Impact of the COVID-19 pandemic on oral health care use in the United States through December 2021.

BACKGROUND: The purpose of this study was to assess the effects of the COVID-19 pandemic on oral health care provided from July 2020 through December 2021 using national claims data. METHODS: Deidentified quarterly claims from 2017 through 2021 were analyzed (2017-2019 provided prepandemic data). Data were sorted into multiple treatment categories. Analyses compared prepandemic with postpandemic procedure volumes and were stratified according to age groups (0-5 years, 6-18 years, 19-64 years, ≥ 65 years). RESULTS: For children aged 0 through 5 years, use of sealants and topical fluorides other than varnish were considerably lower in 2021, as were direct operative and palliative procedures from 2020 through 2021. Only use of silver diamine fluoride, prefabricated crowns, and oral surgery increased significantly (P < .05) in some quarters. For children aged 6 through 18 years, diagnostic, direct operative, periodontic, oral surgery, and palliative procedures were significantly lower in most of 2020 through 2021, and only prefabricated crowns and indirect operative procedures increased significantly in more than 3 quarters. For adults aged 19 through 64 years, diagnostic and preventive procedures were significantly lower in 3 quarters, and direct operative, gingival surgery, endodontic, and palliative procedures were significantly lower in most of 2020 through 2021. Only occlusal guards and scaling and root planing increased significantly in more than 3 quarters. For adults 65 years and older, direct operative, gingival and osseous surgery, and palliative procedures were significantly lower in more than 3 quarters; all other procedures increased significantly in more than 3 quarters. CONCLUSIONS: The pandemic was associated with changes in the provision of oral health care that persisted for more than 1 year. PRACTICAL IMPLICATIONS: Reductions in preventive procedure volumes across age groups younger than 65 years may have implications for longer-term effects of the pandemic.

Oral Health in America: Implications for dental practice.

BACKGROUND: Important, but insufficient, gains have been achieved in access to and delivery of oral health care since the 2000 US surgeon general's report on oral health in America. Access to care has increased for children and young adults, but considerable work remains to meet the oral health care needs of all people equitably. The National Institutes of Health report, Oral Health in America: Advances and Challenges, reviews the state of the US oral health care system, achievements made since 2000, and remaining challenges. In this article, the authors highlight key advances and continuing challenges regarding oral health status, access to care and the delivery system, integration of oral and systemic health, financing of oral health care, and the oral health workforce. RESULTS: Public insurance coverage has increased since 2000 but remains limited for many low-income, minority, and older adult populations. The oral health care workforce has expanded to include new dental specialties and allied professional models, increasing access to health promotion and preventive services. Practice gains made by women and Asian Americans have not extended to other minority demographic groups. Oral health integration models are improving access to and delivery of patient-centered care for some vulnerable populations. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Coordinated policies and additional resources are needed to further improve access to care, develop dental insurance programs that reduce out-of-pocket costs to lower-income adults, and improve the integration of oral and medical health care delivery targeting a common set of patient-centered outcomes. Dental care professionals need to fully participate in meaningful and system-wide change to meet the needs of the population equitably.

Association of food insecurity with early childhood caries.

OBJECTIVES: The aim of this study was to examine the association of food insecurity on the prevalence of dental caries in preschool children. METHODS: Eighty-two children, aged 12-71 months old, from the Marquette University School of Dentistry Community South Clinic and their caregivers participated in this cross-sectional study. Following informed consent, parents completed the validated six-item US Department of Agriculture food insecurity questionnaire and questions regarding demographic information and family structure. Upon clinical examination caries was recorded using the decayed, missing, filled teeth (dmft) index based on the International Caries Detection and Assessment System criteria. RESULTS: The correlation between dmft and food insecurity was found statistically significant (P = 0.002, R2 = 0.115), and children of higher food insecurity demonstrated higher levels of dental caries. Food insecurity was also positively correlated with parental age (P = 0.034), whereby higher levels of food insecurity were associated with the father being less than 25 years of age. Results from the questionnaire revealed that 58.5 percent of the families were fully secure, 11.0 percent had marginal, 24.4 percent had low, and 6.1 percent had very low food security. Results from clinical examination reported dmft 4.09 ± 4.38, dt 2.20 ± 2.83, and ft 1.83 ± 2.95. Most of the children (79.7 percent) were Hispanic, 53.1 percent were female and the median age of the sample was 48 months. CONCLUSIONS: Results of the present study suggest that preschool children with food insecurity have higher levels of dental caries.

