John W. Simecek

Operational Cost Analysis of Dental Emergencies for Deployed U.S. Army Personnel During Operation Iraqi Freedom

The documentation of dental emergency (DE) rates in past global conflicts has been well established; however, little is known about wartime DE costs on the battlefield. Using DEs as an example for decreased combat effectiveness, this article analyzes the cost of treating DEs in theater, both in terms of fixed and variable costs, and also highlighted the difficulties that military units experience when faced with degradation of combat manpower because of DEs. The study found that Dental-Disease and Non-Battle Injury cost the U.S. Army a total of

The Rate of Dental Emergencies in French Armed Forces Deployed to Afghanistan

21.4M between July 1, 2009 and June 30, 2010, and

Estimation of Nonpreventable Dental Emergencies in U.S. Marine Corps Personnel

21.9M between July 1, 2010 and June 30, 2011. The results also revealed that approximately 32% of DE required follow-up treatment over the 2-year period, which increased the costs associated with a DE over time. Understanding the etiology and cost of DE cases, military dental practitioners will be better equipped to provide oral health instructions and preventive measures before worldwide deployments.

An Evaluation of U.S. Navy Dental Corps Classification Guidelines

OBJECTIVES The objectives of this study were as follows: (1) to quantify the dental emergency (DE) rate observed in French soldiers serving in Afghanistan and (2) to determine the percentage of DEs that could have been prevented had predeployment treatment been provided. METHODS All DEs presenting at the French medical-surgical hospital in Kabul, Afghanistan, were documented during the period of December 12, 2009 to February 6, 2010. Dental Officers documented (1) the etiology of each DE and (2) whether the DE could have been prevented with predeployment treatment. RESULTS An estimated rate of 293 DE per 1,000 personnel per year was observed, 78% of the 210 DEs were considered preventable, and 65% of patients required medical evacuation from their units. CONCLUSION Previous studies have observed high DE rates for French Army personnel. The intensity, danger, and geography of the mission in Afghanistan exacerbate the negative operational impact of dental pathologies.

Oral–Maxillofacial Injury Surveillance of U.S. Military Personnel in Iraq and Afghanistan, 2001 to 2014

Previous studies of military personnel have reported that 26% to 75% of dental emergencies cannot be prevented. The aims of this study were (1) to estimate the percentage of dental emergencies for which causative conditions were not indicated for urgent treatment on the previous annual dental examination (nonpreventable dental emergency) and (2) to estimate the rate of dental emergencies that can be expected if all urgent treatment is completed. This retrospective cohort study of Marine Corps recruits revealed that 58.4% to 70.3% of conditions resulting in dental emergencies were nonpreventable. Therefore, the estimated range of dental emergencies that can be expected if all urgent treatment indicated on the previous dental examination is completed is 77 to 92 dental emergencies per 1,000 personnel per year. The rate of nonpreventable dental emergencies should be considered when staffing for level I care.

Longitudinal Analysis of CAD/CAM Restoration Incorporation Rates into Navy Dentistry

OBJECTIVES The aims of this research were to evaluate the effectiveness of two different sets of dental classification guidelines to differentiate dental emergency (DE) rates between deployable and nondeployable personnel. METHODS A retrospective study of the dental records of two cohorts of Marine Corps recruits examined and treated using different classification guidelines was completed. RESULTS Both classification systems showed significant differences between DE rates of nondeployable and deployable personnel. No statistical difference was observed when comparing the adjusted HRs of the two cohorts. CONCLUSIONS Results of this study suggest that both guidelines are able to distinguish between deployable and nondeployable personnel and give reasonable assurance that class 1 and 2 patients will not experience a DE for a 6-month period. Incorporating factors such as caries risk, number of missing and filled teeth, and number of third molars may improve the ability of the dental classification systems in predicting DE.

