Prevalence and risk factors associated with geographic tongue among US adults.

OBJECTIVE: To characterize the prevalence of geographic tongue (GT) among US adults. DESIGN: Population-based case-control study. MAIN OUTCOME MEASURES: The presence or absence of GT. SUBJECTS AND METHODS: Data from 16 833 adults examined during The Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III), a study based on multistage probability sampling were analyzed using SAS-callable SUDAAN 9.0.1. RESULTS: Geographic tongue point prevalence was 1.8% (95% CI: 1.4, 2.3). Multivariate logistic regression showed significant effects of race-ethnicity, with Whites (AOR = 1.8; 1.3, 2.5) and Blacks (AOR = 1.6; 1.2, 2.1) having greater odds of GT than Mexican-Americans; current corticosteroid therapy (AOR = 3.7; 1.54, 8.6). Cigarette smokers had lower GT prevalence (AOR = 0.4; 0.3, 0.6). Fissured tongue (FT) was strongly associated with GT among non-smokers: AOR = 17.5 (7.8, 39.5). We did not find significant associations with age, gender, oral contraceptive use, diabetes mellitus, allergy or atopy, psychological or dermatological conditions as previous research has suggested. CONCLUSIONS: Geographic tongue was more prevalent among Whites and Blacks compared with Mexican-Americans, positively associated with FT, and inversely associated with cigarette smoking.

Risk factors associated with denture stomatitis in the United States.

BACKGROUND: This study reports denture stomatitis (DS) prevalence from a large USA probability sample from the National Health and Nutrition Examination Survey, 1988-1994 (NHANES III). METHODS: Oral examinations were performed on 3450 individuals 18-90+ years of age (mean: 59.2; SD: 0.50 years), 57.7% male and 42.3% female. Multivariable logistic regression models were fitted for DS using sociodemographic, denture quality, blood analytes, alcohol and tobacco use, history of diabetes, and current antibiotic use as covariates. Odds ratios (OR), adjusted for other covariates in each model (AOR) are presented. RESULTS: Of 3450 removable denture wearers, 963 (27.9%) had DS. DS prevalence was associated with wearing maxillary (AOR: 6.20) and mandibular (AOR: 5.21) complete dentures continuously; smoking >/=15 cigarettes day (maxillary complete: AOR = 1.31; mandibular complete: AOR = 1.50; maxillary partial: AOR = 2.04); vitamin A deficiency (mandibular complete: AOR = 5.97; maxillary partial: AOR = 5.67; mandibular partial: AOR = 24.42). Maxillary dentures with inadequate relines had approximately half the OR of DS than those with adequate relines (maxillary complete: AOR = 0.42; mandibular complete: AOR = 0.50). CONCLUSIONS: Denture stomatitis prevalence is associated with the amount of tissue covered by dentures, low vitamin A levels, cigarette smoking, and constant denture wear.

Is there an association between low birth weight and caries in the primary dentition?

OBJECTIVES: An association between low birth weight and caries in the primary dentition has been suggested but not demonstrated. This study analyzed this association using data from a probability sample of US children 2-6 years of age. METHODS: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used. Variables included decayed and filled primary surfaces (dfs), birth weight, gestational age, and Apgar score (a surrogate measure of fetal well-being); maternal age, education, income; number of previous births, marital status, the existence of pregnancy complications, and cigarette smoking during the pregnancy. Data were analyzed using SUDAAN 8.0.2. RESULTS: Bivariate Poisson regression showed that children of mothers who were unmarried (incidence density ratio, IDR = 3.28), with less education (IDR = 1.43), who were 17 years of age or younger at birth (IDR = 1.51), and had 2 or fewer prenatal visits (IDR = 1.65) had a significantly ( p <0.05) greater risk of caries than the reference groups. Children of mothers with pregnancy-related hypertension (IDR = 0.14) had less than 20% the risk of caries than the reference group. Blacks (IDR = 1.37) and Mexican-Americans (IDR = 2.38) had greater risk of caries than whites, and children of low (IDR = 2.57) and middle income (IDR = 2.00) level families had higher caries risks than those of upper income families. Multivariate Poisson regression found only race-ethnicity, age, and income level to be statistically significant. CONCLUSIONS: This study did not support the association between low birth weight and caries of the primary dentition.

Prevalence of oral mucosal lesions in children and youths in the USA.

