Odontología Militar en la Operación Balmis. Retos, actividades realizadas y lecciones aprendidas / Military Dentistry in Operation Balmis. Challenges, activities carried out and lessons learned

Revisión sistemática de las actividades relacionadas con la odontología militar española y su intervención directa o indirecta durante la pandemia por SARS-Cov-2. Se describen las actividades realizadas durante la fase de formación específica en la fase de formación técnica de los alféreces odontólogos a distancia. En este artículo se analizan los problemas afrontados en las consultas dentales, las necesidades de adiestramiento y los requerimientos logísticos que requieren los protocolos odontológicos de actuación en una emergencia sanitaria de estas características tanto durante la fase de pandemia como en la postpandemia

Systematic review of activities related to Spanish military dentistry, and its direct or indirect actuation during the SARS-Cov-2 pandemic. The activities carried out during the specific training phase in the technical remote training phase of cadet ensigns curriculum are described. This article analyzes the problems faced in dental consultations, training needs and the logistical requirements demanded by the dental protocols for action in a health emergency of these characteristics, both during the pandemic phase and in the post-pandemic phase

Avances en anestesia local y su utilidad en el ámbito de la odontología militar: mesilato de fentolamina / New advances in local anesthetics and their applications in military dentistry: phentolamine Mesylate

Objetivo: Describir el mecanismo de acción del mesilato de fentolamina (MF), que es un producto poco conocido en España, capaz de revertir el efecto de los anestésicos locales empleados en odontología, enumerar sus indicaciones y analizar su efectividad y seguridad. Fuentes de datos: se ha realizado una revisión bibliográfica en las principales bases de datos médicas así como en buscadores genéricos. Selección de estudios: Se ha seleccionado los estudios clínicos, llevados a cabo desde su aprobación como medicamento de uso en el campo odontológico, que han sido realizados en los países donde se comercializa con la misma formulación que en España. Recopilación de datos: Se han obtenido datos sobre el tiempo medio de reducción del efecto anestésico y sobre la incidencia de efectos adversos. Síntesis de datos: Todos los estudios muestran una eficacia y presencia de reacciones adversas similares, en relación con la administración del MF y de un placebo, independientemente de la forma en que se ha llevado el estudio. Discusión: El uso del MF en la actuación clínica diaria, debe ser una decisión del profesional basada en la evidencia científica y en el coste-beneficio de su administración, debiendo seleccionar que pacientes son susceptibles de su administración. Conclusiones: El MF es un medicamento eficaz y seguro en la reducción del efecto anestésico y con indicaciones tanto en el ámbito de la odontología civil como militar

Objective: Describing the mechanism of action of the Phentolamine Mesylate (PM), which is not a so well known product in Spain, capable of reversing the effect of local anesthetics used in dentistry, highlighting its indications and analizing its effectiveness and safety. Data sources: A literature review has been carried out in the main medical databases as well as in generic search engines. Selection of studies: Clinical studies have been selected, carried out since its approval as a medicine for use in the dental field, which have been tested in the countries where it is marketed with the same formula as in Spain. Data collection: Data was obtained on the average time of reduction of the anesthetic effect and on the incidence of adverse reactions. Data synthesis: All studies show an efficacy and presence of similar adverse reactions, related to the administration of PM and of a placebo, regardless of the way in which the study was conducted. Discussion: The use of the PM in the daily practice, should be a decision that must be taken by the professional based on the scientific evidence and the cost-benefit of its administration, having to select which patients are susceptible to its administration. Conclusions: PM is an effective and safe medicine in the reduction of the anesthetic effect and with indications both in the field of civil and as in military dentistry

Asistencia odontológica a bordo del Buque de Asalto Anfibio «Galicia» durante la operación de mantenimiento de la paz Atalanta 2015. Incidencias en la primera rotación / Dental aid on board the Amphibious Assault Ship «Galicia» during Atalanta peace keeping operation 2015. Incidence rate in first rotation

OBJETIVOS: Analizar y cuantificar las diferentes emergencias odontológicas que tuvieron lugar durante la primera rotación de la Operación de Mantenimiento de la Paz (OMP) ATALANTA 2015 a bordo del Buque de Asalto Anfibio (BAA) «Galicia». MATERIAL Y MÉTODO: Se realizó un estudio descriptivo longitudinal de incidencias acumuladas de las patologías y tratamiento realizados entre el 20 de abril de 2015 a 1 de julio del mismo año (73 días). RESULTADOS: La patología que mostraron más incidencias fue la caries con un 40% y la gingivitis 31,3% del total. Las restauraciones/obturaciones y las tartrectomías fueron los tratamientos más realizados con un 44% y 28% respectivamente. La patología se acumuló en un cuarto de la población (25,6%). Los pacientes que mostraron más incedencia (95,3%) fueron los destinados en el BAA «Galicia». CONCLUSIONES: Los resultados obtenidos vienen a confirmar que las emergencias bucodentales presentan una alta incidencia. La patología y la necesidad de asistencia se acumulan en un grupo poblacional que sería conveniente su identificación para diagnóstico y tratamiento en fases previas al despliegue. Se observó como la mejora en la oferta o el fácil acceso de los servicios odontológicos incrementó la demanda de asistencia. La caries y las enfermedades gingivales, son sin duda, las lesiones que requirieron más necesidad de asistencia. Estos resultados de confirmarse en próximos estudios, pueden ayudar a dirigir a que las políticas de «salud oral» y el «perfil del Oficial Odontólogo» se adapten mejor a las necesidades asistenciales de la población diana

