[Retrospective analysis of dental trauma among soldiers in the Israel Defense Forces].

OBJECTIVE: Determination of the incidence, types and causes of traumatic dental incidents (TDIs) among Israel Defense Forces (IDF) soldiers. STUDY DESIGN: Dental trauma reports from all active IDF dental clinics between the years 2000-2010 were analyzed. A total of 1671 dental trauma reports were classified according to the incidence, causes and etiologies of the injuries, the number and type of traumatized teeth, and the types of dental injuries. Statistical associations between the number of trauma cases and gender, type of training of the soldier, and the month during which the injury occurred were analyzed. RESULTS: The incidence of dental injuries was 19.65 cases/10,000 soldiers/year. In basic training bases, 75.49 dental trauma cases/10,000 soldiers/year were found in comparison to 14.28 cases in all other bases. Male soldiers were 4.24 times more prone to dental injuries than female soldiers. Significantly more trauma cases occurred during the months of January and August (rate ratio 1.39 and 1.33 respectively), and significantly fewer cases occurred in July (rate ratio 0.59). The most frequent circumstances of TDIs were military training and work related injuries (29.5% and 15% respectively). The etiology of 56.3% of the injuries was trauma from blunt objects that are not a weapon. Of the injuries, 34.9% occurred as a result of trauma from the personal weapon of the soldier. Most trauma cases involved one or two injured teeth (73.2% and 20.1% respectively). Of the trauma cases, 33.8% involved the right maxillary central incisor and 32.5% involved the left maxillary central incisor. There was no significant difference between injuries on the right or left side. The most frequent type of dental injury was a crown fracture (72.8%). CONCLUSION: The risk factors for dental trauma found in this study were male soldiers during basic training in the months of January and August. Most TDIs resulted from blunt objects including personal weapons. Crown fracture was the most frequent type of injury.

Oral and maxillofacial radiologists: career trends and specialty board certification status.

Oral and maxillofacial radiology is the newest specialty to be recognized by the American Dental Association, so knowledge about the parameters of this profession is in the early stages of development. The aim of this study was to understand the current distribution of oral and maxillofacial radiologists (OMFRs) in academia and private practice, the nature of their practice, and trends in their board certification status. An email describing the study's purpose with a link to a survey was sent to "OradList," a listserv that has a majority of OMFRs in the United States and Canada as members. Of the 205 respondents, 46% were female; the age distribution ranged from 25 to over 70 years; and 80% were working full-time. Among the respondents, 66% practiced in an academic setting, 20% in private practice, 8% in both private and academic settings, and 3% in the military. Only 37% of the respondents were board-certified. For OMFRs trained from 1965 to 2009, there was an increasing trend towards becoming board-certified, but a significant decrease occurred after 2009, dropping from 65% to 35% of those trained in those years.

Dental treatment on a German warship during a three-month deployment.

INTRODUCTION: Despite routine dental screenings and treatments before military deployments, dental emergencies may arise due to acute infections, trauma or failed restorations. The purpose of this study is to evaluate the dental service during a three-month deployment on a German warship. METHODS: A retrospective analysis of dental attendances and treatments in a German naval task group of three ships with an average total of 650 soldiers. Diagnosis, treatments performed, percentage of emergencies, routine procedures and numbers of appointments were recorded. RESULTS: Out of 650 soldiers, there were 71 patients (10.92%) with a mean age of 25.1 ±5 .3 years. Out of 136 treatments, 17.65% were for emergency treatment, which is equivalent to 3.69% of all servicemen of the task group. Combining the reasons for dental emergencies, 95.84% were caused by caries. CONCLUSIONS: The pre-screening of sailors before an overseas deployment is necessary to avoid severe dental treatments. Caries remains the main cause for dental emergencies, and medical doctors should be trained to treat caries lesions if a dentist is not on board.

Frequency of restoration replacement in posterior teeth for U.S. Navy and Marine Corps personnel.