INTRODUCTION: There is a dearth of studies of oral lesions in children and youths using probability samples of a general population. The present paper describes the results of the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III), and compares them to those of the National Survey of Oral Health in US Schoolchildren, 1986-1987. METHODS: The NHANES III was a large US study based on a multistage probability sample. Dentist examiners were trained to recognize, classify and record, in a standard manner, the clinical characteristics of each of the 48 conditions of interest using procedures based on the World Health Organization's Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases. RESULTS: Examinations were performed on 10,030 individuals (10.26%) aged between 2 and 17 years, 914 of whom had a total of 976 lesions. The lip was the most frequent site of lesions (30.7%), followed by the dorsum of the tongue (14.7%) and the buccal mucosa (13.6%). Lesions were more prevalent in males (11.76%) than females (8.67%). The most prevalent lesions were lip/cheek bite (1.89%), followed by aphthous stomatitis (1.64%), recurrent herpes labialis (1.42%) and geographic tongue (1.05%). The prevalence of recurrent aphthous stomatitis in the NHANES III child and youth survey was substantially higher than that for adults, while the NHANES III adult estimates for geographic tongue (1.85%; 95% CI 1.42, 2.28) and cheek/lip bite (3.05%; 95% CI 2.36, 3.74) were substantially greater than those for children and youths (0.97% and 2.05%, respectively). CONCLUSION: Reported prevalences for rare conditions in other studies employing more selected samples (especially if standard errors or confidence intervals are not provided) should be interpreted with caution. Studies of adult populations, however valid, may have limited applicability to children.

The association of tobacco and other factors with recurrent aphthous stomatitis in an US adult population.

OBJECTIVE: To determine point and annual prevalence of recurrent aphthous stomatitis (RAS). SETTING: Reported prevalence of RAS in textbooks and much of the literature varies according to study location, patient selection and whether point prevalence (presence of lesions at examination) or period prevalence (history of lesions during a specified period) is reported. Many studies are based on non-probability samples and this may contribute to significant variation in reported prevalence and factors presumed to be associated with RAS. METHODS: We analyzed data from the Third National Health and Nutrition Examination Survey, 1988-1994, a large United States probability sample, for RAS and covariates suggested in the literature using bivariate and multivariate logistic regression. RESULTS: Oral mucosal examinations were performed on 17 235 adults 17 years and older. Of these, 146 (0.89%) had at least one clinically apparent aphthous lesion. For annual (reported) prevalence, Whites (20.87%) and Mexican-Americans (12.88%) had several fold higher prevalence of RAS than Blacks (4.96%). Adults younger than 40 years of age had almost twice the prevalence (22.54%) of those older than 40 years (13.42%). CONCLUSION: Annual prevalence was significantly higher in whites and Mexican-Americans (compared with blacks), individuals 17-39 years of age, cigarette non-smokers, and those with recurrent herpes labialis history; while it was lower in males. Point prevalence was significantly higher in whites, Mexican-American, individuals 17-39 years of age, cigarette non-smokers, and males.

Socio-demographic features and fluoride technologies contributing to higher fluorosis scores in permanent teeth of Canadian children.

OBJECTIVE: To examine levels of fluorosis among children in two Canadian communities exposed to fluoride. BACKGROUND: One community had discontinued fluoride, the other had maintained it. Water supplies, however, were fluoridated for all the children when their esthetically important teeth were mineralized. METHODS: We examined 8,277 children to assess Thystrup-Fejerskov Index (TFI) scores. Multivariate Poisson regression models were used to identify the relationship between TFI and water fluoride status, age, gender, SES, and dietary and fluoride exposure histories (supplements, rinses, toothpaste amount, tooth brushing frequency, and tooth brushing starting age). Parent(s) completed questionnaires. RESULTS: Overall, levels of fluorosis were low to mild, with residents of the fluoridation-ended communities having marginally higher TFI scores than those of the still-fluoridated community. Females had higher TFI scores than males. Children aged 10 years or more had higher TFI scores than younger children. Consuming bottled water between birth and 6 months of age was protective. Exposure to fluoridation technologies was consistently associated with fluorosis experience. Children who began brushing with fluoride toothpaste between their first and second birthdays had higher TFI scores than those who began between their second and third birthdays, regardless of daily brushing frequency. Children who regularly used supplements had higher TFI scores than those who did not. Children with a college-educated father had higher TFI scores than those whose fathers had less education. CONCLUSIONS: Higher fluoride exposure slightly increased the likelihood that a child had a higher TFI score, especially when more fluoridation technologies were used at home.