OBJECTIVE: Analyze and quantify odontological emergencies onboard during first rotation in Peace Keeping Operation ATALANTA 2015 in the Amphibious Assault Ship «Galicia». MATERIAL AND METHOD: A longitudinal descriptive research of incidences and their treatments was carried out, from 20th April to 1st July 2015 (73 days). RESULTS: The most common pathology was caries with 40% and gingivitis 31,3% of the total. Restorations/Fillings and tartar removal were the most frequently carried out treatments during the study period with 44% and 28% respectively. A quarter of the population were affected by some ondontological pathology (25,6%). 95,3% of the patients were crew of the Amphibious Assault Ship «Galicia». CONCLUSIONS: Results confirm that odontological emergencies show a high incidence. The pathology and the need for assistance accumulate in a population group, that would be convenient identify them for diagnosis and treatment in previous deployment phases. It was observed that easy access to odontological services increased the demand of it. Caries and gingivitis disease, are undoubtedly, the injuries which required most of the need for assistance. If the data is confirmed the «oral health» policies and the profile of the Dental Officer must be adapted to improve the care of the target population

[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.

[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.

[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.

Deployment of a dental treatment facility during Operation Gritrock - lessons for future maritime contingency operations.

Following the largest outbreak of Ebola in history, Royal Fleet Auxiliary Argus deployed to Sierra Leone in October 2014 as part of the UK Armed Forces response to the Ebola crisis. Integral to the Primary Casualty Receiving Facility deployment was a dental capability, which was one of the busiest departments on board during the deployment. This paper describes the deployment and unique challenges of conducting dental treatment in an environment where there is an infectious disease epidemic.

The importance of, and the benefits derived from, forward dental peripatetic clinics in Afghanistan.

The majority of dental care for military personnel is carried out in clinics that would be familiar to all dental professionals. In times of conflict, however, dental care is often required to travel to those in need. Dental morbidity has a detrimental effect on a fighting force, both at the personal level and for maintaining combat efficiency. In Afghanistan, two main dental centres provided the majority of emergency care to coalition forces, but from March to September 2012, 23 peripatetic clinics also took place with 472 dental casualties treated. Assessment of these peripatetic clinics demonstrates both quantitative and qualitative benefits. Return travel to main base clinics takes between three to five days. If all personnel during this period had attended a main base and returned to their duty station in only three days, over 1,000 duty days would have been lost. This compares to the 32 days actually lost by attending peripatetic clinics instead and illustrates the considerable time that was saved. Additionally, time spent travelling in a hostile environment is also time at risk of attack. Forty-one anonymous comments about the clinics were left by personnel. All were positive and enthusiastic. The results of this review demonstrate that these clinics save considerable mission time, reduce risk to military personnel, and were greatly valued by those suffering dental problems.

Dental treatment on a German warship during a three-month deployment.

INTRODUCTION: Despite routine dental screenings and treatments before military deployments, dental emergencies may arise due to acute infections, trauma or failed restorations. The purpose of this study is to evaluate the dental service during a three-month deployment on a German warship. METHODS: A retrospective analysis of dental attendances and treatments in a German naval task group of three ships with an average total of 650 soldiers. Diagnosis, treatments performed, percentage of emergencies, routine procedures and numbers of appointments were recorded. RESULTS: Out of 650 soldiers, there were 71 patients (10.92%) with a mean age of 25.1 ±5 .3 years. Out of 136 treatments, 17.65% were for emergency treatment, which is equivalent to 3.69% of all servicemen of the task group. Combining the reasons for dental emergencies, 95.84% were caused by caries. CONCLUSIONS: The pre-screening of sailors before an overseas deployment is necessary to avoid severe dental treatments. Caries remains the main cause for dental emergencies, and medical doctors should be trained to treat caries lesions if a dentist is not on board.

The role of military dental capabilities in mass fatality situations.

Recent experience with the New Zealand Defence Force in supporting the national disaster victim identification operation following destructive earthquakes in Canterbury, New Zealand, highlights the important role military forensic odontology capabilities can provide in supporting a national disaster response. Military dental personnel are well-trained, practiced, and prepared to support short-notice contingencies and can provide important immediate response augmentation to Disaster Victim Identification teams following a multiple-fatality event. The role of military forensic odontology capabilities in multiple-fatality incidents is reviewed.