Effect and acceptance of silver diamine fluoride treatment on dental caries in primary teeth.

OBJECTIVES: Silver diamine fluoride (SDF) treatment has been identified as a potential solution to address the dental public health issues of untreated dental caries and insufficient access to care. The current study assessed the effectiveness of 38 percent SDF in arresting active dental caries lesions and in reducing or preventing associated dental pain and infections in young, at-risk children. METHODS: We enrolled 32 children aged 2-5 years with 118 active caries lesions in primary teeth from a community dental clinic in Oregon. After baseline examinations, carious lesions were treated with 1-2 applications of 38 percent SDF. Children were re-evaluated at 3-week and 3-month recalls to assess color and consistency changes in lesions (soft/hard). Parents were interviewed regarding symptoms of pain or infection and were surveyed regarding subjective feelings about SDF. RESULTS: Of 102 lesions (16 excluded from analyses), 100 were found to be arrested at first recall and all at second recall. The duration of SDF application was not associated with arrest of decay (P = 0.68). No incidence of pain or infection of an SDF-treated tooth was recorded. Parental impression of ease of application, taste, and esthetics was favorable. CONCLUSIONS: Our results suggested SDF was effective in arresting active caries lesions in primary teeth in young children and was well accepted by parents. SDF offers an easy and highly efficient nonsurgical alternative treatment to traditional restorative dental treatment in young children, and it has great potential to aid the dental public health community to address dental caries in at-risk populations.

Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly onefourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.

Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.

Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A report of the American Dental Association and the American Academy of Pediatric Dentistry.

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. CONCLUSIONS AND PRACTICAL IMPLICATIONS: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.

Single and Cumulative Relations of Social Risk Factors with Children's Dental Health and Care-Utilization Within Regions of the United States.

OBJECTIVES: The purpose is to examine the relation of social risk factors, and the cumulative burden of social risk factors, on parent-reported dental health and dental care-seeking behavior. METHODS: National Survey of Children's Health data (2011-2012) were analyzed for US children by Title V Block Grant regions. Multivariate logistic regressions were estimated for ten social risk factors, as well as a cumulative risk index, to find any associations with poor condition of teeth, presence of dental caries, and no dental care visits. RESULTS: Almost all of the risk factors were significantly associated with poor condition of teeth and presence of dental caries for the US. Models associating no dental care visits suggested that low family income (OR 1.58), poor maternal mental health (OR 1.54), high school education or less (OR 1.34), and multi-racial/other race (OR 1.18) were significant factors for the US. Regional variation existed for those risk factors and their association with the outcomes, but income, education, and poor maternal mental health consistently played a significant role in adverse outcomes. The cumulative risk index was strongly related to poor oral health outcomes, with a weaker relationship to dental care utilization. CONCLUSIONS FOR PRACTICE: US children experiencing certain social risk factors, such as low family income, high school education or less, and poor maternal mental health, are likely to be at greater risk for poor dental health and low levels of dental-care seeking behavior. Children experiencing multiple social risks are at greater risk for poor oral outcomes than children who experience fewer social risks. An approach that involves the social determinants of health is needed to address these issues.

Children's utilization of the U.S. military dental insurance.

OBJECTIVES: The objectives of this study were to determine the dental utilization of children enrolled in a military dental insurance program and to assess if utilization differs by socioeconomic status. METHODS: Claims data for children enrolled in the Department of Defense TRICARE Dental Program for the period of February 1, 2010 through January 31, 2011 were used to identify children who had a dental visit during that benefit year. RESULTS: Of the 376,681 continuously enrolled children, 266,862 (71%) had at least one dental visit during the benefit year. 82.7% of children of officers had a dental visit, as compared to 66.4% of children from enlisted families. There was a difference in dental utilization based on the military rank of the sponsors (χ(2) = 8,939.39, df = 1, p < 0.0001). Children of officers were 2.5 times (95% confidence intervals = 2.44-2.61), and children of warrant officers were 1.6 times (95% confidence intervals = 1.51-1.74) more likely to have a dental visit than children from enlisted families. The results also show utilization trends within the enlisted and officer categories with higher utilization among more senior personnel. CONCLUSIONS: Socioeconomic status does play a role in dental care-seeking behavior of military families. Even when families voluntarily enroll in a program and there are no cost shares for services such as preventive services, there may be other barriers to accessing care that need to be addressed so that all groups can maximize their oral health.