Louisiana dentists' attitudes toward the dental Medicaid program.

PURPOSE: This study was performed to determine factors associated with Louisiana dentists' participation in the Dental Medicaid Program. METHODS: Surveys were mailed to all pediatric and general dentists as reported by the Louisiana State Board of Licensing. A second mailing was made to non-respondents. RESULTS: Surveys from 956 of 1,926 dentists (50%) were returned. Of 607 general dentists and 40 pediatric dentists who treated dental Medicaid-enrolled children in the past year, 269 (44%) and 18 (45%), respectively, treated all Medicaid-enrolled children. Newly graduated dentists were more likely to be actively enrolled than their more established counterparts (chi 2 = 10.67; p = 0.01). Medicaid reimbursement levels were viewed as "much less" than private fees by 62%, "less" by 33% and "the same" by 4% of the respondents. Broken appointments were the most prevalent reported problem (80%), followed by low fees (61%), patient non-compliance (59%), unreasonable denial of payments (57%), slow payment (44%), and complicated paperwork (42%). With the exception of the perceived importance of Medicaid reimbursement levels, active and inactive general and pediatric dentists' perceptions of the importance of Medicaid issues were not significantly different. These findings indicated that significantly more Medicaid-active general dentists who allocated 10% of their office visits to Medicaid-eligible children felt that slow payment (p = 0.002) and complicated paperwork (p < 0.001) were more important problems than general dentists who allocated less time to Medicaid-eligible children. CONCLUSIONS: Louisiana dentists' sources of dissatisfaction with Medicaid are similar to those of dentists in other states. Some of the issues are programmatic and are within the power of the dental Medicaid director and state legislature to address. Patient-related issues such as frequent broken appointments may be addressed by assigning case managers to Medicaid beneficiaries.

The association between asthma and dental caries in children and adolescents: A population-based case-control study.

This study explored the potential association between childhood asthma and caries using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III). We fitted GEE Poisson regression models with adjustment for parents' income, gender, race, exposure to potentially xerostomic drugs, and the presence of pit and fissure sealants. There was no association between the use of drugs commonly used by asthmatics (antihistamines, corticosteroids, and antiasthmatic inhalers) and df/DMF scores. Asthmatic children 4-10 years of age at all severity levels had similar dfs scores to the controls, however, severely asthmatic children 4-10 years of age had significantly lower DMFS (p = 0.010) and DMFT (0.049) scores than controls. Similarly, severely asthmatic children 11-16 years of age had significantly lower DMFT scores than controls (p = 0.024) and DMFS scores approaching statistical significance (p = 0.053). While our analysis adjusted for covariates, potential confounders such as fluoride intake from water, diet, use of topical fluorides, and dose of antiasthmatic medication could not be addressed. Our results indicate that any association between asthma and dental caries may occur primarily in younger children with no evidence of an association between asthma and dental caries as children mature.

Tooth-surface progression and reversal changes in fluoridated and no-longer-fluoridated communities over a 3-year period.

OBJECTIVE: To compare permanent tooth surface-specific progression/reversal changes between fluoridation-ended (F-E) and still-fluoridated (S-F) communities in British Columbia, Canada, over a 3-year period. METHODS: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. RESULTS: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit-and-fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F-E site compared to the S-F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F-E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. CONCLUSION: Progressions were found to be weakly linked to socio-demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F-E communities had more frequent progressions than a S-F community.

Carpal tunnel syndrome: effect on Army dental personnel.

The purpose of this study was 2-fold: (1) to determine the prevalence of hand problems, in particular carpal tunnel syndrome (CTS), among Army dental personnel; and (2) to identify dental professionals at risk. A 12-page survey was mailed to all U.S. Army military and civilian dental personnel. Of the 6,320 surveys mailed, 80.9% were returned completed. An analysis was performed identifying the prevalence of hand problems and CTS and noting differences between civilian and military dental personnel. Of the 5,115 surveys analyzed, 44.8% indicated hand problems and 25.4% were determined to indicate a high probability of CTS. Of the 18 dental job specialties, dental therapy assistants and dental hygienists had the highest prevalence of CTS, 73% and 57%, respectively. Army dental personnel are at greater risk of developing CTS than the general public, especially civilian dental personnel, who were female, older, and employed longer.

Restoring teeth that are endodontically treated through existing crowns. Part II: Survey of restorative materials commonly used.

