[Dental care to the Israeli Defense Forces' fighters]

The combat soldiers of the Israeli Defense Forces (IDF) get comprehensive dental care. The service of a combat soldier in the IDF can be divided into two periods: the period of training that includes basic training and advanced training lasting six to eight months, followed by a period of operational activity within the framework of the battalions. Throughout his service, the combat soldier is exposed to dental disease including dental caries, periodontal disease and dental trauma attributed to his terms of service with low availability to maintain adequate oral hygiene in high intensity training. There is no available data as to the dental status of new recruits. This information is needed in order to determine the level of oral and dental health among combatsoldiers in order to guarantee operational continuity. Every recruit undergoes a full dental examination in order to determine his level of oral and dental health. From this point on, dental treatment is offered and performed according to the level of oral and dental health, in order to treat the most severe levels. The dental treatment is carried out so that throughout his service, the combat soldier is summoned to various dental clinics: the base unit training clinic, clinics serving the Brigades and experts clinics. All the factors mentioned above, are designed to help increase the provision of therapy, and lead to an increase in the number of fighters who receive comprehensive dental care.

[Research in military dentistry in the Israeli Medical Corps]

The article reviews selected studies conducted in the Dental branch of the Israel Defense Forces Medical Corps in the topics of dental caries, prosthodontics, periodontics, dental trauma and maxillofacial injuries, aviation dentistry and diving dentistry, dental managing and health economics, decision making in military dentistry, dental anxiety, oral medicine in military population, temporomandibular disorders, and dental-related lifestyle and health behavior.

[The influence of military underwater activity on the oral cavity]

The military dentists who serve in the navy, treat divers, among other patients. Divers are being exposed to a changing, unique environment on a regular basis. The aim of this article is to review latest literature on the different effects of scuba diving on the diver's head, face and oral regions and to emphasize methods of disease prevention, diagnostic tools and treatment guidelines. The review focuses on diving barotrauma (pressure- induced injury related to an air space) as well as scuba diving mouthpiece-related oral conditions, which include facial, jaw pain and headaches, decompression sickness and mouthpiece-related herpes infection. Each condition is described by its effect on the oral cavity and in particular the teeth.

[Multidisciplinary approach to oral rehabilitation in wounded fighters]

Maxillofacial injuries during military service and in operations in particular, often involve soft and hard tissues, including fractures of bone and teeth. This kind of injury demands a multidisciplinary approach including specialists in oral and maxillofacial surgery periodontists, endodontics, orthodontics and prosthodontics. A comprehensive therapy is achieved by a complete cooperation between the disciplines for a long-term. We present a case report of a complex oral rehabilitation of a fighter wounded in "Zuk Eitan" operation, as an example of the multidisciplinary approach in our department.

[Big data in dentistry and oral medicine]

Knowledge about the extent of dental and oral diseases and needs in Israel is very limited with no official governmental body responsible for data collection. The aim of the "Dental Oral Scale (DOS) project is to measure the extent of dental and oral diseases, their risk factors, and their association with demographics and various systemic conditions. The DOS project includes demographic, dental and medical records of all patients attending IDF dental clinics in 2014, as well as a control group of patients. Records were obtained from three computerized military databases: a sociodemographic record, a medical record (Clinical Patient Record-CPR) and a dental record (Dental Patient Record-DPR). The DOS project analyses the associations between these oral-health related conditions and sociodemographic parameters as well as behavioral parameters and systemic general health-related conditions.

[Dental care to military dogs]

Oketz is a military special unit that operates different dog species for various missions. The dogs get routine medical and dental treatments in order to maintain their health and function. The dental treatment is based on the principles of contemporary dentistry for small animals. Furthermore, these working dogs need special care due to higher risk to trauma and attrition. The dogs go through routine dental examination and prophylactic dental cleaning. Each dental procedure is performed under general anesthesia; therefore it is well planned ahead including all the pre-operative workup needed. The article presents the current concepts of dental treatment of dogs especially in respect to their activity.

[The crucial role of forensic odontology in the IDF]

Israel's recent military engagements have been asymmetric in nature, defining the captivity of a solider as the enemy's' strategic achievement. Casualty care during war, is a delicate mission, requiring the collaboration of 3 distinct corps - the medical corps, chaplaincy corps and the adjutant corps. In this article, we will review the crucial role forensic odontologists play in the identification of casualties. In addition to biometric identification which is carried out through DNA analysis, fingerprint co-matching and forensic odontology, the forensic battalion of the medical corps investigates the cause of death, delivering crucial information to different branches of the military.