STATEMENT OF PROBLEM: There are no recent data that describe the replacement rates of resin composite and dental amalgam restorations placed by US Navy dentists. Information is needed to provide the best possible care for our military personnel which would minimize the probability of dental emergencies, especially for those who are deployed. PURPOSE: The purpose of this study was to determine if the frequency of posterior restoration replacement in military personnel differed based on the type of restorative material utilized. METHODS AND MATERIALS: Data contained in dental records in an observational study (retrospective cohort) were evaluated to identify resin composite and dental amalgam restorations placed by navy dentists in posterior teeth. The status of all erupted, unerupted, missing, and replaced teeth was documented. The type and condition of all existing restorations were recorded for each posterior tooth. Investigators reviewed 2921 dental records, and of those, 247 patients met the criteria for inclusion in the study. A total of 1050 restorations (485 resin composite and 565 amalgam) were evaluated. RESULTS: A Cox proportional hazards model was adjusted for number of tooth surfaces restored, caries risk, and filled posterior surfaces at initial exam. The overall rate of replacement for all restorations in the sample was 5.7% during the average 2.8-year follow-up. No significant elevation of risk for restoration replacement existed when comparing resin composite and amalgam. Both the number of restored surfaces and caries risk status were independent risk factors for replacement. When restoring multisurface cavity preparations, providers placed amalgams by an approximate 2:1 ratio over resin composites for this study population. CONCLUSION: The results for this study show that no difference existed in the rate of replacement for amalgam vs resin composite. When restorations increased from just a single occlusal surface to additional surfaces, the rate of replacement was elevated and statistically significant for both materials. A higher caries risk status was also significant in elevating replacement rates for both materials.

Is there a differential in the dental health of new recruits to the British Armed Forces? A pilot study.

BACKGROUND AND AIM: Figures from the British Defence Dental Services reveal that serving personnel in the British Army have a persistently lower level of dental fitness than those in the Royal Navy or the Royal Air Force. No research had been undertaken to ascertain if this reflects the oral health of recruits joining each Service. This study aimed to pilot a process for collecting dental and sociodemographic data from new recruits to each Service and examine the null hypothesis that no differences in dental health existed. METHOD: Diagnostic criteria were developed, a sample size calculated and data collected at the initial training establishments of each Service. RESULTS: Data for 432 participants were entered into the analysis. Recruits in the Army sample had a significantly greater prevalence of dental decay and greater treatment resource need than either of the other two Services. Army recruits had a mean number of 2.59 (2.08, 3.09) decayed teeth per recruit, compared to 1.93 (1.49, 2.39 p <0.01) in Royal Navy recruits and 1.26 (0.98, 1.53 p <0.001) in Royal Air Force recruits. Among Army recruits 62.7% were from the two most deprived quintiles of the Index of Multiple Deprivation compared to 42.5% of Royal Naval recruits and 36.6% of Royal Air Force recruits. CONCLUSION: A significant difference in dental health between recruits to each Service does exist and is a likely to be a reflection of the sociodemographic background from which they are drawn.

The severity of oral/facial problems treated in Iraq March 2008 to February 2009.

BACKGROUND: The objective of this study was to describe the severity of oral/facial problems occurring in Navy and Marine Corps personnel deployed to Iraq. METHODS: Data documented by Navy Dental Officers deployed to Iraq were used to determine the number and type of oral/facial problems treated and to determine the percentages of severe, moderately severe, and pain/loss of function oral/facial problems treated in Iraq from March 2008 through February 2009. RESULTS: During the year of data collection, a total of 13,933 dental visits were documented for Navy and Marine Corps personnel. Of these, 1,641 were encounters to treat an oral/facial problem in Navy and Marine Corps personnel. In all, 37 (2.2%) of the 1,641 encounters for oral/facial problems were considered severe, 266 (16.2%) moderately severe, and 1,338 (81.5%) were for pain/loss of function. CONCLUSIONS: Although the majority of military personnel with oral/facial problems experience mild to moderate pain or loss of dental function, approximately 20% are of sufficient severity to cause the warfighter to experience a limitation of their operational capability.

The effect of tobacco use on oral health and dental readiness in the Croatian Army.