OBJECTIVE: A survey was undertaken to categorize the materials used for the restoration of endodontic access openings through complete-coverage crowns after completion of nonsurgical root canal treatment. METHOD AND MATERIALS: The survey package consisted of a cover letter stating instructions, rationale, and purpose for the questionnaire, a questionnaire of 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists), was selected. Collected data were analyzed with the chi-square analysis. RESULTS: Most general practitioners (93%), endodontists (61%), and prosthodontists (75%) reported that they frequently or always permanently restore teeth after nonsurgical root canal treatment. Empress was the all-ceramic system used most commonly by prosthodontists (42%) and general practitioners (38%). A statistically significant difference in restorative material preference was found (P < 0.0001), depending on the type of crown used. CONCLUSION: Amalgam alone and in combination with bonding agents are materials of choice for restoration of access openings through all-metal complete crowns, while resin composite is the choice for all types of complete crowns involving porcelain. Endodontists preferred "other" materials.

Restoring teeth that are endodontically treated through existing crowns. Part I: Survey of pulpal status on access.

OBJECTIVE: The purpose of this study was to identify the pulpal findings encountered by practitioners when accessing complete-coverage crowns that require nonsurgical root canal treatment and the relevance of coronal leakage to the success of the RTC. METHOD AND MATERIALS: The survey package consisted of a cover letter stating the instructions, rationale, and purpose for the questionnaire, a questionnaire with 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists) was selected. Collected data were analyzed with the chi-square test. RESULTS: A 60% response rate was obtained. Statistically significant differences were found among the practitioner groups, depending on the question. General practitioners and endodontists obtain access through crowns and maintain these crowns as final restoration significantly more often than do prosthodontists. Practitioners responded that teeth with complete crowns require nonsurgical root canal treatment after 5 to 10 years. CONCLUSION: Respondents believe that leakage must be addressed when endodontic access cavities in artificial crowns are restored after nonsurgical root canal treatment. General practitioners perform nonsurgical root canal treatment more frequently than do prosthodontists. Practitioners indicated that when teeth with complete crowns require nonsurgical root canal treatment, treatment is most often performed 5 to 10 years after placement of the crown.

Influence of the digital image display monitor on observer performance.

OBJECTIVE: To assess the influence of the display monitor on observer performance. MATERIAL AND METHODS: Artificial enamel lesions were created in 40 extracted teeth at random using 1/4 and 1/2 round burs. Teeth were mounted in dental stone blocks to simulate a hemidentition. Approximate exposures were recorded at 70 kVp using a Digota (Soredex, Orion Corp, Helsinki, Finland) digital imaging system, calibrated to achieve optimum density. Six dentists rated each image on a five-point scale for the presence or absence of a lesion. Radiographic images were viewed on the following monitors: (1) AlphaScan 711 (Sampo Corp.); (2) Multiscan 17 Se II (Sony Electronics Inc.); (3) DS 2000 (Clinton Electronics Corp.) and (4) Latitude CP Laptop (Dell Computer Corp.). Raters were allowed to magnify and to adjust density and contrast of each image at will. Receiver Operating Characteristic (ROC) analysis was performed and curves were plotted for each image. Data was subjected to repeated measures analysis of variance and ordinal logistic regression to test for significance between variables and to determine odds ratios. RESULTS: Mean ROC curve areas ranged from 0.8728 for the Sampo monitor to 0.8395 for the Sony. Repeated measures analysis of variance showed significant differences between observers (P < 0.0001), lesion size (P < 0.0001), examiner/monitor interaction (P < 0.033) and examiner/block interaction (P < 0.013). However, no significant difference was found between monitors. CONCLUSION: This study suggests that observer performance is independent of the visual characteristics of the display monitor.

Orofacial injuries in youth soccer.

PURPOSE: The purpose of this study was to estimate the incidence of orofacial injuries in youth soccer in the 1995 fall and 1996 spring seasons for eight Dallas, Texas metropolitan area YMCA youth soccer leagues. METHOD: Surveys requesting orofacial injury as well as game and practice information were sent to all soccer coaches of children 3 to 12 years of age in eight cooperating YMCA leagues in the Dallas metropolitan area. RESULTS: The incidence of orofacial injury was low. In 47,772 hours of games and practice only 17 orofacial injuries were reported by the 122 coaches who responded. All reported injuries were to soft tissue and none required professional attention. CONCLUSION: The reported incidence of orofacial injury was very low suggesting that at the age and skill levels represented by these YMCA teams, soccer appears to be relatively safe to the maxillofacial complex.

