The 2008 Army Recruit Oral Health Survey results.
Oral health (Surveys)
|Author:||Moss, David L.|
|Publication:||Name: U.S. Army Medical Department Journal Publisher: U.S. Army Medical Department Center & School Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 U.S. Army Medical Department Center & School ISSN: 1524-0436|
|Issue:||Date: Jan-March, 2011|
|Organization:||Government Agency: United States. Army|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
This report presents the findings from an oral health survey of US Army recruits at time of entry into the armed services. The survey was conducted from December 2007 to November 2008. Prior to analysis, the sample of 1,928 Army recruits was weighted to represent the estimated total number of Army recruits attending basic training (171,348) during this period. Weighting factors included military service, gender, and military service status or component, thus allowing comparisons among Regular (Active Duty), Reserves, and National Guard recruits of each service. The distribution of the recruits by service:
* Army 57.1%
* Marines 15.2%
* Navy 15.1%
* Air Force 12.6%
The distribution of Army recruits by component:
* Regular 50.3%
* Reserve 16.8%
* National Guard 32.9%
The oral health findings were compared to results from the 1994 and 2000 Tri-Service Oral Health Recruit Studies where data were available.
DoD Dental Fitness Classification
The percentage of recruits in Department of Defense (DoD) Dental Fitness Class (DFC) 3 was 52.5% compared to 42% in 2000 and 33.3% in 1994.
Only 4.3% of 2008 Army recruits did not require any treatment at the time of examination (DFC 1).
There was no statistical difference in the distribution of DFC among the 3 Army components.
Almost all (84.3%) 2008 Army recruits needed an oral prophylaxis. While only 4.3% of Army recruits were DFC 1 at initial exam, an additional 6.7% would be DFC 1 after prophylaxis.
Operative needs were the most common area of dental treatment required for recruits. One quarter of recruits did not require any restorations and 21% required 7 or more restorations. The operative need of recruits was similar for all components. Mean number of restorations needed for each recruit was 3.7.
Seventeen percent of recruits required some fixed pros care, none were completely edentulous, and no removable partial dentures were indicated.
There was a significant improvement in the percentage of Army recruits who required no extractions (39.6%) in 2008 compared to 27.1% in 2000.
The status of 2008 recruits did not significantly change when compared to 2000 Army recruits. The percentage of 2008 recruits who had a worst periodontal screening and recording (PSR) score of 1 was 24.8% compared to 28% for year 2000 Army recruits.
Only 7.7% of 2008 recruits required any endodontic treatment, compared to 10.9% in 2000 and 18.1% in 1994.
The percentage of 2008 Army recruits who had seen a dentist within the 12 months prior to reporting for training was 38.3% and increased to 66.5% within the previous 2 years.
The percentage of recruits who had some type of dental insurance before reporting to the recruit center was 44.3%.
Perceived Need for Dental Care
The percentage of 2008 Army recruits who felt they needed dental care was 60.4%.
Among those who felt they needed dental care, 27.1% responded that they needed dental care "right away", 41.5% "within 6 months."
The most common reason for not seeking care prior to training was that it was too expensive.
The TRICARE Management Activity directed the Tri-Service Center for Oral Health Studies with concurrence by the Services' Deputy Dental Corps Chiefs, to conduct the 2008 DoD Recruit Oral Health Survey. The primary goal of the survey was to estimate the level of dental readiness, oral health, and dental treatment needs of recruits entering military service. The results provide essential information for determining dental manpower requirements and other areas of readiness planning that are especially vital during wartime. Key objectives of the survey were to identify initial dental classification and specific dental treatment needs for recruits, determine dental caries prevalence, periodontal status and other oral conditions, evaluate levels of risk for dental caries, oral cancer, and periodontal disease, and describe results of the DoD Recruit Oral Health Survey Questionnaire. When possible, findings from this survey were compared to the 1994 and 2000 Tri-Service Comprehensive Oral Health Surveys.