This study examined tobacco use as a risk factor in the development of periodontal disease as dental emergency and dental readiness among soldiers. A total of 884 soldiers were followed: 650 recruits and 234 professional active veterans. They were categorized into dental readiness classes, and questionnaires were completed about tobacco use. Overall, 62.7% of soldiers reported current smoking, with a higher prevalence of smokers among recruits. The results showed a significant difference in smokers vs. non-smokers in dental readiness, supragingival/subgingival calculus, gingivitis, and Class 3 dental fitness. More recruits (63.8%) smoked than veterans (59.4%), but greater prevalence of daily cigarette smoking and duration of smoking habits was found among veterans. In both groups, soldiers who smoked were characterized by a higher percentage of periodontal health problems and decreased combat readiness compared to soldiers who did not smoke. This indicates a need for oral health prevention program, and cigarette smoking and cessation programs.

Use of the Army Dental Command Corporate Dental Application as an electronic dental record in the Iraq theater of operations.

More than 97% of the dental encounters in Iraq between June 2009 and July 2010 were captured on an electronic dental record. Data from more than 56,000 patient encounters, with detailed treatment notes, and 19,000 DNBI surveys indicates that caries accounted for 22.5% of the dental emergency visits, pulpal disease requiring endodontic (root canal) therapy accounted for 20%, and visits associated with wisdom teeth (third molars) accounted for 4.2%. This data, in combination with the large numbers of one dental officer clinics, indicates that every dental officer must be proficient in endodontic and exodontia diagnosis and treatment. There is evidence that Dental Fitness Category 3 definitions should be revised.

Oral-maxillofacial injury surveillance in the Department of Defense, 1996-2005.

INTRODUCTION: Oral-maxillofacial injuries can lead to deformity and malfunction, greatly diminishing quality of life and worker productivity. Data suggest that over 10% of civilian emergency room visits are due to craniofacial injuries. The size and scope of oral-maxillofacial injuries in the military is not well understood. This study reports U.S. military rates of oral-maxillofacial injuries, causes of oral-maxillofacial hospitalizations, and recommends approaches to improving surveillance, research, and prevention. METHODS: Active duty U.S. military personnel who sought inpatient or outpatient treatment for one or more oral-maxillofacial injuries from 1996 to 2005 were identified in the Defense Medical Surveillance System using ICD-9-CM diagnosis codes associated with oral-maxillofacial injuries. ICD-9-CM diagnosis codes were divided into two categories: oral-maxillofacial wounds and oral-maxillofacial fractures. RESULTS: The oral-maxillofacial fracture rates for men were consistently 1.5 to 2 times higher than those for women, with 2000-2005 rates between 1.2 and 1.5/1000 person-years for men and between 0.7 and 1.0/1000 person-years for women. Wound rates for men were similar to those for women for all years examined (p<0.001), with 2000-2005 rates ranging from 11.0 to 14.6/1000 person-years for men and 12.2-14.8/1000 person-years for women. Compared to the over-40 age group, active duty personnel under age 25 had the highest rates of both oral-maxillofacial fractures and wounds (p<0.001). Among those injuries with a cause recorded, fighting (13.5%) was the leading cause of oral-maxillofacial injury hospitalizations in 2005. CONCLUSIONS: Oral-maxillofacial injuries can and should be monitored using military medical surveillance data. Surveillance efforts would be enhanced by the addition of dental care data. There is also a need for additional quality intervention studies on the strategies to prevent oral and craniofacial injury.

Knowledge, attitudes, and behaviors of federal service and civilian dentists concerning minimal intervention dentistry.

BACKGROUND: Although minimal intervention dentistry (MID) is on the increase, little is known about the patterns of knowledge, attitudes, and behaviors of dentists in the United States. METHODS: Federal service and civilian dentists who were active members of the American Dental Association (N = 1,500) received a pretested questionnaire about their knowledge, attitudes, and behaviors concerning MID. Descriptive statistics and bivariate analyses were conducted to assess dentist personal and practice characteristics associated with the knowledge, attitudes, and behaviors. RESULTS: Federal service dentists reported more knowledge of MID than civilian dentists (Cochrane Mantel Haenszel Ridit Scores), p < 0.0043, with similar attitudes toward fluoride (p = 0.11), and decisions regarding monitoring or restoring enamel caries (p = 0.22). Federal service dentists remineralized noncavitated carious lesions more (p < 0.0001) and had lower composite scores, indicating more MID tendency (Wilcoxon p < 0.0001). CONCLUSION: Federal service dentists reported more knowledge and clinical practices regarding minimal intervention dentistry compared to civilian dentists.

