The Rewarding Experience of Serving as a US Air Force Dentist.

Providing care to service members and veterans as an active duty United States Air Force (USAF) dentist is a unique and rewarding experience that can be quite different from the private sector. As a USAF officer, I balance military and dental responsibilities, which has taught me to be flexible and adaptive. Virtually every dentist in the dental corps (DC), unless they are a resident, holds some form of a leadership position, whether that be overseeing clinic operations, the laboratory, an infection control program, or so on. The USAF doesn't just build clinicians, it builds leaders.

Unique challenges in naval military dentistry.

Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver's head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines.

What are the possible barriers and benefits to the use of dental therapists within the UK Military Dental Service?

Introduction All dental service delivery organisations and their workforce need to adopt more efficient and effective delivery models including increased skill-mix.Aim The aim of this study was to investigate the possible barriers/benefits to the utilisation of dental therapists (DTs) in the UK Military Dental Service.Method An explanatory mixed-methods study of sequential design was conducted using purposive sampling of dentists and DTs in the Defence Military Service. Electronic questionnaires (25) were sent to dentists and DTs with an overall response rate of 80% (15/18 dentists and 6/7 DTs). Following analysis of the questionnaires, seven semi-structured interviews (four dentists, three DTs) were thematically analysed.Results All dentists and DTs agreed that DTs could play a positive role within the Defence Military Service, but the barriers and benefits of their use centred on the six main themes of: leadership, delegation, new ways of working, scope of practice, skill-mix and utilisation.Conclusions To address the barriers and maximise the benefits of using DTs, effective leadership at the organisational, dental centre and individual levels is required. This leadership is key to unlocking the benefits of improved teamwork, increased skill-mix and maximised use of all dental care professionals within the Defence Military Service.

Efectividad en reducción de unidades formadoras de colonias con soluciones desinfectantes en tina ultrasónica / Effectiveness in reducing colony forming units with disinfecting solutions in an ultrasonic vat

En la práctica clínica, los odontólogos se encuentran expuestos al riesgo de infecciones, que se transmiten a través de instrumentos contaminados con exudados. Instrumentos en contacto con el personal deben estar esterilizados o sometidos a un proceso de desinfección. Se realizó un estudio transversal-prospectivo a 30 pacientes, de los que se tomaron tres muestras con espejos estériles, pasando por fondo de saco, carrillos y lengua, después las muestras se desinfectaron, se realizó el hisopado de cada espejo y se incubó en agar tripticaseína-soya (TSA) 24 horas a 37 oC. Pasadas 24 horas se realizaron diluciones en tubos Eppendorf, y se sembraron en cajas de Petri con agar sangre, se incubaron por 48 horas a 37 oC; se contabilizaron las unidades formadoras de colonias (UFC) y registraron para su análisis. Al obtener los resultados se encontró que ID 213 tuvo mayor reducción con una media = 62.5 en comparación con Zeta 1 Ultra, media = 89.23, y control, media = 164.50, de igual manera se observó una diferencia en reducción de UFC/mL entre ID 213 con respecto a Zeta 1 Ultra con significancia de 0.012. Ambos desinfectantes resultaron efectivos, pero se estableció que ID 213 utilizando la tina ultrasónica resulta más efectivo en la reducción de UFC, que Zeta 1 Ultra (AU)

In clinical practice, dentists are exposed to the risk of infections, which are transmitted through instruments contaminated with exudates. Instruments in contact with personnel must be sterilized or subjected to a disinfection process. A cross-sectional-prospective study was carried out in 30 patients. From which three samples were taken with sterile mirrors, passing through cul-de-sac, cheeks and tongue, later the samples were disinfected with disinfectants, each mirror was swabbed and incubated in TSA 24 hours at 37 oC. After 24 hours, dilutions were made in Eppendorf tubes, and they were seeded in Petri dishes with blood agar, they were incubated 48 hours at 37 oC; CFUs were accounted for and recorded for analysis. When obtaining the results, it was found that ID 213 had a greater reduction with mean = 62.5 compared to Zeta 1 Ultra mean = 89.23 and control mean = 164.50, in the same way a difference in reduction of CFU/mL was observed between ID 213 with respect to Zeta 1 Ultra with significance of 0.012. Both disinfectants were effective but it was established that ID 213 using the ultrasonic tub is more effective in reducing CFU, than Zeta 1 Ultra (AU)

Dentistry and the British Army: 1661 to 1921.

Between 1661 and 1921, Britain witnessed significant changes in the prevalence of dental caries and its treatment. This period saw the formation of the standing British Army and its changing oral health needs. This paper seeks to identify these changes in the Army and its dental needs, and place them in the context of the changing disease prevalence and dental advances of the time. The rapidly changing military and oral health landscapes of the late nineteenth century and early twentieth century bring recognition of the Army's growing dental problems. It is not, however, without years of campaigning by members of the profession, huge dental morbidity rates on campaign and the outbreak of a global conflict that the War Office resource a solution. This culminates in 1921 with, for the first time in 260 years, the establishment of a professional Corps within the Army for the dental care of its soldiers; the Army Dental Corps is formed.

A Survey of US Air Force General Dentists Regarding Computer-aided Design/Computer-aided Manufacturing Usage.

