiency in the osseointegration process of a dental implant by way of a case report. SUMMARY: A 29-year-old soldier attended clinic with a fractured mandibular premolar (tooth 44) that was traumatised following head trauma related to the detonation of an Improvised Explosive Device (IED) whilst serving on operational duty. The tooth was deemed unsalvageable and was extracted with immediate placement of a dental implant. The patient experienced no problems but at assessment, five months post-operatively, no osseo-integration of the implant was found. Concurrent medical investigations revealed that he was severely Vitamin D deficient and that this may have contributed to the implant failure. CONCLUSION: Vitamin D deficiency may play a role in the failure of osseointegration in dental implants. The assessment of vitamin D status in patients who have been in long-term hospital care or rehabilitation should be considered, prior to the placement of dental implants.