An evaluation of replacement rates for posterior resin-based composite and amalgam restorations in U.S. Navy and marine corps recruits.

BACKGROUND: Restoration replacement is a clinical concern that has not been studied among military personnel. The authors determined the prevalence of placement of posterior amalgam and resin-based composite restorations and the incidence of replacement among U.S. Navy and Marine Corps personnel. METHODS: The authors analyzed dental records from 2,780 personnel to determine the relative risk of replacement for initially sound restorations during subjects' first years of military service. RESULTS: At the initial examination, 964 (15.2 percent) of amalgam restorations and 199 (17.4 percent) of resin-based composite restorations required re-treatment. Of those judged clinically acceptable, 14.2 percent of amalgam and 16.7 percent of resin-based composite restorations required replacement during the observation period. The authors found significant increases in replacement rates for resin-based composite restorations compared with amalgam restorations for replacement due to all causes (adjusted hazard ratio, 1.28; P < .05), as well as for replacement due to restoration failure (adjusted hazard ratio, 1.64; P < .01). CONCLUSIONS: About 30 percent of posterior restorations required replacement, either at the initial examination or during the subjects' first years of military service. In a young military population, significantly more resin-based composite restorations in place at the initial examination will require replacement than will amalgam restorations. Multi-surface restorations had higher rates of replacement than did one-surface restorations, and subjects at high caries risk experienced significantly higher replacement rates than did those at low caries risk. CLINICAL IMPLICATIONS: The number of surfaces restored and subjects' caries risk status may influence the longevity of resin-based composite and amalgam restorations.

Dental support for U.S. Marines in Iraq.

This article describes the experiences of the author while assigned to a dental detachment in Iraq. The mission of the dental detachment was to provide emergency care and, when the situation allowed, essential nonemergency care as far forward as required to reduce the effect of dental disease and degradation of mission. The challenges of deploying a system of dental care presented several logistical problems. This article discusses some of the challenges and offers comments concerning the capture of dental emergency data in the deployed setting.

Review of current U.S. Army dental emergency rates.

The purpose of this article was to review current dental emergency rates for U.S. Army personnel and to identify shortfalls in dental emergency research. The Department of Defense Dental Classification System is intended to identify military personnel at the greatest risk for dental emergencies, allowing military dental assets to prioritize dental treatment. Only two studies have been published on the emergency rates of U.S. Army Soldiers since 2000, both detailing emergency rates for Soldiers deployed to Bosnia. The Stabilization Force VII study identified that Soldiers experienced dental emergencies at a rate of 156 per 1000 per year, whereas the Stabilization Force VIII study found the rate of 170 per 1000 per year. No studies have been conducted for the Army during Operation Iraqi Freedom due to difficulty in capturing all dental treatment encounters. Researchers should attempt to standardize the nomenclature and definitions to aid in the comparability of future dental emergency rate studies.

Dental events during periods of isolation in the U.S. submarine force.

BACKGROUND: Planning of dental support for populations serving in isolation is essential. Many programs of national or scientific interest such as U.S. Navy submarine missions, the manned space program, and research in Antarctica require long periods where dental care is not available. Submariners make an excellent study population due to their relatively large numbers, good health, excellent dental screening, and professional status. METHODS: This study examines dental events occurring while underway on 240 submarine patrols from January 1, 1997 to September 30, 2000. A health events database contains medical encounter notes, demographic information, crew rosters, and medical evacuation reports. A special survey database contains information from three surveys conducted aboard 1 submarine during a 101-day submergence. The evacuation database contains medical evacuation data from the Atlantic and Pacific submarine fleets from 1991 through 1999. RESULTS: One hundred nine initial dental emergency visits and 45 revisits were recorded during these patrols. Of these visits, 48.6% were for an emergency related to an endodontic or caries problem. The incidence rate for all dental problems was 5.0 per 100,000 person-days at sea. Smoking was significantly associated with the occurrence of a periodontal-related emergency and also with the occurrence of any dental emergency. The rate of dental emergencies per 100,000 person-days decreased over time with the rate for the first 7 days being 7.5, days 8 through 14 being 5.5, and after day 14 being 4.6. Dental problems accounted for 6.9-9.3% of all medical evacuations from submarines between 1991 and 1999. The special survey of self-reported dental problems was designed to obtain information on minor conditions that might not be recorded in the medical encounter database. Of the problems reported, 13.1% had a dental problem during the 101-day submergence, 9.8% had a canker sore, and 4.1% had a gum problem.