[Military aviation dentistry]

The aim of this article is to introduce the concepts of military aviation dentistry, including facial barotraumas (external otitic barotrauma, barosinusitis and barotitis- media), dental barotrauma, barodontalgia, and dental care for aircrews. Special considerations have to be made when planning restorative, endodontic, prosthodontic and surgical treatment to an aircrew patient. The article supplies the military dental officer with diagnostic and treatment guidelines, and the principles of prevention, periodic examination, and dental-related flight restriction.

[Treatment organization for patients with gunshot wounds of the maxillo-facial region evacuated during the military operations in the Far East (1938-1939) and the war with Finland (1939-1940)]

This article describes the path of the maxillo-facial surgery to becoming an independent part of the general surgery. We will look closely at the experience, gained y field surgeons during the events at Lake Hasan and Halkin-Gol river. The war with Finland, that enabled the surgeons to develop the system of specialized dental help for the gunshot wounds, to create standarts of specialized equipment, examples of splints, etc, which were widely used during the World War II.

[About improvement of outpatient dental health service for young serviceman]

The article gives a detailed account of results of epidemiological survey of dental morbidity in young serviceman and different types of outpatient dental health service needs. Medical norms for dispensary supply with all types of outpatient dental health service for young servicemen are estimated. Suggestions for improvement of organizational and staff structure of dental office of medical company are formulated.

[Improvement of outpatient dental care in the military district]

The paper presents proposals for improving outpatient dental care in the military area. To improve all types of outpatient dental care it is encouraged to use mobile multi-purpose field dental system based on chassis KamAZ, versatile portable dental kit. The construction kit has a modular design that supports rapid deployment of the dental office. For its operation is designed dental kit, which includes modern dental materials, instruments and medicines. Equipping the army medical service data development will help to improve outpatient dental care in the Army.

Patient and provider population dynamics analysis in a large dental organization: a tool for management

Health care managers are faced with difficult decisions on a daily basis. Some of those issues involve productivity. Statistical analyses of patient and provider population dynamics offer an important tool with which to base decisions. In this study, two representative clinics out of seven were selected. The patient and provider populations were subjected to the means square successive difference test and a linear regression test. The results differed from management perceptions. Provider decision processes in clinic A were more efficient than those in clinic B. There was no relationship between provider presence and the patient population in both clinics. The patient populations in both clinics displayed random arrivals. Specific recommendations to management from the results of this study include: billeting decisions, appointing process decisions, emergency policies, and the need for a focused marketing plan. There are many useful tools with which to study population dynamics. This is one example.

[Medical standards of dispensary guarantee of call-up aged persons by ambulatory stomatological aid]

The article presents results of epidemiological research of dental morbidity among persons of call-up age and indexes of their need in different types of dental aid. Were calculated medical standards for dispensary supply, elaborated propositions in standard of medical survey of persons of call-up age on specialization "stomatology" during registering on military registration and proximately during the call-up on military service in determination of fitness for military service. These data could be used in improvement of organizational structure of dental institutes of Health Ministry of social development of the Russian Federation.

[Development of tooth implantation in the Central Stomatologic Polyclinic of Ministry of Defense of Ukraine]

The article presents information on stages of the development of teeth implantation in the central stomatologic polyclinic of Ministry of Defense of Ukraine. The authors showed obtained results after introduction of replanatation of teeth and implantation. Advantage of clinical use of implantation against traditional teeth prosthetics was shown.

[Stages of the development of military stomatology and oral surgery in main Clinical Military Hospital of Ministry of Defence of Ukraine]

The article presents stages of the foundation and development of military stomatology and oral surgery in main clinical military hospital of ministry of defence of Ukraine for last 250 years. The authors outlined the role of scientists and physicians of the hospital in the treatment and prophylactics of teeth diseases of military persons as well as in studing dentofacial wounds and their replacement. Cumulative expirience was shown to be important for the development of military stomatology in total.

[Organization of stomatological care in Russian army during first World War 1914-1917 y]

The article presents issues on organization of stomatological care in Russian army during First World War. The author showed reasons of low efficiency of the treatment of soldiers with maxillofacial region. Injuries beginning of a new stage in the treatment of maxillofacial region fire wounds and origin of a new specialty developed a military maxillofacial surgery.

