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.

Periodontal health status in a cohort of young US Navy personnel.

OBJECTIVES: Neither the prevalence of periodontal disease nor long-term trends in periodontal health among US military personnel has been well studied. The authors analyzed dental records to assess the prevalence and severity of periodontal disease, characterize changes in periodontal health, and determine the associations of age, race, gender, and tobacco use with periodontal status among US Navy personnel. METHODS: Dental records from 1,107 personnel who entered military service in 1997 were gathered from eight US Navy dental treatment facilities. Demographic information, tobacco use status, and periodontal health status, as reflected by the Periodontal Screening and Recording (PSR) information recorded at each required dental examination during the 4-year observational period (1997 to 2001), were collected. To improve sensitivity in measuring the extent of periodontal disease, the standard five-point PSR scale was reexpressed as a "PSR grade." RESULTS: Over 98 percent of Navy recruits exhibited some level of periodontal disease at initial examination. Most (76 percent) exhibited gingivitis of varying severity. Over a mean observational period of 3.4 years, 91 percent of subjects received at least one oral prophylaxis, and over 60 percent received two to four prophylaxes. Subjects with severe periodontal conditions received as many as 22 appointments for prophylaxis or periodontal therapy. From initial to final examination, periodontal status improved for 29.2 percent of subjects, deteriorated for 31.3 percent, and remained unchanged for 39.5 percent. Subjects presenting initially with healthy periodontia, or gingivitis without evidence of periodontitis, tended to deteriorate or remain unchanged, while those exhibiting periodontitis tended to improve with periodontal therapy. Race (non-White) and greater age at entry were significantly associated with increased risk for poorer periodontal health at both initial and final examination. CONCLUSIONS: Although a needs-based dental care model appears effective in managing periodontal disease among those receiving active therapy, patients who receive sporadic care may deteriorate over time. To maintain periodontal health in this population, appropriate preventive and periodontal therapies should be provided soon after entry and repeated at intervals specific to individual patient need.

Dental sealant longevity in a cohort of young U.S. naval personnel.

BACKGROUND: The U.S. Navy emphasizes caries prevention and encourages the placement of dental sealants on the caries-susceptible teeth of patients at risk of developing caries. The authors analyzed dental records to assess the longevity of dental sealants placed in naval personnel. METHODS: A cluster sample of dental records from 1,123 personnel who entered naval service in 1997 was drawn from eight Navy dental treatment facilities. The authors determined the number of sealants provided, the number of sealants that failed over the observation period (1997-2001), the dates of sealant failure and the longevity of sealants placed during and after recruit training. RESULTS: A total of 319 personnel received sealants during their first two years of service. The authors evaluated 1,467 sealed teeth. They followed the sealants for an average of 35 months. They noted 179 sealant failures in 102 subjects; 69 previously sealed teeth required sealant replacement, and 110 sealed teeth required restoration of the occlusal surface. Among those sealants that failed, the mean length of time from placement to failure was 26 months. Sealant failure rates were significantly higher among subjects at moderate risk or high risk of developing caries than among subjects at low risk. CONCLUSIONS: After an average of 35 months, 87.8 percent of the sealants placed in this population were retained and functional. Subjects who were at moderate or high risk of developing caries demonstrated significantly higher sealant failure rates than those at low risk of developing caries. CLINICAL IMPLICATIONS: Dental sealants can be retained successfully in adults. They should be considered a viable treatment alternative for adult patients who are susceptible to caries; however, patients at elevated risk of developing caries may require more frequent re-evaluation and maintenance to achieve maximum benefit.