A longitudinal study of dental experience during the first four years of military experience.

This longitudinal study examined changes in oral health and emergency rates of Army, Air Force, and Navy recruits during the 4 years immediately following entry on active duty. In 1998, 1,331 dental records of recruit participants in the 1994 Tri-Service Comprehensive Oral Health Survey were located, and dental readiness classification and emergency data were analyzed. All services were successful in achieving and maintaining operational readiness among 1994 recruits who spent >93% of their first 4 years of military service in a deployable oral health status (Dental Readiness Classification 1 or 2). However, among recruits with initial Dental Readiness Classification 3, only 57.4% achieved class 1 (oral health) at any point during the 4-year study period. An annual dental emergency rate of 749 per 1000 was found among class 3 personnel, 192 per 1000 among class 2, and 85 per 1000 among class 1.

A statistical method to evaluate dental classification systems used by military dental services.

UNLABELLED: The aim of this research project was to develop a systematic approach to evaluate the effectiveness of dental classifications used by military dental services to predict dental emergencies. DESIGN: A retrospective cohort study of U.S. Navy recruits were followed for an average of 3.5 years. Dental records of 1,114 recruits who had their initial dental examination during the calendar year 1997 were collected in 2001. Four hundred sixty-two dental emergencies (DE) were recorded, of which 50 were class 3 patients. The incidence density ratio (IDR) of DE was 2.2 (p < 0.001; class 3 compared to class 1 or 2 patients). The mean times to DE in patients who experienced DE were 92 days (class 3 patients) and 418 days (class 1 and 2 patients; p < 0.001), while the median times to DE were 59 days and 295 days (p < 0.001) for class 3 and class 1 or 2, respectively. The adjusted hazard ratio for DE in class 3 versus class 1 and 2 patients was 1.519 (p = 0.0149). We have concluded that examination of the following statistics is necessary to assess the effectiveness of military dental classification systems: (1) the percentage of DE that occur in class 3 patients, (2) the IDR of DE, (3) the mean time to DE, (4) the median time to DE, and (5) the hazard ratio of DE.

Emergencias orales en los militares españoles desplegados en Bosnia Herzegovina. Incidencias durante 9 semanas (2000-2001) / Oral emergencies in the Spanish military unfolded in Bosnia Herzegovina. Incidences during 9 weeks (2000-2001)

se presenta la incidencia y distribución de las causas de emergencias dentales en los militares españoles desplegados en Bosnia-Herzegovina (BiH). Definimos emergencia oral como las circunstancias que hacen que el soldado se ausente de su servicio o de su tiempo libre por una causa oral. Se trata de un estudio descriptivo longitudinal. El número de soldados españoles desplegados en BiH en la última semana del año 2000 y las primeras 8 semanas del año 2001 fue de 1063, y fueron tratados en el 2º escalón de Mostar-Aeropuerto, primer nivel de asistencia odontológica. En esos momentos en las exploraciones previas al despliegue no se clasificaba al contingente por su estado de salud oral. La tasa de incidencia fue de 304 asistencias/ 1000 personas/ año. Estas se distribuyeron de la siguiente forma: 39,3% por caries y restauraciones defectuosas, pulpitis y patología periapical 16,1%, gingivitis y periodontitis 16,1%, pericoronaritis 5,36%, complicaciones de exodoncias 1,79%, traumatismos 1,79%, fracturas dentales (sin trauma) 3,57%, lesiones de las mucosas 1,79%, dolor oro facial/ síntomas ATM 3,57%, causas protésicas 3,57%, hiper oclusión, trauma oclusal 5,36%. De estas emergencias el 57% podrían haberse evitado con un diagnostico y tratamiento oportuno previo. Por ello las estrategias de prevención son la clave, para poder en un futuro desplegar en situación de aptitud dental