Review of current U.S. Army dental emergency rates.

The purpose of this article was to review current dental emergency rates for U.S. Army personnel and to identify shortfalls in dental emergency research. The Department of Defense Dental Classification System is intended to identify military personnel at the greatest risk for dental emergencies, allowing military dental assets to prioritize dental treatment. Only two studies have been published on the emergency rates of U.S. Army Soldiers since 2000, both detailing emergency rates for Soldiers deployed to Bosnia. The Stabilization Force VII study identified that Soldiers experienced dental emergencies at a rate of 156 per 1000 per year, whereas the Stabilization Force VIII study found the rate of 170 per 1000 per year. No studies have been conducted for the Army during Operation Iraqi Freedom due to difficulty in capturing all dental treatment encounters. Researchers should attempt to standardize the nomenclature and definitions to aid in the comparability of future dental emergency rate studies.

Army dental officer retention.

OBJECTIVE: The objective of this article was to identify major factors associated with the retention of Army dentists. METHODS: Customized survey instruments were designed. The 2006 survey was e-mailed to all Army Dental Corps captains and majors and the 2007 survey to all lieutenant colonels and colonels. Responses were returned by e-mail, fax, or traditional mail. RESULTS: Response rates were 42% for the 2006 survey and 76% for the 2007 survey. More than one-half (53%) of junior officers responded as being highly unlikely or unlikely to remain on active duty, although the majority of senior officers reported being likely or very likely to remain in the Army until retirement. The results indicated that pay is a major driver for retention, because 72% of junior officers cited increases in bonuses as the first or second most important retention item. Sixty-nine percent of junior officers thought that a bonus of $30,000 to $40,000 per year would be influential in retention. Pay was important to senior officers, but quality of practice, quality of life, and less frequent moves were rated higher than pay. All respondents felt that both senior and local leaders were aware of the retention issues but only 41% of junior officers, compared with 75% of senior officers, felt that action was being taken to address the issues. CONCLUSIONS: Retention of Army Dental Corps officers is multifactorial in nature. Pay is a major retention factor, but retention initiatives need to be broader in scope.

Patient satisfaction with dental hygiene providers in US military clinics.

PURPOSE: Military service members receive their dental care from military dental clinics. The purposes of this study were to assess satisfaction and to identify predictors of patient satisfaction with the hygiene provider in military dental treatment facilities. METHODS: Standardized surveys were administered from 2000 through 2004 by the Tri-Service Center for Oral Health Studies. Dependent variables were overall satisfaction with today's visit and overall satisfaction with the clinic's ability to take care of your needs. Independent variables were grouped by environment of care, beliefs about the care, and demographic characteristics. Principal component factor analysis and hierarchical multiple linear regression were used to test the hypotheses. RESULTS: A total of 98 792 surveys, with no missing data, from a sample of 130 801, were analyzed. Patients treated by hygiene providers were highly satisfied with dental care, as the mean score for satisfaction with today's visit was 6.61, and overall satisfaction with the clinic was 6.44 on a 7-point bipolar adjective rating scale. Factor analysis revealed that beliefs about care (46.7%) and environment (26.8%) were the most important factors to satisfaction. Both regression models developed for patient satisfaction achieved statistical significance. Model one, overall satisfaction with today's visit, obtained R(2) =.311, with F (6, 98785) = 8923, p<.0001. Model two, overall satisfaction with the clinic, obtained R(2) =.284 with F (6, 98785) = 7848, p<.0001. CONCLUSIONS: This study demonstrated that beliefs about care are the most important factors associated with patient satisfaction with the hygiene provider. The interpersonal experience has a strong association with patients' assessment of care and thus, training providers about the relationship of satisfaction with the interpersonal experience can enhance overall satisfaction.

The development of a conceptual model for evaluating dental patient satisfaction.

