Dental Disease Nonbattle Injury Rates of Deployed NATO Militaries in the Middle East Region: A Scoping Review.

INTRODUCTION: The occurrence of dental emergencies, now termed as dental disease nonbattle injuries (D-DNBIs), has long been an impacting factor on militaries' operational effectiveness. Owing to D-DNBIs contributing to low morale, the removal of personnel from duty, causing logistical hardships, and requiring deployable dental teams to operate in theater, there remains a significant benefit in the reduction in the occurrence of D-DNBIs. No study to date has reviewed D-DNBI rates specific to a modern military, and insight into whether militaries are seeing improvements in their dental preparedness remains to be gained. MATERIALS AND METHODS: A scoping review was conducted in accordance with the guidelines set out by Joanna Briggs Institute. Databases searched included SCOPUS, PubMed, OVID, and DOSS. Six hundred and one articles were initially screened, and six articles were included in the final review. RESULTS: A D-DNBI rate of 172 per 1,000 members per year was reported across the coalition, with the U.S., UK, and French militaries reporting on their dental experience. Both the French data and one UK study reported significantly higher D-DNBIs than their U.S. counterparts, who described 124 D-DNBIs per 1,000 members per year. A significant proportion of these D-DNBIs were reported to be "preventable," which raises questions on the efficacy of garrison healthcare services. Dental disease nonbattle injury rates appear to be largely consistent with what was first reported decades ago, and there remains ongoing and significant value in expeditionary dental services providing supportive healthcare for any deployed military personnel. CONCLUSION: Rates of D-DNBIs appear to be stable with what was historically reported when an international coalition is considered, with national variation. There remains a significant number of D- DNBIs which require dental treatment within the operational theater, and further efficiencies can be gained from predeployment treatment of "preventable" D-DNBIs.

Optimal dose and duration of amoxicillin-plus-metronidazole as an adjunct to non-surgical periodontal therapy: A systematic review and meta-analysis of randomized, placebo-controlled trials.

AIM: This systematic review aimed to determine the optimum dose and duration of amoxicillin-plus-metronidazole prescribed as an adjunct to non-surgical treatment of periodontitis. METHODS: Electronic searching identified 376 records, of which 18 were eligible blinded, randomized placebo-controlled trials. The primary outcomes assessed were periodontal pocket depth and clinical attachment level at 3 months, and secondary outcomes were adverse events and compliance. Subgroup analyses were conducted to compare lower and higher doses, and 7- and 14-day courses. RESULTS: Meta-analysis showed a small beneficial effect of adjunctive amoxicillin-plus-metronidazole for each primary outcome, but there was <0.1 mm variation with antibiotic dose or duration. Risk differences for adverse events in the higher dose and longer duration groups were minimally greater (0.04 and 0.05, respectively), and there was one report of anaphylaxis; 1.3% of patients were not fully compliant. CONCLUSION: There was no clinically meaningful difference between different doses or duration of amoxicillin-plus-metronidazole at 3 months post-treatment. Without compelling evidence to suggest that any one regimen performed superiorly, principles of responsible antibiotic use generally recommend the highest dose for the shortest duration of time to reduce the risk of antibiotic resistance. Therefore, a 7-day regimen of 500/500 mg or 500/400 mg of amoxicillin and metronidazole would be most appropriate.

A Novel Evidence-Based Periodontal Prognosis Model.

OBJECTIVE: Patients with periodontal disease and the dental professionals responsible for their care want to know which teeth are expected to respond favorably to periodontal treatment and which teeth are likely to be lost in the short and long term. A number of different periodontal prognosis systems have been previously proposed but do not consider important patient-level factors, such as smoking and diabetic control, in the calculation of the expected outcome and often use subjective measures that introduce potential inaccuracies. The aim of this report is to translate the best available evidence on periodontal prognosis into a clinical model to facilitate decision-making and improve patient outcomes. METHODS: Criteria for an ideal prognostic system were proposed and used to assess the previously reported models. With an emphasis on the inclusion of patient-level modifiers (PLMs) and the exclusive use of objective parameters, a new evidence-based model was developed. RESULTS: This report proposes a new tooth-level prognosis model that uses 9 evidence-based quantifiable parameters to provide a prognosis of secure, doubtful, poor, or irrational to treat. Six tooth-level risk predictors (bone loss:age, pocket depth, furcation involvement, infrabony defects, anatomical factors, and mobility) and 3 PLMs (smoking, diabetes, and bleeding on probing) are used to determine the expected course of disease with specific reference to the suitability of the tooth for future dental treatment. CONCLUSIONS: PLMs must be considered when determining the prognosis of a tooth with periodontal disease. The model proposed in this report is based on the best available evidence for factors affecting tooth survival and has been designed to be as simple and objective as possible to facilitate its adoption in clinical practice. It will be retrospectively and prospectively validated to determine its ability to accurately predict the course of disease.