AIM: The purpose of this study was to survey all United States Air Force (USAF) general dentists regarding their experience with computer-aided design/computer-aided manufacturing (CAD/CAM) while in a dental school. Dental school graduation year and location was compared to the type and amount of CAD/CAM training and clinical experience during dental school to better understand the differences and influence of this technology. MATERIALS AND METHODS: A survey consisting of six questions was sent through e-mail to 546 general dentists in the AF Dental Corps in 2018 of which 306 replied (56% response rate). RESULTS: Dentists who graduated in 2005 or earlier and between 2006 and 2009 stated they did not receive CAD/CAM training in dental school, while more respondents in the group of graduation years 2014-2017 stated that they did receive training. About 11% of the respondents who graduated in 2014-2017 completed 6-10 restorations and 9% completed 11 or more restorations compared to the other year groups. More respondents who graduated from a dental school in the southwest and southeast regions of the United States reported completing more restorations compared to other school regions. CONCLUSION: Computer-aided design/computer-aided manufacturing is now becoming a prevalent curriculum in US dental schools, both as a core requirement and an elective. Its training platforms varied from lectures and literature reviews to preclinical laboratory. CLINICAL SIGNIFICANCE: More respondents in the groups of graduation years 2014-2017 had completed more CAD/CAM restorations compared to other year groups; however, most of the respondents did not feel their training was sufficient enough to use CAD/CAM technology independently.

A Retrospective, Radiographic Outcomes Assessment of 1960 Initial Posterior Root Canal Treatments Performed by Endodontists and Dentists.

INTRODUCTION: The Air Force Dental Service has established evidence-based treatment standards for endodontics, including 3-dimensional filling of the canal system, cuspal coverage restoration of endodontically treated posterior teeth, and use of rubber dam. The purpose of this retrospective study was to determine the effect of these standards on outcomes of initial posterior root canal treatments (RCTs) completed by Air Force (AF) and civilian dentists with and without accredited postgraduate training. METHODS: Treatment and follow-up radiographs of AF members who had an initial posterior RCT completed in 2011 were evaluated. A survey of all radiographs was performed to determine the (1) RCT obturation quality, (2) healing of periapical pathosis, and (3) presence and quality of cuspal coverage restorations. RESULTS: A total of 2262 RCTs were examined, with 1960 RCTs meeting inclusion criteria for at least 1 evaluation category. For RCT obturation quality, 1810 RCTs were evaluated, and 96.0% were considered adequate. For cuspal coverage restorations, 1856 RCTs were evaluated, and of these 2.7% were inadequately restored. Healing of periapical pathosis was 91.5% and 85.7% for AF and referred civilian providers, respectively. Survivability was 94.4% for endodontists, 95.3% for AF general dentists with additional training, 87.9% for AF general dentists without additional training, and 78.4% for civilian general dentists. Overall, survivability was 94.1% for a follow-up period ranging up to 47 months, with a mean of 27 months. CONCLUSIONS: In this retrospective, radiographic analysis, evidence-based practices as followed in the Air Force Dental Service and accredited postgraduate training resulted in improved treatment outcomes.

Comparing human resource planning models in dentistry: A case study using Canadian Armed Forces dental clinics.

OBJECTIVES: To compare two methods of allocating general dentists to Canadian Armed Forces (CAF) dental detachments: a dentist-to-population ratio model and a needs-based model. METHODS: Data obtained from CAF sources were analysed to compare models. Times assigned to treatment plan procedures were used as a proxy for treatment needs. Full-time equivalents (FTEs) were used as an indicator for the number of dentists allocated to each detachment. FTE values were adjusted for military dentists to account for time spent on compulsory nonclinical duties. The paired-samples t test was used to assess differences between the models for all clinics (dental detachments) and by clinic size. RESULTS: The dentist-to-population ratio model for the CAF population (n=68 183) estimated an allocation of 83.25 FTE general dentists to CAF dental detachments. Based on a systematic sample of the CAF population (n=2226), the needs-based model estimated the requirement for 64.71 FTE general dentists. The average difference between models was 0.71 FTE (SE=0.273), which was statistically significant (P=0.015). In terms of differences by clinic size, differences were more pronounced in clinics serving more than 4000 CAF personnel (2.63 FTEs, SE=0.613, P=0.008). CONCLUSIONS: The findings reveal differences between estimation models of <1 FTE, with higher estimates produced from the dentist-to-population ratio model. A larger difference was found in clinics with larger populations. The perceived overestimation of dental human resource requirements suggests that changing to a needs-based model may result in cost savings.

[Dental health and the combat readiness].

Oral diseases are still amongst the most common human ailments in the western world and in Israel. Acute dental illness may cause intense pain, malaise, nutrition impairment, disturbance and loss of operative activities. The article reviews the literature from the last two decades regarding dental classification of military service candidates, incidence of acute dental conditions and emergency treatment needs in military population, and dental preparation programs for military recruits.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[Necrotizing ulcerative diseases in military population].

Necrotizing ulcerative diseases were prevalent in military personnel throughout history. Nowadays, its prevalence declined substantially in industrialized countries. Studies among immunocompromised patients suggest it is still a reason for concern among this population. We present two cases diagnosed and treated at our department. It seems that necrotizing ulcerative diseases are still a relevant entity in the Israeli Defense forces therefore it is of great importance to conduct proper diagnosis, treatment and follow up of the patients.

[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.