The purpose of this study was to identify levels and predictors of patient satisfaction and develop a conceptual model for dental patient satisfaction in military treatment facilities. Respondents completed 658,443 surveys during 17 fiscal quarters, beginning with the fourth quarter of 2000. The final data set contained 309,261 surveys, with no missing data. Principal component factor analysis was used for data reduction and hierarchical multiple linear regression to assess the predictive effects of the dependent variables on the two independent variables: (1) overall satisfaction with today's visit and (2) overall satisfaction with the clinic. On a 7-point, bipolar adjective rating scale, patients' mean score was 6.53 regarding satisfaction with visit, suggesting that patients are highly satisfied. Patients' beliefs about care received and environment of care were the most important satisfaction attributes. These findings are useful in educating providers about the relationship of consumer satisfaction with the interpersonal experience.

Association of caries and tobacco risk with Dental Fitness Classification.

OBJECTIVE: Dental emergencies negatively affect the Army during combat. Dental readiness continues to be a primary mission of the Army Dental Care System and is an important part of mobilization. Dental Fitness Classification (DFC) is used to evaluate the oral health status and current treatment needs of soldiers. Caries and tobacco risk assessments were recently added to the annual examination of Army soldiers. The aim of this project was to determine whether any association existed between the DFC and caries and tobacco risk assessments of Army soldiers. METHODS: The study population consisted of 66,484 U.S. Army active duty soldiers. The data were obtained from an Army electronic database that maintains all patient visits. The following information was obtained for each soldier; rank, DFC, caries risk, and tobacco risk assessment. Summary statistics were computed and DFC was compared with caries risk, tobacco risk, and rank using the chi2 analysis and logistic regression model. RESULTS: High-caries risk soldiers were 15.6 times more likely to be a DFC 3 or 4 as compared to DFC 1 and 2 soldiers. DFC 3 or 4 soldiers were 1.43 times more likely to be tobacco users than DFC 1 or 2 soldiers. Logistic regression models showed that high-caries risk soldiers were at 13 times the odds of being a DFC 3 or DFC 4 as compared to DFC 1 or DFC 2. Soldiers who used tobacco products were also more likely to be in higher DFC classification compared to those that did not use any tobacco products. CONCLUSIONS: This study has shown clear associations between DFC categories and caries and tobacco risk wherein DFC 3 and 4 soldiers are at higher risk for future caries and of being tobacco users. This relationship warrants the inclusion of caries and tobacco risk in the overall dental assessment of soldiers.

First-term dental readiness.

Army recruits have high levels of dental disease, and traditionally the dental needs of soldiers have not been addressed until the soldiers arrive at their first permanent duty station. Today's expeditionary Army requires that soldiers be fully deployable. This article addresses an initiative (called First-Term Dental Readiness) aimed at providing dental care in the initial training of a soldier's career, implementation of pilot programs at Fort Sill and Fort Knox, and the lessons learned from those pilot programs.

Digital dental radiography needs assessment utilizing the Delphi process.

This article reports the results of a needs assessment using the Delphi process. The purpose of this study was to determine the architecture and equipment (radiographic and computer network) for establishing and supporting an enterprise's vast digital dental radiographic program. Two panels of subject matter experts identified the needs for a digital dental radiography system; one expert panel consisted of dentists while the other panel's members were information management/information technology (IM/IT) experts. Panelists rated digital dental radiography needs using descriptive statistics and a 7-point bipolar scale. Among dentists, the four most important needs were the capability to store images, image appearance, centralized image storage, and a dedicated back-up server; among IM/IT panelists, they were ensuring HIPAA compliance, use of a standard formatting procedure, excellent print quality, and use of encryption for data transmission. This study's findings are useful for any organization seeking to initiate or improve its own digital radiography program.

Army junior dental officer retention.

OBJECTIVES: The objectives of the survey were to quantify the extent of indebtedness of junior dental officers and to determine the impact of a loan repayment program on career decisions. METHODS: We designed a customized survey instrument because no preexisting, validated, survey instrument was available. A query was performed in the Medical Operations Data System to identify all captains (0-3) currently on active duty in the Army (N = 348). The survey sample included 64 junior officers with a 2000 date of rank to captain (0-3), of whom only 52 were in the Medical Command Outlook address book or the Army Knowledge Online white pages. The questionnaire was sent out to these targeted junior dental officers through their official e-mail accounts. Dentists assigned to Korea and to dental field units do not use the same e-mail system as the rest of the Dental Command; therefore, their addresses were not available. In an attempt to increase response rates, commanders were asked to emphasize the importance of responding to the questionnaire. RESULTS: From the sample population of 52 officers who were queried directly, 34 responses were received, for a response rate of 65%. However, commanders forwarded the survey to all Dental Command captains and 102 responses were received. The respondents represented 30% of the total Army inventory of captains; 92% of respondents reported that they had dental school loans, with 43% reporting loans in excess of dollar 50,000. The average dental school indebtedness was approximately dollar 60,700. More than 60% of all respondents reported that loan repayment could change their minds about remaining on active duty. Officers not included in the original sample rated the impact of loan repayment statistically higher than did officers in the original sample. CONCLUSIONS: The findings were that the majority of junior Army dental officers had significant student loans and many of these officers indicated that they would consider remaining on active duty if loan repayment or other monetary inducements were offered.

