The Impact of a Pandemic on a Military Oral and Maxillofacial Pathology Biopsy Service.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) and the resulting societal reaction presented new challenges to the medical community by limiting patient access to care in 2020 and 2021. The Navy Postgraduate Dental School (NPDS) oral and maxillofacial pathology biopsy service is dependent on in-office physician or dentist appointments and patient biopsies. The purpose of this study was to understand the regulatory and societal impacts of COVID-19 restrictions on biopsy service submissions by assessing NPDS biopsy submission quantities and disease distribution. MATERIALS AND METHODS: All NPDS oral and maxillofacial pathology biopsy submissions from calendar years 2015 to 2016 and 2019 to 2021 were evaluated, and patient demographics and biopsy diagnoses were recorded in a biopsy registry. Data collected included age, sex, biopsy site, and diagnosis. Data from 2015, 2016, and 2019 were defined as pre-COVID and 2020 and 2021 as COVID. Biopsy reports for each year were organized in quarters. Diagnoses were categorized as malignant, pre-malignant, or benign. Categorical and continuous data were evaluated and presented as counts with percentages and means or medians with standard deviations, respectively. Significant differences in proportions or means were assessed using chi-square analysis or Student t-test, respectively. Cases were aggregated by quarter and year and assessed for temporal trends using linear regression analysis. RESULTS: The study evaluated 9,351 biopsy submission reports. The annual pre-COVID count mean (± standard deviation) and yearly counts for 2020 and 2021 were 2,063 ± 33.3, 1,421, and 1,742, respectively. The mean (± standard deviation) percentage of diagnoses classified as malignant from pre-COVID, 2020, and 2021 were 2.46 ± 0.005%, 3.59%, and 3.04%, respectively. Case counts and representation as a percentage of all biopsy diagnoses for Human Papillomavirus (HPV)-associated squamous cell carcinoma increased significantly during COVID compared to pre-COVID years (P < .05). CONCLUSIONS: Overall, preventative COVID-19 health measures and protocols resulted in a reduction in biopsy submission frequency, particularly during the second quarter (April to June) of 2020. However, case counts for malignant biopsies remained consistent between pre-COVID and COVID time intervals, suggesting that the identification and analysis of cases requiring follow-on care were unaffected by COVID-19 protocols.

Causes of Oral-Maxillofacial Injury of U.S. Military Personnel in Iraq and Afghanistan, 2001-2014.

Background: Few studies have examined the causes or mechanisms of oral-maxillofacial (OMF) injury among deployed military populations. This study reports causes of OMF injuries to U.S. Department of Defense personnel deployed to Afghanistan in Operation Enduring Freedom (OEF) or to Iraq in Operation Iraqi Freedom (OIF) and Operation New Dawn (OND). This study provides follow-on analysis of a previous report of OMF injury rates among U.S. military personnel in Iraq and Afghanistan from 2001 to 2014. Methods: The populations studied were military personnel deployed to Afghanistan in OEF or Iraq in OIF and OND, who sought care at a level III military treatment facility for one or more OMF injuries. Injuries were identified in the Department of Defense Trauma Registry using diagnosis codes associated with OMF battle and non-battle injuries. Causes associated with these injuries were identified by evaluation of the data field "dominant injury mechanism." All OMF injuries incurred from October 19, 2001, to June 30, 2014, were included. Findings/Results: Approximately 89% of all OMF battle injuries in both OIF/OND and OEF were due to explosives or explosive devices. The three leading causes of OMF non-battle injuries for both OIF/OND and OEF were motor vehicle crashes/accidents (MVCs), falls, and "other blunt" trauma. MVCs as well as other blunt trauma accounted for a greater percentage of OMF non-battle injuries in OIF/OND than in OEF (p < 0.01). OMF non-battle injuries due to falls were more likely to occur in OEF (p = 0.05). Helicopter/plane crashes were responsible for a significantly higher percentage of OMF non-battle injuries in OEF compared with OIF/OND (p < 0.01). Discussion/Impact/Recommendations: Across both theaters of war, Iraq and Afghanistan, the main causes of OMF battle and non-battle injuries were consistent. Battle injuries were primarily due to explosives or explosive devices and the three main causes of non-battle injuries were MVCs, falls, and other blunt trauma. However, the distribution of causes differed by war theater. Future studies should focus on potential reasons for cause distribution disparities in MVCs and helicopter/plane crashes as they can only be partially explained by topography and infrastructure differences between Iraq and Afghanistan. Further surveillance is needed to understand the scope of OMF injuries in military-armed conflicts and operations.

Oral health status of older adults in Kentucky: results from the Kentucky Elder Oral Health Survey.

The purpose of the Kentucky Elder Oral Health Survey (KEOHS) was to assess the oral health status of Kentuckians 65 and older. The KEOHS consisted of a self-administered questionnaire and a clinical examination. Recruitment occurred from May 2002 through March 2005 of persons aged 65 and older (n = 1,386) whose functional ability was classified by residential setting. Independent elders living in their own homes were designated as "well-elders," those who lived in skilled nursing facilities and who were functionally dependent were designated as "nursing home elders," and those older adults who were considered frail were designated as "homebound elders." Significant associations were found between the functional ability of the elders and demographic characteristics. While elders who were homebound reported the highest rate of barriers to care, dental insurance, affordability, and transportation were consistently reported as barriers for all groups of elders. This study has established the baseline oral health status of older adults in Kentucky and the data show differences that exist for various community living situations.