For a detailed discussion on the methods used for the 2008 DoD Recruit Oral Health Survey, refer to the Methods section of the DoD report of the 2008 DoD Recruit Oral Health Survey (available at: http://www.usuhs.mil/tscohs/).
A total of 1,928 Army recruits were examined at the five Army Basic Combat Training (BCT) sites from December 2007 thru November 2008 (Table 1).
The component distribution of the sample is presented in Table 2. The numbers were weighted in order to adjust the sample to the actual population distribution of the 2008 recruit total.
Tables 3 and 4 present the sample population distribution by pre-enlistment education levels and age. The overall percentage of recruits without a high school education is 2.8% is likely an exaggeration due to National Guard recruits on a split entry option reporting for BCT prior to high school graduation.
During the dental examination, each recruit's DoD Dental Classification was calculated based upon the worst dental class assigned to each tooth, each PSR sextant, soft tissue finding, and temporomandibular disorder/orthodontic referral as noted by the study examiners.
Figure 1 shows the trend in DFC distribution over the 3 study years. The distribution of DFC did not differ significantly among the 3 Army components for the 2008 data.
Survey examiners assessed the health status and treatment needs of each tooth using standardized mirrors and explorers and current radiographs. Examiners were instructed to use a very light touch when using the dental explorer to avoid causing cavitation with aggressive probing.
The mean number of restorations needed for 2008 recruits was 3.7. The distribution of required restorations is shown in Table 5.
This distribution among those that required at least one restoration was not statistically different across the 3 study years. The mean number of restorations by type for 2008 recruits is shown in Table 6.
This distribution also did not vary significantly across the 3 study years. The distribution of dental fitness class based solely on operative need for 2008 recruits is presented in Table 7.
Oral Surgery Requirements
Among 2008 recruits, there was a significant decrease in the number of recruits who needed oral surgery treatment. In the 2000 study, 26.6% had no need. In the current study, this increased to 39.6%, as shown in Figure 2. The average number of extractions among all 2008 recruits was 2.1.
Based only on oral surgery conditions, 39.6% of 2008 recruits were DFC 1, 35.1% DFC 2, and 25.4% were in DFC 3.
Among 2008 recruits that required at least one extraction, the majority required 3 to 4 teeth removed indicative of a treatment plan for the removal of all third molars. The mean number of extractions among this group by type was 0.9, 0.25, and 2.3 for simple, complex, and impacted, respectively.
There was no statistical difference for oral surgical need across the 3 components.
Peridontal Health Status and Treatment Needs
Periodontal status and treatment needs were assessed using the Periodontal Screening and Recording (PSR) index. Survey examiners recorded the PSR score for each sextant of the dentition using the #23/Hu-Friedy WHO Style Expro (XP23/11.5B) explorer/periodontal probe.
Figure 3 shows the distribution of recruits by worst PSR score in each study year. The percentage of 2008 recruits whose worst PSR score is 3 or 4 (indicating periodontal disease) has decreased significantly from 55% in 1994 and 18% in 2000 to only 10% in 2008. Nearly 90% of 2008 recruits had a worst PSR score of 2 or lower.
The distribution of PSR scores was similar among the 3 components as shown in Figure 4.
Survey examiners assessed the number of missing teeth and/or teeth requiring removal for each patient and made the determination whether to replace missing teeth using fixed or removable prostheses. Current use of partial or complete removable prostheses was assessed along with need for their replacement or repair.
Among 2008 recruits, only 17% required any fixed pros care, none were completely edentulous, and no removable partial dentures were indicated (Table 8). This compares to 24% and 34% requiring care in 2000 and 1994, respectively. The mean number of fixed pros units among those that required pros care was 2 units.
ENDODONTIC TREATMENT REQUIREMENT
The majority of endodontic need will be diagnosed acutely and not at routine examination. Survey examiners assessed the potential need for endodontic therapy using radiographs and visual inspection. Definitive vitality testing for suspect teeth was beyond the scope of this survey. If the examiner believed a tooth would require endodontic care following extensive restorative procedures, it was indicated in the record as needing endodontic care.
