Dental Disease Nonbattle Injury Rates of Deployed NATO Militaries in the Middle East Region: A Scoping Review.

INTRODUCTION: The occurrence of dental emergencies, now termed as dental disease nonbattle injuries (D-DNBIs), has long been an impacting factor on militaries' operational effectiveness. Owing to D-DNBIs contributing to low morale, the removal of personnel from duty, causing logistical hardships, and requiring deployable dental teams to operate in theater, there remains a significant benefit in the reduction in the occurrence of D-DNBIs. No study to date has reviewed D-DNBI rates specific to a modern military, and insight into whether militaries are seeing improvements in their dental preparedness remains to be gained. MATERIALS AND METHODS: A scoping review was conducted in accordance with the guidelines set out by Joanna Briggs Institute. Databases searched included SCOPUS, PubMed, OVID, and DOSS. Six hundred and one articles were initially screened, and six articles were included in the final review. RESULTS: A D-DNBI rate of 172 per 1,000 members per year was reported across the coalition, with the U.S., UK, and French militaries reporting on their dental experience. Both the French data and one UK study reported significantly higher D-DNBIs than their U.S. counterparts, who described 124 D-DNBIs per 1,000 members per year. A significant proportion of these D-DNBIs were reported to be "preventable," which raises questions on the efficacy of garrison healthcare services. Dental disease nonbattle injury rates appear to be largely consistent with what was first reported decades ago, and there remains ongoing and significant value in expeditionary dental services providing supportive healthcare for any deployed military personnel. CONCLUSION: Rates of D-DNBIs appear to be stable with what was historically reported when an international coalition is considered, with national variation. There remains a significant number of D- DNBIs which require dental treatment within the operational theater, and further efficiencies can be gained from predeployment treatment of "preventable" D-DNBIs.

Parental reference photos do not always improve the accuracy of forensic age progressions.

During long-term missing children cases, forensic artists construct age-progressions to estimate the child's current appearance. It is commonly believed that incorporating information about the child's biological relatives is critical in accurately estimating the child's current appearance. However, some evidence suggests that predicting appearance based on inheritance of features may be error prone. The present studies examine whether age-progressions constructed with the aid of a biological reference photos led to better recognition than those constructed without a biological reference. We also investigated whether there would be any variation depending on the age-range of the age-progressions. Eight professional forensic artists created age-progressions based upon photographs provided by each of our eight targets. Half of their age progressions with the aid of parental reference photos and half without parental reference photos. Furthermore, half were age-progressed across a longer age-range (5-20 years) and half covered a shorter age-range (12-20 years). In Experiment 1 similarity scores were higher over shorter age-ranges. Further, across longer age-ranges age-progressions created with the aid of a parental reference were lower than those without a reference. In Experiment 2 recognition performance was higher across shorter age-ranges. Additionally, across longer age-ranges age-progressions created with the aid of a parental reference were recognized worse than those without a reference. These results suggest that in long-term missing person cases, forensic artists may benefit from not relying on biological references. Finally, consistent with previous research (e.g. Lampinen et al., 2012) age-progressions provided no benefit over using outdated photographs.

Patients' views on dentists' ability to manage medical crises - results of focus group research.

BACKGROUND: Australia faces an ageing population which is more medically complicated than in years past, and it is important that we meet public expectations of management of medical emergencies in the dental clinic. No research before has examined in depth the public perception of dentists' medical emergency management. AIM: To qualitatively assess the publics' perception of medical emergencies in dentistry and their expectations of medical emergency management by dentists. METHODS: Twelve members of the public associated with a university clinic participated in two focus groups of six persons, where semi-structured discussions were carried out, audio recorded and transcribed, and subsequently underwent comprehensive thematic analysis. RESULTS: Key findings included a high expectation of dentists' general medical knowledge, as well as potential concern regarding a lack of routine medical assessment prior to undertaking dental treatment. CONCLUSIONS: Participants expected dentists to be highly proficient at managing medical crises and support the concept of medical emergency management certification for dentists.

Oral Midazolam Sedation For Uncooperative Children In Outpatient Paedodontics: Time For Reappraisal.

Sedation is frequently desired to facilitate dental procedures in uncooperative paediatric patients. Oromucosal Midazolam sedation is a popular choice among paediatric dentists world wide due to its many advantages such as ease of administration, good efficacy, presence of reversal agents and a wide margin of safety. On the other hand, many investigators have reported that midazolam sedation may not be successful for carrying out all types of dental procedures. This may be attributed to diverse nature of various treatment plans coupled with the extent of behavioural changes in the child and operator's experience. Due to the heterogeneity involved in treatment of paediatric dental procedures, the specific indications for oral midazolam use that ensure its success rate, probably need to be defined. This may enable the clinicians to have a convenient and quicker option for managing the cases rather than facing sedation failure or at times, ending up giving general anaesthetics. This article therefore brings forth the possible causes of midazolam sedation failure and proposes a 'case selection criterion'.

Analysis of oxygen saturations recorded during dental intravenous sedations: a retrospective quality assurance of 3500 cases.

The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels (≥ 94%) be consistently maintained by a single operator/sedationist? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification (I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia.

The Australian experience in dental classification.

The Australian Defence Health Service uses a disease-risk management strategy to achieve two goals: first, to identify Australian Defence Force (ADF) members who are at high risk of developing an adverse health event, and second, to deliver intervention strategies efficiently so that maximum benefits for health within the ADF are achieved with the least cost. The present dental classification system utilized by the ADF, while an excellent dental triage tool, has been found not to be predictive of an ADF member having an adverse dental event in the following 12-month period. Clearly, there is a need for further research to establish a predictive risk-based dental classification system. This risk assessment must be sensitive enough to accurately estimate the probability that an ADF member will experience dental pain, dysfunction, or other adverse dental events within a forthcoming period, typically 12 months. Furthermore, there needs to be better epidemiological data collected in the field to assist in the research.