Medical Evacuation of French Forces for Dental Emergencies: Operation Serval

BACKGROUND Cranial and oral-maxillofacial injuries accounted for 33% of military visits to in-theater (Level III) military treatment facilities for battle injuries during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Even after years of conflict, the size and scope of oral-maxillofacial injuries in military armed conflict is still not fully understood. This study reports U.S. Department of Defense (DoD) rates of oral-maxillofacial injuries that can be used for further surveillance and research. METHODS The populations studied were military personnel deployed to Afghanistan in OEF or Iraq in OIF and Operation New Dawn (OND), who sought care at a Level III military treatment facility for one or more oral-maxillofacial injuries. Injuries were identified in the DoD Trauma Registry (DoDTR) using diagnosis codes associated with oral-maxillofacial battle and nonbattle injuries. All oral-maxillofacial injuries incurred from October 19, 2001, to June 30, 2014, were included. The Defense Manpower Data Center provided DoD troop strength numbers to serve as the study denominators. RESULTS Battle injuries accounted for 80% of oral-maxillofacial injuries in OEF. There were 2,504 oral-maxillofacial injuries in OEF. The Army accounted for 1,820 (72.7%), the Marines 535 (21.3%), the Air Force 75 (3.0%), and the Navy 74 (3.0%). The oral-maxillofacial injury rates in OEF for the Army ranged from 1.10 to 4.90/1,000 person years (PY), for the Marines from 0.57 to 9.39/1,000 PY, for the Navy from 0 to 3.29/1,000 PY, and for the Air Force from 0 to 3.38/1,000 PY. The Army tended to have the highest incidence of all services in the early and latter part of the conflict, whereas Marines tended to have the highest incidence in the middle years. The Marines, Army, and Navy all had their individual highest incidences in 2009, the first year of the 2009 to 2011 OEF troop surge. Battle injuries accounted for 75% of oral-maxillofacial injuries in OIF/OND. There were 3,676 oral-maxillofacial injuries in OIF/OND. The Army accounted for 2,798 (76.1%), the Marines 731 (19.9%), the Navy 91 (2.5%), and the Air Force 56 (1.5%). The injury rates in OIF/OND for the Army ranged from 0.66 to 8.69/1,000 PY, for the Marines from 0.88 to 42.7/1,000 PY, for the Navy from 0.35 to 19.16/1,000 PY, and for the Air Force from 0.24 to 1.13/1,000 PY. In OIF/OND, the Marines had the highest overall oral-maxillofacial injury rate (42.70/1,000 PY) in 2003. The other services had their individual peak incidences in either 2003 or 2004. DISCUSSION/IMPACT/RECOMMENDATIONS This is the first study, which quantified the incidence of oral-maxillofacial injury in theaters of conflict over prolonged periods. The Army has the highest number of injuries. The Marines had the highest incidences during the initial stages of OIF and the OEF troop surge. Intensity of the conflict could account for the upswing in rates. These increases in injury rates highlight the need for additional health care personnel to be deployed near the battlefield to treat these injuries.

Risk of Dental Disease Non-Battle Injuries and Severity of Dental Disease in Deployed U.S. Army Personnel

