Caries remineralization therapy: implications for dental readiness.

Caries remineralization therapy can effectively arrest or reverse the progression of incipient proximal caries lesions. Remineralization of tooth structure is accomplished via a series of topical fluoride applications over time using a combination of both in-office and at-home fluoride agents. Remineralization therapy should be considered a viable noninvasive alternative to restoration for all caries lesions that do not exhibit frank cavitation of the proximal enamel surface (i.e., all lesions in enamel, as well as most lesions in the outer dentin). Combining a conservative restorative approach with an aggressive caries remineralization program may provide substantial therapeutic benefit and significantly reduce both costs and long-term restorative need among military patient populations.

Clinical use of dental classification.

The Dental Classification system used by the uniformed services is supposed to predict the incidence of dental emergencies in the operational setting, at least on the unit level. Since most Sailors and Marines are deployed without close dental support, the sea services have adopted a policy of early treatment of class 3 dental conditions during recruit training. The other services are beginning to do the same. Recently, two factors have emerged that are affecting this early dental class 3 treatment. These factors must be considered when planning to provide early dental treatment. First, changing population and dentist provider demographics in the civilian sector are beginning to affect the class 3 treatment needs of incoming military recruits. Second, attrition from recruit training results in treatment provided to recruits who leave military service before finishing their training. Some view this as a waste of resources, others as a cost of doing business. As operational jointness increases, the three services must develop and use a single dental classification terminology, as well as unified standards and guidelines, both for better research in this area and for the readiness and well-being of our patients.

Clinical user evaluation of field dental equipment under military deployment conditions.

The purpose of this work was to evaluate the clinical performance of a number of types of field (i.e., portable) dental equipment used under actual military deployment conditions. This equipment is often used under demanding field conditions where temperature, humidity, and air quality are not controlled. This article presents the results of a project conducted by the Naval Institute for Dental and Biomedical Research and the Air Force Dental Evaluation and Consultation Service to evaluate commercially available field dental equipment through laboratory testing and clinical user evaluations at military deployment sites. The purpose of the study was to identify the best-performing and most cost-effective field dental equipment for possible operational use by the U.S. Navy. Initial laboratory testing was performed at the Naval Institute for Dental and Biomedical Research and the equipment was then shipped to Okinawa, Japan, where it was tested by military dentists and assistants under deployment conditions. The testing provided beneficial results by identifying equipment that performed properly and equipment that exhibited shortcomings serious enough to render it inappropriate for field use.

Army junior dental officer retention.

OBJECTIVES: The objectives of the survey were to quantify the extent of indebtedness of junior dental officers and to determine the impact of a loan repayment program on career decisions. METHODS: We designed a customized survey instrument because no preexisting, validated, survey instrument was available. A query was performed in the Medical Operations Data System to identify all captains (0-3) currently on active duty in the Army (N = 348). The survey sample included 64 junior officers with a 2000 date of rank to captain (0-3), of whom only 52 were in the Medical Command Outlook address book or the Army Knowledge Online white pages. The questionnaire was sent out to these targeted junior dental officers through their official e-mail accounts. Dentists assigned to Korea and to dental field units do not use the same e-mail system as the rest of the Dental Command; therefore, their addresses were not available. In an attempt to increase response rates, commanders were asked to emphasize the importance of responding to the questionnaire. RESULTS: From the sample population of 52 officers who were queried directly, 34 responses were received, for a response rate of 65%. However, commanders forwarded the survey to all Dental Command captains and 102 responses were received. The respondents represented 30% of the total Army inventory of captains; 92% of respondents reported that they had dental school loans, with 43% reporting loans in excess of dollar 50,000. The average dental school indebtedness was approximately dollar 60,700. More than 60% of all respondents reported that loan repayment could change their minds about remaining on active duty. Officers not included in the original sample rated the impact of loan repayment statistically higher than did officers in the original sample. CONCLUSIONS: The findings were that the majority of junior Army dental officers had significant student loans and many of these officers indicated that they would consider remaining on active duty if loan repayment or other monetary inducements were offered.

Influence of the method of funding on the age of failed restorations in general dental practice in the UK.

OBJECTIVE: This study examined the effect of the method of funding treatment on the age of restorations at the time of replacement. METHOD: A group of general dental practitioners were recruited to take part in the study. Each participant was asked to record the reason for placement and replacement of restorations. The age and class of the restoration being replaced was also recorded, together with details of the material being used and the material being replaced. Details of the method of payment of the failed restoration were recorded. RESULTS: Details of the reason for placement/replacement were received for 3,196 restorations from 32 GDPs. Of the restorations placed, 54% were amalgam, 32% composite, 8% compomer and 7% glass ionomer. The age of restorations at the time of replacement was significantly associated with the method of payment for the restoration, with restorations placed in the Armed Forces having been in service significantly longer at the time of their replacement than restorations placed under NHS regulations. CONCLUSION: Statistical analysis indicated that restorations placed within the NHS regulations were replaced at a significantly lower age than restorations placed under the other funding arrangements investigated.