[Standardization of work force and techniques provided in stomatology institutions and determination of quality criteria on providing stomatology service in Ukrainian army]

The article presents the definition of the standardization of work force and techniques provided in stomatology institutions and determination of quality criteria on providing stomatology service to military personnel, army staff and definite rank of personnel at different level of health care institutions to optimally organize stomatology service in Ukrainian army.

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.

Dentistry in the Armed Forces

This paper describes the way dentistry is practiced in the Armed Forces and highlights the differences with civilian practice, especially during military operations. The military lifestyle is discussed and the various training pathways and career options available to Armed Forces dentists are outlined.

Public health model for Dental Specialty MEDRETE

OBJECTIVE

Dental readiness training exercises constitute one form of a specialty medical readiness and training exercise (MEDRETE). Traditional dental missions have been a part of general MEDRETEs and have focused care on extractions and the provision of oral hygiene instructions. This article describes the tenets of a prevention-based dental humanitarian mission to Honduras in 2002.

MATERIALS AND METHODS

The U.S. Army Southern Command requested a Dental Specialty MEDRETE for fiscal year 2002. A site visit revealed the absence of water fluoridation, high levels of dental disease, and a desire to have an American dental team perform the dental readiness training exercises at the Escuala Lempira, a low-income elementary school in the Honduran capital city of Tegucigalpa.

RESULTS

The U.S. Army Dental Command in conjunction with the 257th Medical Company (Dental Services) performed a pediatric dental readiness training exercises in Tegucigalpa March 4-15, 2002. In over 9 treatment days, there were 369 patient encounters totaling 1,593 treatment procedures. In keeping with the preventive focus of the mission, 514 dental occlusal sealants were provided compared with only 90 extractions. Over dollar 76,000 in dental services was provided.

CONCLUSIONS

The 2002 Honduran Dental Specialty MEDRETE represented a changing paradigm from extraction-based dental missions toward prevention-based missions. With this philosophical shift in focused care, Dental Specialty MEDRETEs have the ability to enhance the oral health of children, including those not fortunate enough to have received direct interventional dentistry.

The Air Force Dental Service--cross into the blue

The Air Force Dental Service was founded shortly after World War II in order to provide oral health care to active duty, retired, and active reserve Air Force personnel, their families while overseas, and designated others. Grouped with medical facilities and organized by functional commands, the Air Force Dental Service enjoys a strong reputation in special operations, including education, forensics, expeditionary services (including combat and humanitarian efforts), the Dental Investigation Service, and the Air Force Inspection Agency.

Providing care for America's Army

The Army Dental Corps' three-part mission is to maintain soldiers fit for combat, promote health, and ensure the Dental Corps ability deploy and deliver in the field. Consistent with this mission, the corps is developing innovative dental delivery systems and promoting tobacco cessation, sealants, mouth guard use, cancer detection, and identification of child, elder, and other abuse. The corps' training programs include options and benefits at the dental student, postdoctoral residency, and specialty levels. Recent technology innovations include light-weight field equipment, an integrated computer database to manage treatment, rapid ordering and delivery of supplies, and distance education.

Dental class 3 intercept clinic: a model for treating dental class 3 soldiers

OBJECTIVE

Dental Fitness Classification (DFC) 3 indicates that a soldier has a dental condition that, if not treated, is expected to result in a dental emergency within 12 months. Forty-two percent of Army recruits have DFC 3 conditions as reported by the 2000 Tri-Service Center Recruit Study. Initial entry training schools allow minimal time for dental care. The Fort Hood Class Three Intercept Clinic (CTIC) was created to treat DFC 3 conditions prior to soldiers being assigned to their units. The purpose of this study was to evaluate CTIC's ability to make soldiers dentally deployable before joining their new units at Fort Hood, Texas.

MATERIALS AND METHODS

A retrospective review of the CTIC daily sign-in logs for the period of January 1999 to May 2001 was used to identify DFC 3 soldiers. The data were analyzed to determine frequency of DFC 3 by rank, DFC after CTIC visits, distribution of treatment type needed to establish dental readiness, and to identify soldiers whose DFC 3 conditions were not treated. Additionally, for the 6 months between November 2000 and April 2001, all soldiers who remained a DFC 3 when released to their units were followed to assess how long it took for them to attain a DFC 1 or 2 status.