INTRODUCTION Computer-aided design/computer-aided manufacturing (CAD/CAM) has gained increasing popularity since the first commercially viable dental system was introduced in the mid-1980s. Digitally milled dental restorations can be fabricated chairside in the course of one dental appointment, reducing time, cost, and manpower when compared with traditional laboratory-fabricated analog restorations. Clinical performance, physical properties, and esthetics of digital restorations have been shown to be comparable to traditional analog restorations. The Navy has incorporated CAD/CAM systems into dental clinics on multiple platforms to include ships. The efficiency of this technology has the potential to positively impact dental health and mission readiness. The objective of the present study was to evaluate placement rates of CAD/CAM restorations by Navy dental providers. MATERIALS AND METHODS Placement rates of CAD/CAM restorations from October 2011 to June 2017 (Department of Defense created codes specific to CAD/CAM restorations in 2011) and of laboratory-fabricated analog restorations from January 2008 to June 2017 were queried from the Dental Common Access System (DENCAS) and Corporate Dental Access system (CDA) and evaluated. Scatterplots for each dental restoration category were generated using monthly production data and overlaid with simple linear regression lines and 95% confidence intervals. Regression analysis was performed to determine whether changes in the monthly percentages of placements before and after CAD/CAM were increasing or decreasing and to determine whether the monthly percent change from before CAD/CAM implementation and after CAD/CAM implementation was significantly different from one another. RESULTS A total of 20,512 CAD/CAM restorations were placed by Navy providers over the 68-month period. A year-over-year increase in digitally fabricated restorations was observed. As a percentage of total indirect restorations, CAD/CAM units surged from 13.8% in 2012 to 38.1% in 2017. All ceramic restorations fabricated by the classical analog method also increased significantly through the period. Traditional analog porcelain fused to metal (PFM) restorations and large amalgam restorations, which frequently serve a similar clinical purpose as indirect or direct full or partial tooth coverage restorations, both decreased significantly after CAD/CAM productivity tracking was initiated. CONCLUSIONS Implementation of CAD/CAM digital restorations has led to a significant decline in specific traditional analog procedures since productivity tracking of CAD/CAM was initiated in 2011. Navy dentistry has embraced CAD/CAM as an efficient means to prepare sailors and marines for deployments, improve operational dental readiness, and potentially decrease dental emergencies by reducing the need for provisional restorations. The trend toward increased utilization of digital dentistry is expected to continue for the following reasons: (1) incorporation of CAD/CAM technology into dental school curricula, (2) advancement of CAD/CAM systems equipped with fast-evolving user interfaces, (3) increased accessibility to CAD/CAM technology in Navy clinics, and (4) training of a greater proportion of dentists in digital CAD/CAM technology. Future studies should investigate the survival rate of CAD/CAM restorations placed within military settings, cost, and manpower of maintaining CAD/CAM units, and impact on military dental laboratories associated with increased CAD/CAM usage.

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

OBJECTIVES The objectives of this study were to (1) quantify the number of intratheater dental Medical evacuations (MEDEVACs) required for French Soldiers in Mali during Operation Serval and (2) determine a Soldiers time away from their unit because of MEDEVAC, dental treatment, and return to unit. METHODS Data concerning MEDEVACs occurring during Operation Serval were recorded by the Patient Evacuation Coordination Center. MEDEVACs resulting from oral/facial/dental conditions were evaluated for the period from February 15, 2013 to May 15, 2013. RESULTS Fifty-four (15.7%) of the 338 MEDEVACs recorded were required to treat dental emergencies. Dental emergencies accounted for 54 (23.9%) of nonbattle injury MEDEVACs. Soldiers evacuated for dental problems were unavailable to their units an average of 10.5 days. CONCLUSIONS French military personnel often require MEDEVAC to treat dental problems occurring in the theater of operation. Dental casualties requiring MEDEVAC are absent from their units for almost 2 weeks, which could drastically decrease their operational capacity and ability to complete their mission. Predeployment dental readiness and the presence of a dental surgeon in close proximity to deployed forces may reduce the number of MEDEVACs required and reduce the time away from the unit.

Waterline biofilm and the dental treatment facility: a review.

Dental Disease and Non-Battle Injuries (D-DNBI) continue to be a problem among U.S. Army active duty (AD), U.S. Army National Guard (ARNG), and U.S. Army Reserve (USAR) deployed soldiers to Operation Iraqi Freedom/Operation New Dawn in Iraq and Operation Enduring Freedom in Afghanistan. A previous study reported the annual rates to be 136 D-DNBI per 1,000 personnel for AD, 152 for ARNG, and 184 for USAR. The objectives of this study were to describe D-DNBI incidence and to determine risk factors for dental encounters and high severity diagnoses for deployed soldiers. The 78 diagnoses were classified into three categories based on severity. Poisson regression was used to compare D-DNBI rates and logistic regression was used to analyze the risk of high severity D-DNBI. In both campaigns, Reserve had a higher risk of D-DNBI than active duty. For Afghanistan, ARNG and USAR demonstrated over 50% increased risk of D-DNBI compared to AD. In Iraq, USAR had a 17% increased risk over AD. Females had a higher risk of D-DNBI (>50%) compared to males in both campaigns. High severity D-DNBI made up 2.77% of all diagnoses. Within Afghanistan, there was a 4.6% increased risk of high severity D-DNBI for each additional deployment month.