This study reports about dental emergency rates and cause distribution of Spanish military troops deployed in Bosnia Herzegovina (BiH). Oral emergency is defined as those circumstances that force soldiers away from their duties or free time due to oral problems. This is a descriptive longitudinal analysis of incidences. The number of Spanish soldiers deployed in BiH in the last weeks of 2000 and the first 8 weeks of the 2001 were 1063. The soldiers received oral care at the 2nd echelon posted in Mostar-Airport, the first level of dental assistance. At the time, and before deployment, the military personnel were examined but not classified according to their oral health status. The incidence rate was of 304 attendances per 1000 military personnel per year. The distribution was as follows: 39.3% presented defective restorations or caries, pulpitis and periapical pathology 16.1%, gingivitis and periodontitis 16.1%, pericoronaritis 5.36%, post extraction related complications 1.79%, traumatisms 1.79%, fractured teeth (without trauma) 3.57%, oral pathology 1.79%, oro-facial pain / TMJ symptoms 3.57%, prosthodontics 3.57%, hyper occlusion and occlusal trauma 5.36%. From these emergencies it was concluded that 57% could have been prevented with proper previous diagnosis and treatment. For this reason prevention strategies are the key to deploying a dentally fit unit in the future

The military oral health care system as a model for eliminating disparities in oral health.

BACKGROUND: Healthy People (HP) 2010 is a national health promotion and disease prevention initiative of the U.S. Department of Health and Human Services. The HP 2010 report highlighted a range of racial/ethnic disparities in dental health. A substantial portion of these disparities appear to be explained by differences in access to care. Members of the U.S. military have universal access to care that also has a compulsory component. The authors conducted a study to investigate the extent to which disparities in progress toward achievement of HP 2010 objectives were lower among the military population and to compare the oral health of the military population with that of the civilian population. METHODS: The participants in this study were non-Hispanic white and non-Hispanic black males aged 18 to 44 years. They were drawn from the Tri-Service Comprehensive Oral Health Survey (10,869 including 899 recruits who participated in the TSCOHS Recruit Study) and the Third National Health and Nutrition Examination Survey (4,779). RESULTS: We found no disparities between black and white adults in untreated caries and recent dental visit rates in the military population. Disparities in missing teeth were much lower among military personnel than among civilians. CONCLUSIONS: A universal access-to-care system that incorporated an aspect of compulsory treatment displayed little to no racial disparity in relevant oral health outcomes. This demonstrates that it is possible for large, diverse populations to have much lower levels of disparities in oral health even when universal access to care is not provided until the patient is 18 or 19 years of age.

Class 3 dental treatment time.

OBJECTIVE: Dental emergencies take soldiers away from their assigned duties. The objective of this project was to determine the average clinical treatment time needed to correct nondeployable dental conditions using actual treatment times noted in an electronic scheduler. METHODS: The Fort Hood Class Three Intercept Clinic forwarded their daily treatment logs to the Dental Command for each week from November 1, 2002 through February 13, 2003. Clinical treatment times and types of services provided for dental fitness category (DFC) 3 conditions were tracked with the Corporate Dental Application scheduler. RESULTS: The project identified 398 DFC 3 soldiers who were scheduled to receive treatment at the Fort Hood Class Three Intercept Clinic between November 1, 2002 and February 13, 2003. Twenty-three of those soldiers did not receive treatment; therefore, the total sample size was 375. On average, it required 2.2 hours of clinical dental treatment time to make a DFC 3 soldier dentally deployable. CONCLUSIONS: The findings of this study suggest that treating DFC 3 conditions is time-intensive but most DFC 3 soldiers can be treated in approximately 2 hours in an efficient and properly staffed dental clinic. Without proper preventive education and maintenance, these soldiers may develop additional oral disease and may require repeated episodes of increasingly intensive dental treatment.