As shown in Figure 5, only 7.7% of 2008 recruits required endodontic treatment at the time of initial examination.
Among those Army recruits who required endodontic care, the mean number of teeth is one.
The distribution of the type of teeth that required endodontic care (Figure 6) shows that the majority are molars. The 2008 recruit components were not statistically different in distribution of endodontic treatment need.
Other Clinical Findings
Overall, 3.4% of 2008 recruits exhibited a soft tissue lesion. The distribution of the types of lesions is very similar with the most common being pericoronitis, orthodontic issues, and aphthous ulcers, 1.2%, 0.6%, and 0.5%, respectively. The prevalence of temporomandibular dysfunction was less than 0.2%. The mean number of dental sealants treatment planned was 0.4 per recruit and the mean number of teeth treatment planned for remineralization was 1.2 (Table 9).
Dental Care Prior to Entry
Dental utilization prior to entering military service was assessed for all recruits using a self-administered questionnaire.
The distribution of responses for 2008 recruits concerning the time since last dental visit prior to reporting for training is shown in Figure 7.
The percentage of 2008 recruits who had seen a dentist within the last 12 months prior to reporting for training was 38.3%, increasing to 66.9% within the last 24 months. There was no statistical difference among the 3 components for time since last visit.
Among those recruits who received dental care within the last 12 months, the percentage that had their teeth cleaned prior to reporting for training was 80.6%, 30.4% had operative care, and 17.2% had teeth removed.
The percentage of 2008 recruits who had some type of dental insurance was 44.3% (Figure 8).
Perceived need for dental care was also assessed for all recruits using the same self-administered questionnaire. The percentage of 2008 Army recruits who felt that they needed dental care was 60.5%. Among those that perceived a need for dental care, 27.1% responded that they needed dental care right away and 41.5% responded that they needed dental care within 6 months. The most common reason for recruits who felt they needed care, but had not received it, was the anticipated expense.
This article is a reprint of the report, 2008 Army Recruit Oral Health Survey Results, which is the US Army data from the 2008 DoD Recruit Oral Health Survey. The Army results and DoD report may be obtained through the Uniformed Services University of the Health Services, http://www.usuhs.mil/tscohs/.
COL David L. Moss, DC, USA
COL Moss is Director, Tri-Service Center for Oral Health Studies, Department of Preventive Medicine and Biometrics, and Assistant Professor of Preventive Medicine and Biometrics at the Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Table 1. Distribution of study sample population across Army Basic Combat Training Locations Basic Combat Unweighted Estimated Training Location Sample Population Fort Benning 403 39,041 Fort Jackson 586 61,613 Fort Knox 202 19,246 Fort Leonard Wood 462 33,375 Fort Sill 275 18,073 Total 1,928 171,348 Table 2. Distribution of study sample population by component and gender. Component Male Female Overall Active Army 42.4% 7.9% 50.3% Army National Guard 26.2% 6.6% 32.9% Army Reserve 12.0% 4.8% 16.8% Total 80.6% 19.3% 100.0% Table 3. Distribution of study sample population by pre-enlistment education. Component Non-high school High school Post high graduate graduate school studies Active Army 