[Improvement of outpatient dental care in the military district].

The paper presents proposals for improving outpatient dental care in the military area. To improve all types of outpatient dental care it is encouraged to use mobile multi-purpose field dental system based on chassis KamAZ, versatile portable dental kit. The construction kit has a modular design that supports rapid deployment of the dental office. For its operation is designed dental kit, which includes modern dental materials, instruments and medicines. Equipping the army medical service data development will help to improve outpatient dental care in the Army.

USAF dental readiness classifications and caries-risk assessment.

Assurance of the overall health of all uniformed Department of Defense (DoD) personnel is the responsbility of the Military Health System. To ensure the accomplishment of that mission, the Office of the Assistant Secretary of Defense (Health Affairs) requires that all uniformed personnel be classified according to their wartime dental readiness status. The recording, collection, monitoring, and reporting of this metric enables the effective and efficient management of care of DoD military members. Especially in times of war, there are often occasions for care to be rendered to members of other military Services by USAF dental treatment providers. Therefore, it is vital that dental health classifications among the Services be standardized to minimize confusion and to ensure that appropriate, optimal dental treatment is rendered to all DoD military members. This article discusses how the USAF assesses dental readiness classification and caries risk of military members.

Dental support for U.S. Marines in Iraq.

This article describes the experiences of the author while assigned to a dental detachment in Iraq. The mission of the dental detachment was to provide emergency care and, when the situation allowed, essential nonemergency care as far forward as required to reduce the effect of dental disease and degradation of mission. The challenges of deploying a system of dental care presented several logistical problems. This article discusses some of the challenges and offers comments concerning the capture of dental emergency data in the deployed setting.

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.

Dental fitness classification in the Canadian forces.

The Canadian Forces Dental Services utilizes a dental classification system to identify those military members dentally fit for an overseas deployment where dental resources may be limited. Although the Canadian Forces Dental Services dental classification system is based on NATO standards, it differs slightly from the dental classification systems of other NATO country dental services. Data collected by dental teams on overseas deployments indicate a low rate of emergency dental visits by Canadian Forces members who were screened as dentally fit to deploy.

The impact of retained third molars on the deployed airman.

Dental emergencies can significantly affect the mission of the deployed unit. As many as 22% of all emergency department visits at a deployed Expeditionary Medical Support facility can be attributed to dental problems and many of these problems are caused by impacted third molar teeth. Currently, there is no reliable method of predicting when asymptomatic, partially erupted third molar teeth will become painful. Therefore, it is imperative that Air Force dental providers carefully consider the consequences of giving patients a clean bill of health when asymptomatic, partially erupted third molar teeth are present in the oral cavity. Recommendations for future study are presented.

Caries remineralization therapy: implications for dental readiness.

Caries remineralization therapy can effectively arrest or reverse the progression of incipient proximal caries lesions. Remineralization of tooth structure is accomplished via a series of topical fluoride applications over time using a combination of both in-office and at-home fluoride agents. Remineralization therapy should be considered a viable noninvasive alternative to restoration for all caries lesions that do not exhibit frank cavitation of the proximal enamel surface (i.e., all lesions in enamel, as well as most lesions in the outer dentin). Combining a conservative restorative approach with an aggressive caries remineralization program may provide substantial therapeutic benefit and significantly reduce both costs and long-term restorative need among military patient populations.

[Development of tooth implantation in the Central Stomatologic Polyclinic of Ministry of Defense of Ukraine].

The article presents information on stages of the development of teeth implantation in the central stomatologic polyclinic of Ministry of Defense of Ukraine. The authors showed obtained results after introduction of replanatation of teeth and implantation. Advantage of clinical use of implantation against traditional teeth prosthetics was shown.

Is a Dental Health Risk Assessment predictive of dental health?

A complete dental examination is the basis for identifying the dental readiness of Air Force Reserve Command members. Historically, these were done on an infrequent basis. Recently, an annual dental examination has been mandated for all military members. Current dental personnel manning and resources are not sufficient to accomplish this dramatic increase in dental examination workload. To help alleviate this demand, a Dental Health Risk Assessment questionnaire was developed and tested to see if it could accurately screen out a dental problem severe enough to make a member non-worldwide deployable (Dental Readiness Classification of 3). These members would be scheduled for a dental examination first. The questionnaire asked members to self-identify dental health problems. Their answers were compared with the findings from the military dental examination. Unfortunately, the results did not match the survey's expectation. Accurately predicting who needed to be scheduled for a comprehensive dental examination, based on how a member answered the survey questions, was not accomplished. It is hoped that further research and refinement may make a predictive Dental Health Risk Assessment possible.