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Oral Health Status and Treatment Needs of Navy and Marine Corps Reserve Components Andrew K. York, CAPT, DC, USN David L. Moss, LTC, USA, DC Susan W. Mongeau,

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Presentation on theme: "Oral Health Status and Treatment Needs of Navy and Marine Corps Reserve Components Andrew K. York, CAPT, DC, USN David L. Moss, LTC, USA, DC Susan W. Mongeau,"— Presentation transcript:

1 Oral Health Status and Treatment Needs of Navy and Marine Corps Reserve Components Andrew K. York, CAPT, DC, USN David L. Moss, LTC, USA, DC Susan W. Mongeau, Lt Col, USAF, DC Tri-Service Center for Oral Health Studies Uniformed Services University of the Health Sciences Bethesda, MD February 2003

2 Table of Contents Background2 Methods2-3 Study Sample3 Oral Health Status (DoD Dental Classification)4 Operative Treatment Needs5-7 Oral Surgery (extraction) Treatment Needs8-9 Endodontic Treatment Needs10-11 Prosthodontic Treatment Needs12-13 Periodontic Treatment Needs14-15 Treatment Needs Expressed as Dental Weighted Values16-20 Department of Defense Oral Health and Readiness Standards21-22 (Appendix A) 1

3 Background Prior to this study, the dental treatment need among Navy and Marine Corps Reserve Components was largely unknown. Anecdotal accounts from Operation Desert Storm (1991) reported poor dental health and large amounts of dental treatment need. In October 2001, the largest reserve component mobilization in a decade began with the onset of Operation Noble Eagle/Enduring Freedom. This presented a unique opportunity to assess the dental condition of this group. The Tri-Service Center for Oral Health Studies (TSCOHS) was tasked and funded by the DoD Health Affairs, TRICARE Management Activity (TMA) to develop and implement a scientific protocol to assess and document the oral health status and treatment needs of these mobilized reservists. In October 2001, the Navy Bureau of Medicine and Surgery Dental Division tasked all Navy Dental Commands to collect and submit data, according to the protocol provided by TSCOHS, for all reservists mobilizing through their command. Methods 1. Data Collection Reservist dental records are reviewed by Navy dental personnel as part of the mobilization process. This review determines whether or not a dental examination is required, based upon the individual’s DoD Dental Classification, Appendix A. Navy Dentistry captures the results of patient dental examinations and tracks their individual treatment needs using form EZ603. All dental facilities were tasked to send TSCOHS a copy of the most recent EZ603 from the dental record of each reservist mobilizing through their facility. If a new dental examination was performed, a copy of that new EZ603 was collected. If a new dental examination was not required, a copy of the most recent EZ603 in the patient’s record was collected. All data was received by TSCOHS via US mail in postage paid, pre-addressed envelopes. 2. Computer Data Entry / Analysis TSCOHS dental personnel manually transferred the treatment needs for 7,008 Navy and Marine Corps reservists into a customized computer data entry screen designed using Microsoft Access® This data was then converted into a SPSS ® 11.0 database for statistical analysis. 2

4 3. Study Sample The six month data collection period ran from October 2001 through March TSCOHS received data from 19 Navy dental treatment facilities (DTF) representing 12 Naval Dental Centers (NDC) world-wide, Table 1. Table 2 shows the total number of records analyzed for Navy and Marine Corps reservists. We collected 55.3% of Navy reservists and 35.3% of Marine Corps reservists, mobilized during the study period. The sample is approximately 10% of all Navy and Marine Corps reservists and representative of the entire group. The representative strength of this large sample is bolstered by the natural randomization resulting from data collection at many geographically disbursed data collection sites. No indications of systematic bias were found. NDC# SUBMITED Camp Lejeune948 Camp Pendleton288 Europe 9 Gulf Coast 1,215 Great Lakes762 Mid-Atlantic685 Northeast126 National Naval Dental Ctr. 364 Northwest629 Pearl Harbor138 Southeast566 Southwest 1,278 TOTAL 7,008 NavyMarine Corps Total Reservists Mobilized (Oct 01- Mar 02) 9,8274,467 Total Records Analyzed5,4321,576 Percent of Reservists Captured Table 1 Table 2 3 Methods

5 [ ] Margin of Error = 1.96*SE Oral Health Status (DoD Dental Classification) Figure 1 shows the DoD dental classification distribution among Navy and Marine Corps reservists. There are no Class 4 reservists since those who had not received a dental examination within 12 months were reexamined at inprocessing. Based on dental classification, Navy reservists enjoyed significantly better oral health compared to Marine Corps reservists. 4