0.8% 33.8% 11.5% Army National Guard 1.4% 21.7% 7.9% Army Reserve 0.6% 9.6% 4.9% Total 2.8% 65.1% 24.2% Component 2 year 4 year degree degree and beyond Active Army 2.2% 2.0% Army National Guard 1.0% 0.9% Army Reserve 0.7% 1.1% Total 4.0% 4.0% Table 4. Distribution of study sample population by age. Component Age 40 & 17 18-19 20-24 25-29 30-34 35 -39 up Active Army 3.2% 20.8% 18.8% 5.0% 1.4% 0.8% 0.2% Army National 3.1% 13.5% 10.9% 3.1% 1.2% 0.9% 0.2% Guard Army Reserve 1.1% 6.3% 6.2% 1.5% 0.9% 0.6% 0.2% Total 7.4% 40.4% 36.0% 9.6% 3.6% 2.2% 0.6% Table 5. Number of restorations required for the 2008 recruit sample population. None 1-3 4-6 7+ 25.4% 34.0% 19.8% 20.9% Table 6. Mean number of restorations by type for the 2008 recruit sample population. 1 Sur 2 Sur 3 Sur 4 Sur 5 Sur 1.53 1.40 0.57 0.17 0.05 Table 7. Distribution of DFC based only on operative needs of the sample population. Study Year DFC 1 DFC 2 DFC 3 2008 25% 33% 42% 2000 23% 51% 26% 1994 20% 50% 30% Table 8. Distribution of the number of fixed prosthodontic units needed by 2008 recruits. Fixed Prosthodontic Units Mean Fixed units Needed (Per 1,000 Recruits) None 1-2 3-6 7+ 82.8% 12.8% 3.8% 0.7% 366 Table 9. Remineralization and sealant requirements among 2008 recruits. Sealants Required None 1-2 3-4 5 + Mean 82% 11.9% 4.2% 1.8% 0.4 Remineralizations Required 70.3% 14.9% 4.9% 10% 1.2 Figure 1. The DFC classification of Army recruits in each of the 3 Tri-Service Oral Health Recruit Studies. DFC 1 DFC 2 DFC 3 2008 Recruits 4.3 43.2 52.5 2000 Recruits 1.3 56.7 42.1 1994 Recruits 1.1 65.6 33.3 Note: Table made from bar graph. Figure 2. Distribution of Army recruits requiring oral surgery in each of the 3 Tri-Service Oral Health Recruit Studies. 0 1-2 3-4 5+ 2008 Recruits 39.6 17.0 38.6 4.6 2000 Recruits 26.6 15.5 52.6 5.3 1994 Recruits 27.1 16.0 54.0 2.9 Note: Table made from bar graph. Figure 3. Distribution by Tri-Service Oral Health Recruit Study year of sample population periodontal screening and recording score (based on patient's worst sextant PSR score). PSR0 PSR1 PSR2 PSR3 PSR4 2008 Recruits 1.0 24.8 64.0 9.7 0.4 2000 Recruits 5.0 28.0 49.0 15.0 3.0 1994 Recruits 5.0 19.0 21.0 50.0 5.0 Note: Table made from bar graph. Figure 4. Distribution by component of 2008 recruit periodontal screening and recording score (based on patient's worst sextant PSR score). PSR0 PSR1 PSR2 PSR3 PSR4 Active Army 0.7 23.3 64.5 11.1 0.4 Army National Guard 1.3 27.6 63.8 6.9 0.5 Army Reserve 1.6 23.9 62.4 11.2 0.7 Note: Table made from bar graph. Figure 5. Distribution by Tri-Service Oral Health Recruit Study year of sample population recruits who required endodontic treatment. 0 1 2-3 4 or More 2008 Recruits 92.3 6.0 1.5 0.2 2000 Recruits 89.1 8.2 2.5 0.1 1994 Recruits 81.9 12.3 4.9 0.9 Note: Table made from bar graph. Figure 6. Distribution by Tri-Service Oral Health Recruit Study year of the types of endodontic treatment required by the sample population. Anterior Premolar Molar 2008 Recruits 14.6 20.3 69.4 2000 Recruits 19.0 15.0 66.0 1994 Recruits 10.0 19.0 66.0 Note: Table made from bar graph. Figure 7. Time since last dental visit prior to reporting for training for 2008 recruits. 12 months 38% 1 to 2 years 29% 3 to 5 years 18% More than 5 years 13% Never 2% Note: Table made from pie chart. Figure 8. Distribution of dental insurance coverage among 2008 recruits. TRICARE 3.6% Private 32.8% Subsidized 7.9% No insurance 33.6% Unknown 21.6% Note: Table made from pie chart.
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