RESULTS

The retrospective review of the CTIC records identified 5,851 DFC 3 soldiers who in-processed to Fort Hood from January 1999 to May 2001. CTIC successfully converted 86.9% (N = 5,083) of the soldiers to DFC 1 or 2. Of a sample of 185 DFC 3 soldiers released to their units as a DFC 3, only 54% had converted to DFC 1 or 2, with 60.5 days being the mean days to convert.

CONCLUSIONS

Trainees have large demands for dental care with minimal time to seek treatment during Initial Entry Training. A CTIC, or hybrid, can provide the necessary emergent dental care to remove soldiers from DFC 3 prior to their being assigned to their first permanent duty station.

Identifying clinical supply requirements for Marine Corps dental capability

The Naval Health Research Center developed and used a systematic process to review Marine Corps dental supply requirements. The approach (1) identified the dental procedures required to treat patients with dental conditions and (2) determined the consumable supplies and equipment needed to complete each procedure. By establishing the clinical requirement for each item pushed forward, the Naval Health Research Center model significantly reduced weight, cubic volume, and cost while enhancing far-forward dental capability. This effort produced a database that clarifies the relationship among dental conditions, dental procedures, consumables, and equipment when conducting authorized dental allowance list reviews, determining training requirements, and configuring supplies for future deployments.

Military and VA general dentistry training: a national resource

In 1999, HRSA contracted with the UCLA School of Dentistry to evaluate the postgraduate general dentistry (PDG) training programs. The purpose of this article is to compare the program characteristics of the PGD training programs sponsored by the Armed Services (military) and VA. Surveys mailed to sixty-six VA and forty-two military program directors in fall 2000 sought information regarding the infrastructure of the program, the program emphasis, resident preparation prior to entering the program, and a description of patients served and types of services provided. Of the eighty-one returned surveys (75 percent response rate), thirty were received from military program directors and fifty-one were received from VA program directors. AEGDs reported treating a higher proportion of children patients and GPRs more medically intensive, disadvantaged and HIV/AIDS patients. Over half of the directors reported increases in curriculum emphasis in implantology. The program directors reported a high level of inadequate preparation among incoming dental residents. Having a higher ratio of residents to total number of faculty predicted inadequate preparation (p=.022) although the model was weak. Although HRSA doesn't financially support federally sponsored programs, their goal of improved dental training to care for medically compromised individuals is facilitated through these programs, thus making military and VA general dentistry programs a national resource.

Put more "bite" into health promotion: a campaign to revitalize health promotion in the Army Dental Care System. Part I. The mouthguard, sealant, and nursing caries initiatives

During the course of 1998, the Army Dental Care System launched "Put More 'Bite' into Health Promotion," a campaign to revitalize health promotion in the Army Dental Care System. In this paper, we discuss the content, rationale, and evidence base for three of five health promotion initiatives that are part of the campaign: mouthguard fabrication and counseling, sealant placement and education, and nursing caries education.

Dental health promotion and preventive dentistry practices of U.S. Army dentists

In May 1997, all Army dentists assigned full-time to clinical duties (1,100) were sent a mail survey that queried how often they deliver dental health promotion and preventive dentistry services and the type and source of their patient educational materials. By August, 606 dentists had responded. Simple frequencies were generated using SPSS. Results show that tobacco, oral hygiene, and periodontal counseling and oral cancer and blood pressure screening are delivered frequently, whereas nursing caries, mouthguard, sealant, and nutrition services are delivered infrequently. Army dentists relied almost exclusively on oral presentations to deliver health promotion messages. Few used more than one source for health promotion materials. These results suggest that the delivery of dental health promotion and preventive dentistry services in the Army is suboptimal. A campaign to heighten provider awareness of the importance of delivering these services should be launched. The campaign should also teach providers how to make their health promotion efforts maximally effective through the application of proven health marketing techniques.

Endodontics and dental readiness

The primary mission of the Dental Corps--maintaining the dental health of our soldiers at an optimum level to ensure their readiness to deploy and fight--is more important than ever in today's downsized, high-operational-tempo Army. A review of the literature indicates that 20 to 25% of all soldiers will report on dental sick call during a 1-year deployment, and approximately half will require endodontic intervention. This could cost a division more than 18,000 man-days of combat effectiveness in a theater of battle, an unacceptable loss. Approximately three-fourths of these sick call visits could be prevented if selected conditions were identified and treated before deployment. Endodontic conditions, which result in the majority of dental sick call complaints, should be given priority for treatment in garrison, and the identified soldier should be placed in dental fitness class 3 until the tooth is definitively treated.