6 Operative Treatment Needs Marine Corps reservists require statistically significantly more operative treatment (1467 restorations per 1000 reservists) compared to Navy (684 restorations per 1000 reservists), Figure 2. Figure 3 shows that Marine Corps reservists need twice as many tooth surfaces restored. [ ] 95% CI 5

7 Operative Treatment Needs Less than one-third of Navy reservists require operative treatment, while approximately half of Marine Corps reservists require operative treatment. Figures 4 and 5 provide the distribution of all operative treatment needs and Class 3 operative treatment needs, respectively. [ ] Margin of Error = 1.96*SE 6 Number of Teeth

8 Operative Treatment Needs Approximately half of all restorations required are one surface, and more than one-third are two surface restorations, Figures 6 and 7. There are no clinically significant differences in the surface distribution of restorations required by Navy and Marine Corps reservists. 7

9 Oral Surgery (Extraction) Treatment Needs Marine Corps reservists require approximately 5 times the number of extractions per 1000 reservists compared to Navy reservists. This difference is both statistically and clinically significant. Figure 8 shows extraction needs by dental classification and extraction complexity. A complex extraction is defined as requiring surgical removal and/or tooth sectioning. All impaction removals are considered complex. [ ] 95% CI 8

10 Oral Surgery (Extraction) Treatment Needs Only 6.6% of Navy reservists require a tooth extraction, compared to 27.2% of Marine Corps reservists, Figure 9. Class 3 extraction needs are limited to 2.1% of Navy and 5.3% of Marine Corps reservists, Figure 10. [ ] Margin of Error = 1.96*SE 9

11 Endodontic Treatment Needs Approximately two-thirds of endodontic treatment required is on molar teeth, Figure 11. There is no statistically significant difference in endodontic treatment need between Navy and Marine Corps reservists. [ ] 95% CI 10

12 Endodontic Treatment Needs There is no significant difference between the percentage of Navy (2.1%) and Marine Corps (2.9%) reservists requiring endodontic treatment, Figure 12. Only 0.4% of reservists require more than one endodontic treatment. [ ] Margin of Error = 1.96*SE 11

13 Prosthodontic Treatment Needs There is no statistically significant difference between the prosthodontic treatment need of Navy and Marine Corps reservists, when expressed as units per hundred reservists. [ ] 95% CI 12

14 Prosthodontic Treatment Needs The requirement for fixed prosthodontic care is confined to less than 7% of Navy and Marine Corps reservists, Figure 14. There is no statistically significant difference between services in the distribution of number of fixed prosthodontic units required. [ ] Margin of Error = 1.96*SE 13

15 Periodontic Treatment Needs The periodontal condition of each reservist is indicated by the Periodontal Screening and Recording (PSR) score. PSR scores are defined as PSR 0 (maximum probing depth less than 3.5mm, no calculus or defective margins, gingival tissues are healthy with no bleeding on probing); PSR 1 (maximum probing depth less than 3.5mm, no calculus or defective margins, bleeding on probing); PSR 2 (maximum probing depth less than 3.5mm, calculus or defective margins present); PSR 3 (probing depth 3.5mm to 5.5mm); PSR 4 (probing depth greater than 5.5mm). Figure 15 shows significantly less PSR 0 and PSR 1, and significantly more PSR 3 Marine Corps reservists compared to Navy. This indicates higher levels of periodontal disease among Marine Corps reservists. Significantly more Marine Corps reservists require dental prophylaxis compared to Navy reservists, Figure 16. Among Class 2 reservists nearly half require a dental prophylaxis as their only dental treatment need, Figure 17. [ ] Margin of Error = 1.96*SE 14

16 Periodontic Treatment Needs [ ] Margin of Error = 1.96*SE 15

17 Dental Treatment Needs Expressed As Dental Weighted Values (DWV) American Dental Association Current Dental Terminology (CDT3) is a list of dental procedures and nomenclature used by civilian and military dentistry to record dental treatment provided. Dental Weighted Values (DWV) are weights assigned by military dentistry to each CDT3 dental procedure. These weights (DWV) are based on the fee charged by civilian dentists for each procedure (DWV = Civilian Fee /100). The use of dental weighted values allowed us to convert the treatment needs of Navy and Marine Corps reservists into the dollar cost to provide the required dental care. Table 3 provides the DWV, by treatment type, and the overall civilian cost estimate for the Navy reserve component. Information is provided for treatment necessary to achieve military operational readiness (DoD Class 1 or 2), and treatment necessary to achieve full dental health (DoD Class 1), Appendix A. Table 4 provides similar information for the Marine Corps reserve component. Dental examination and bitewing radiographs for those who have not been examined for more than 12 months are included in the Class 3 cost, since this is required treatment. In a simultaneous sub-study of 300 reservists mobilized at NDC Great Lakes, 75% needed a new panoramic radiograph to be in compliance with dental and forensic requirements. Therefore, for every 1000 reservists mobilized an estimated 750 would require a panoramic radiograph (0.70 DWV). This would add 750 * 0.70 * $100 = $52,500 to the cost estimates provided in Tables 3 and 4. Based on the mean number of DWV needed, the average civilian cost to move a Class 3 reservist to Class 2 is $448 (Navy) and $436 (Marine Corps). Another $957 (Navy) and $878 (Marine Corps) worth of care would be required to move this reservist to Class 1(oral health). For the average Class 2 reservist, a mean of $466 (Navy) and $614 (Marine Corps) worth of care would be needed to reach Class 1. Eleven percent of Navy reservists and only 1% of Marine Corps reservists require no dental treatment. 16