Dental public health for the 21st century: implications for specialty education and practice.

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.

Effect of different background lighting conditions on diagnostic performance of digital and film images.

OBJECTIVE: To compare the performance of a photostimulable phosphor (PSP) imaging system with radiographic film for the detection of approximal lesions under two background lighting conditions. METHODS: Bitewing exposures were made of the extracted human teeth with artificial approximal lesions using D-speed and E-speed radiographic film and a PSP imaging plate. Eight dentists rated 12 approximal surfaces in each image on a 5-point scale. Images were viewed with overhead fluorescent room lighting on and off. ROC curves were generated for each image receptor and lighting condition. Repeated measures analysis of variance ANOVA tested differences between observers, lesion size, image receptor, lighting condition. RESULTS: Mean ROC curve areas for D-speed film viewed in full ambient light scored highest (0.8030) followed by E-speed film using dark conditions (0.7386). The lowest mean curve area was found when PSP (enhanced mode) images were viewed in a dark room (0.6726). Significant differences were found between observers, lesion size, image receptor and image receptor-lesion size interaction. No significant difference was found with background lighting. CONCLUSIONS: Background lighting does not appear to effect the ability to detect artificial approximal lesions.

Acute ethanol toxicity from ingesting mouthwash in children younger than 6-years of age.

The purpose of our study was to analyze reports of the American Association of Poison Control Centers (AAPCC) of suspected overingestion of ethanol from mouthrinses by children younger than 6 years of age between 1989 and 1994. Annual incidence rates of reported ethanol exposures attributed to mouthrinses were calculated. Lethal and toxic amounts of several mouthrinses were calculated using peak blood ethanol concentrations of 500 and 50 mg per 100 mL, respectively. In 1994, there were 2937 calls reported by poison control centers related to ethanol-containing mouthrinses, an estimated incidence of 168 reported exposures per 100,000 children younger than 6 years of age. A 15-kg child who ingests 212 mL (7.2 oz.) of Listerine (26.9% ethanol) ingests 57 mL (1.9 oz.) of ethanol, which is potentially lethal. Approximately one-tenth that amount of ethanol can produce a toxic reaction. Physicians, dentists, and other health care providers should inform parents of the dangers associated with accidental ingestion of mouthrinse and encourage them to keep mouthrinse out of the reach of children. The Food and Drug Administration (FDA) should require readily visible warning labels and child-resistant caps for containers with potentially toxic volumes of ethanol. The American Dental Association (ADA) should re-evaluate its acceptance criteria for advertising cosmetic mouthrinses in its publications and consider including child-resistant caps and warning labeling.

Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age.

OBJECTIVE: This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home-use fluoride products in children younger than 6 years of age. METHODS: Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg. RESULTS: Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF2 gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose. CONCLUSIONS: Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child-resistant packaging for all fluoride products intended for use in the home.

Consumer satisfaction with dental care: where have we been, where are we going?

This paper reviews research developments in the area of dental patient satisfaction over the past three decades, contrasts these with comparable developments in medicine, and suggests directions for future work in the dental arena. The conclusion of the review is that developments in managed care in medicine have stimulated a level of effort in patient satisfaction measures that have gone well beyond that in managed dental care. Analogous work in dentistry is needed as managed dental care plans grow in number.

The prevalence of chapped lips during an army hot weather exercise.

OBJECTIVES: To identify risk factors associated with chapped lips in soldiers during prolonged exposure to a hot, dry environment. METHODS: We examined 1,053 of 2,500 soldiers (42%) participating in a desert training exercise at Fort Irwin, California, in September 1983. We measured the prevalence of chapped lips during the third week of a 4-week training period. Our independent variables (complexion, sex, lip protectant use, age, and the prevalence of recurrent herpes labialis) were obtained by observation and interview. RESULTS: We found severe chapping in 150 (10%) and moderate chapping in 247 (23.5%) of the soldiers. Stepwise ordinal logistic regression was used to identify risk factors associated with chapped lips and to determine the prevalence odds ratios (OR). Risk factors with statistically significant associations with chapped lips were the presence of recurrent herpes labialis (OR = 2.88), very fair complexion (OR = 3.23), and fair complexion (OR = 1.58). CONCLUSIONS: Moderate to severe chapping occurred in approximately one-third of the soldiers. Lip protectants appeared to be relatively ineffective in the prevention and treatment of chapped lips but were associated with a lower prevalence of recurrent herpes labialis.