Class 3 dental treatment time.

OBJECTIVE: Dental emergencies take soldiers away from their assigned duties. The objective of this project was to determine the average clinical treatment time needed to correct nondeployable dental conditions using actual treatment times noted in an electronic scheduler. METHODS: The Fort Hood Class Three Intercept Clinic forwarded their daily treatment logs to the Dental Command for each week from November 1, 2002 through February 13, 2003. Clinical treatment times and types of services provided for dental fitness category (DFC) 3 conditions were tracked with the Corporate Dental Application scheduler. RESULTS: The project identified 398 DFC 3 soldiers who were scheduled to receive treatment at the Fort Hood Class Three Intercept Clinic between November 1, 2002 and February 13, 2003. Twenty-three of those soldiers did not receive treatment; therefore, the total sample size was 375. On average, it required 2.2 hours of clinical dental treatment time to make a DFC 3 soldier dentally deployable. CONCLUSIONS: The findings of this study suggest that treating DFC 3 conditions is time-intensive but most DFC 3 soldiers can be treated in approximately 2 hours in an efficient and properly staffed dental clinic. Without proper preventive education and maintenance, these soldiers may develop additional oral disease and may require repeated episodes of increasingly intensive dental treatment.

Staffing model for dental wellness and readiness.

Oral health is an integral part of general health. Previous research has shown that untreated oral conditions can result in increased rates of disease and nonbattle injury for deployed soldiers. The purpose of this study was to develop models for U.S. Army dental wellness and readiness using a multivariate regression analysis approach. Staffing levels and dental wellness and readiness rates were examined for the first three quarters of fiscal year 2002 at 40 Army installations. Full regression model equations were developed for percent dental wellness and readiness using location, time, dental provider types, and basic training installation as predictor variables. Both models were shown to be statistically significant, with wellness R2 = 0.37, F12,107 = 5.18, p < 0.001 and readiness R2 = 0.23, F12,107 = 2.65, p < 0.01. Further tests of specific predictor effects revealed that wellness was significantly associated with the specialties of general dentistry, hygienists, and oral surgery, and that readiness was significantly associated with region and the oral surgery specialty. Results may be useful for the U.S. Army to identify the best practices in an effort to optimize dental wellness and readiness.

Validity of using a panoramic radiograph for initial dental classification of Army recruits.

OBJECTIVE: The objective of this study was to examine the validity of classifying Initial Entry Training (IET) soldiers into dental fitness classification 2 or 3 based solely on examining panoramic radiographs. MATERIALS AND METHODS: The dental readiness classification, derived from a clinical screening examination versus a panoramic radiological examination, was compared for 1,050 Fort Sill Basic Training recruits during a 1-month period. The dentist who reviewed the panoramic radiograph and determined a dental classification was blinded to the earlier dental classification from the clinical examination. The Spearman's rank order correlation test was used to determine if a statistically significant correlation existed between classifications based on the clinical examination versus classification by review of the panoramic radiograph alone. RESULTS: The project identified that 18% (n = 186) and 23.7% (n = 249) of the sample population had at least one class 3 condition identified from the clinical screening examination and the panoramic radiograph review, respectively. Of the 186 dental fitness category 3 conditions identified from the routine dental screening, 81.7% (152) of them were also identified from the review of the panoramic radiograph. Spearman's rank order correlation test statistic was 0.633 for a p < 0.001, indicating a statistically significant correlation in the identification of IET soldiers with class 3 conditions using a screening examination with a review of the panoramic radiograph. CONCLUSIONS: The findings of this study suggest that panoramic radiograph review can identify IET soldiers with dental fitness category 3 conditions and implies that a policy change may be prudent to allow this type of initial classification.