18 Table 3. DWV Associated With Providing Required Treatment by Procedure Type (Per 1000 Mobilized Navy Reservists) Procedure TypeClass 2 DWVsClass 3 DWVsTotal DWVs Exam/Bitewings (Class 4s only) n/a253.1 Operative Oral Surgery (Extractions) Endodonticsn/a140.5 Prosthodontics Periodontics TOTAL DWVs (Civilian Cost) ($399,980) ($85,900) ($485,880) 17

19 Table 4. DWVs Associated With Providing Required Treatment by Procedure Type (Per 1000 Mobilized Marine Reservists) Procedure TypeClass 2 DWVsClass 3 DWVsTotal DWVs Exam/Bitewings (Class 4s only) n/a297.4 Operative Oral Surgery (Extractions) Endodonticsn/a199.9 Prosthodontics Periodontics TOTAL DWVs (Civilian Cost) ($578,540) ($133,670) ($712,210) 18

20 Dental Treatment Needs Expressed As Dental Weighted Values (DWV) Over half of Navy Class 2 reservists and one third of Marine Corps Class 2 reservists require less than $200 of dental treatment, while approximately three percent of Class 2 reservists require more than $2,000 of dental care. * Based on Dental Weighted Values 19

21 Dental Treatment Needs Expressed As Dental Weighted Values (DWV) Class 3 patients by definition require more urgent dental treatment than Class 2 patients. On the average, they also require a larger quantity of dental care as reflected in the cost of treatment distribution, Figure 19. Approximately, one sixth of Class 3 reservists require more than $2,000 of dental care. * Based on Dental Weighted Values 20

22 21 Department of Defense Oral Health and Readiness Standards The oral health status of uniformed personnel shall be classified as follows: a. Class 1. (Oral Health): Patients with a current dental examination, who do not require dental treatment or reevaluation. Class 1 patients are worldwide deployable. b. Class 2. Patients with a current dental examination, who require non-urgent dental treatment or reevaluation for oral conditions, which are unlikely to result in dental emergencies within 12 months. Class 2 patients are worldwide deployable. Patients in dental class 2 may exhibit the following: 1.Treatment or follow-up indicated for dental caries or minor defective restorations that can be maintained by the patient. 2.Interim restorations or prostheses that can be maintained for a 12 ‑ month period. This includes teeth that have been restored with permanent restorative materials for which protective cuspal coverage is indicated. c. Class 3. Patients who require urgent or emergent dental treatment. Class 3 patients are not normally considered to be worldwide deployable. 1.Treatment or follow-up indicated for dental caries, symptomatic tooth fracture or defective restorations that cannot be maintained by the patient. 2.Interim restorations or prostheses that cannot be maintained for a 12 ‑ month period. Appendix A

23 3.Patients requiring treatment for the following periodontal conditions that may result in dental emergencies within the next 12 months. a)Acute gingivitis or pericornitis. b)Active progressive moderate or advanced periodontitis. c)Periodontal abscess. d)Progressive mucogingival condition. e)Periodontal manifestations of systemic disease or hormonal disturbances. f)Heavy subgingival calculus. 4.Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication or communication, or acceptable esthetics. 5.Unerupted, partially erupted, or malposed teeth with historical, clinical, or radiographic signs or symptoms of pathosis that are recommended for removal. 6.Chronic oral infections or other pathologic lesions including: a)Pulpal, periapical, or resorptive pathology requiring treatment. b)Lesions requiring biopsy or awaiting biopsy report. 7.Emergency situations requiring therapy to relieve pain, treat trauma, treat acute oral infections, or provide timely follow-up care (e.g., drain or suture removal) until resolved. 8.Acute temporomandibular disorders requiring active treatment that may interfere with duties. d. Class 4. Patients who require periodic dental examinations or patients with unknown dental classifications. Class 4 patients are normally not considered to be worldwide deployable. 22


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