The implications of protocol-based care on dental services in the military

Downsizing, limited resources, and increasing costs provide challenges to the military health system. Variations in the diagnosis and treatment of dental disease add to the demands on the delivery system to provide access and ensure quality for uniformed personnel. Evidence-based dentistry is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. An evidence-based practice combines individual clinical expertise with the best external evidence available from systematic review of research findings. It provides a scientific basis for patient care, planning and implementation of health services, and development of health policy. Practice guidelines formulated on scientific evidence can reduce variations in the diagnosis and treatment of various dental conditions. A risk assessment protocol for treating dental caries can reduce operative dental treatment recommended at the initial examination and decrease the need for restorative care during a military career.

The prevalence and treatment of dental caries among Israeli permanent force military personnel

A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education.

Senior executive behaviors for the Army Dental Care System of the 21st century

Challenges will most likely confront the Army Dental Care System as it moves into the next century. Like any other learning organization, the Army dental care system must develop a continuous stream of dynamic leaders to direct its evolution if it wants to survive. Using the Delphi method, the investigators surveyed senior dental leaders to determine the attitudes and behaviors believed to be required to perform successfully as commanders, residency directors, and senior staff officers. The essential executive behaviors appear to be consistent: be honest, act with integrity, be accountable for your actions, be dedicated to mission accomplishment, and perform your duty with care and compassion. Relying solely on ratings assigned to the behaviors, discriminant function analyses could predict proper group membership with an accuracy of 79.4%. When demographic information was included, prediction accuracy improved to 96.7%.

The establishment of the Croatian Dental Crops: the front-line experience of a dentist volunteer

The establishment of the first dental office of the Croatian Dental Corps (CDC) in the city of Zadar represented at the same time the beginning of the CDC. This article describes the front-line experience of a dentist who volunteered to provide basic medical help, which eventually laid the groundwork for providing general dental care and establishing the first CDC dental office. The office was opened on December 16, 1991, and provided general dental care except prosthetics. Although faced with numerous problems and extremely difficult conditions, the office staff completed 1,913 initial and 1,157 control checkups and performed 4,002 services by treating 12 to 16 patients per day. The main causes for emergencies were caries (59%) and endodontic complications (28%). This variety of services in the proximity of the front line is considered extensive even for advanced medical corps of modern armies.

Efficiency in Israel Defence Forces Dental Labs: assessing the need for privatizing publicly provided services

In the last 10 to 15 years, privatization has been used as a policy instrument to reduce the involvement of the public sector in the provision of a variety of services. The purpose of this paper is to discuss models of privatization in the dental technician market and to report on the findings of an analysis of the functioning and efficiency of such services within the framework of the Israel Defence Forces (IDF). We also develop a method for assessing the quality and efficiency with which such services are produced and assess the need for privatization of the service. Currently, the IDF employs a mixed model of privatization whereby some dental technician services are produced in-house and others are contracted out to the civilian private market. A comparative quantitative analysis of the efficiency, quality, and cost of services indicates that the civilian labs are able to produce prosthetic services at a lower cost per unit of output and at a higher level of quality than are the IDF labs. The highly competitive nature of the industry as well as the relative ease with which the IDF could monitor the quality of service further supports the case for privatization of the entire service. The analysis and method described in this paper can serve as a paradigm for evaluating dental technician services in a variety of settings.

Dental emergency visits of Marine Corps personnel

The purpose of this study was to determine the incidence and distribution of dental emergencies in Marine Corps personnel. Dental emergencies were recorded from June 1989 to June 1990 for personnel who were in garrison, deployed, or participating in field exercises. A standardized data-collection form was distributed to participating Marine Corps dental clinics and to dental officers assigned to Marine Corps deployments or field exercises. A total of 890 dental emergency visits by Marines were recorded: 699 for Marines while in garrison, 136 while deployed, and 55 while participating in field exercises. Tooth/restoration fracture without pulpal involvement and pericoronitis were the most frequent diagnoses at emergency visits in each of the three environments. The mean incidence rate of dental emergencies per 1,000 person-years for deployed Marine Corps personnel was 57.2.