Bond strengths of two dental bonding systems.

A new bonding system named Kevloc has been introduced. It is based on acrylization of the metal surface with the goal of preventing the occurrence of a marginal gap between the metal and the resin. The purpose of this investigation was to determine the values of the shear bond strength achieved using the Kevloc technique on Ag-Pd (Auropal SE) and Co-Cr (Basil S) alloys and to compare them with those obtained with the OVS technique. The shear bond strengths were measured with the Smitz-Schulmayer shear test in a universal testing machine for polymer materials. A microscope image analyzer was used to measure the thickness of bonding layers and to reveal the possible occurrence of the marginal gap with both techniques. No marginal gap was detected with either technique. Kevloc provided better results than OVS only in a group of specimens tested after polymerization. Immersion in water and thermocycling reduced the initially high bond strength values of Kevloc specimens, whereas the bond strength values of OVS specimens remained unchanged regardless of which aging treatment was used. Microscopic examination did not reveal the existence of the marginal gap for either bonding system. According to the results obtained, it can be concluded that the Kevloc bonding system does not provide better shearing bond strength than the OVS bonding system.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Dental Program. Office of the Secretary, DoD. Final rule.

This final rule revises the comprehensive CHAMPUS regulation pertaining to the Expanded Active Duty Dependents Benefit Plan, or more commonly referred to as the TRICARE Family Member Dental Plan (TFMDP). The TFMDP limited eligibility to eligible dependents of active duty members (under a call or order that does not specify a period of thirty (30) day or less). Concurrent with the timeframe of the publication of the proposed rule, the Defense Authorization Act for Fiscal Year 2000 (Public Law 106-65, sec. 711) was signed into law and its provisions have been incorporated into this final rule. The Act authorized a new plan, titled the TRICARE dental program (TDP), which allows the Secretary of Defense to offer a comprehensive premium based indemnity dental insurance coverage plan to eligible dependents of active duty members (under a call or order that does not specify a period of thirty (30) days or less), eligible dependents of members of the Selected Reserve and Individual Ready Reserve, and eligible members of the Selected Reserve and Individual Ready Reserve. The Act also struck section 1076b (Selected Reserve dental insurance), or Chapter 55 of title 10, United States Code, since the affected population and the authority for that particular dental insurance plan has been incorporated in 10 U.S.C. 1076a. Consistent with the proposed rule and the provisions of the Defense Authorization Act for Fiscal Year 2000, the final rule places the responsibility for TDP enrollment and a large portion of the appeals program on the dental plan contractor; allows the dental plan contractor to bill beneficiaries for plan premiums in certain circumstances; reduces the former TFMDP enrollment period from twenty-four (24) to twelve (12) months; excludes Reserve component members ordered to active duty in support of a contingency operation from the mandatory twelve (12) month enrollment; clarifies dental plan requirements for different beneficiary populations; simplifies enrollment types and exceptions; reduces cost-shares for certain enlisted grades; adds anesthesia as a covered benefit; provides clarification on the Department's use of the Congressional waiver for surviving dependents; incorporates legislative authority for calculating the method by which premiums may be raised and allowing premium reductions for certain enlisted grades; and reduces administrative burden by reducing redundant language, referencing language appearing in other CFR sections and removing language more appropriate to the actual contract. These improvements will provide Uniformed Service members and families with numerous quality of life benefits that will improve participation in the plan, significantly reduce enrollment errors and positively effect utilization of this important dental plan. The proposed rule was titled the "TRICARE Family Member Dental Plan".

Expenditures on family dental care by active duty soldiers.

Expenditures on family dental care by U.S. active duty soldiers were explored in this 1992 worldwide survey. Of 9,560 respondents (62% response rate), 7,187 claimed dependents and 5,569 provided reliable data. Mean annual expenditures and multinomial regression on a distribution of expenditures were calculated. Results show average family dental care expenditures were as follows: total sample, $135; childless couples, $59; couples with children, $154; and single parents, $120. Between 72 and 83% of families spent $0 on dental care. Excluding non-spenders, overall expenditures averaged as follows: total sample, $531; childless couples, $354; couples with children, $560; and single parents, $470. Regression results show that expenditures on family dental care by soldiers are influenced by different factors depending on family composition. Policy measures to encourage optimal dental care by families of active duty soldiers should focus on increasing insurance coverage and use.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); expanded active duty dependents dental benefit plan--DoD. Final rule.

The rule establishes an expanded dental program for dependents of active duty members of the Uniformed Services. The amendment specifically describes: the legislative authority for expansion of dental benefits outside the United States; the continuation of dental benefits for active duty survivors; eligibility for pre-adoptive wards; the enhanced benefit structure; enrollment and eligibility requirements; premium cost-sharing; and benefit payment levels. The provisions of this rule will provide military families with the high quality of care they desire at an affordable price.