Dental class 3 intercept clinic: A model for treating dental class 3 soldiers

Military Medicine, Jul 2003 by Marburger, Troy, Chaffin, Jeffrey, Fretwell, Darwin

Objective: Dental Fitness Classification (DFC) 3 indicates that a soldier has a dental condition that, if not treated, is expected to result in a dental emergency within 12 months. Forty-two percent of Army recruits have DFC 3 conditions as reported by the 2000 Tri-Service Center Recruit Study. Initial entry training schools allow minimal time for dental care. The Fort Hood Class Three Intercept Clinic (CTIC) was created to treat DFC 3 conditions prior to soldiers being assigned to their units. The purpose of this study was to evaluate CTIC's ability to make soldiers dentally deployable before joining their new units at Fort Hood, Texas. Materials and Methods: A retrospective review of the CTIC daily sign-in logs for the period of January 1999 to May 2001 was used to identify DFC 3 soldiers. The data were analyzed to determine frequency of DFC 3 by rank, DFC after CTIC visits, distribution of treatment type needed to establish dental readiness, and to identify soldiers whose DFC 3 conditions were not treated. Additionally, for the 6 months between November 2000 and April 2001, all soldiers who remained a DFC 3 when released to their units were followed to assess how long it took for them to attain a DFC 1 or 2 status. Results: The retrospective review of the CTIC records identified 5,851 DFC 3 soldiers who in-processed to Fort Hood from January 1999 to May 2001. CTIC successfully converted 86.9% (N = 5,083) of the soldiers to DFC 1 or 2. Of a sample of 185 DFC 3 soldiers released to their units as a DFC 3, only 54% had converted to DFC 1 or 2, with 60.5 days being the mean days to convert. Conclusions: Trainees have large demands for dental care with minimal time to seek treatment during Initial Entry Training. A CTIC, or hybrid, can provide the necessary emergent dental care to remove soldiers from DFC 3 prior to their being assigned to their first permanent duty station.

Introduction

Dental emergencies in deployed military populations have been well documented and evaluated. Up to 20% of all sick-call patients presenting to field medical treatment facilities are dental related.1,2 Dental diseases comprise a significant percentage of the disease nonbattle injuries. Dental emergencies can significantly degrade a unit's ability to accomplish the mission in an efficient and timely manner. In today's highly technological force, mission success often depends on each soldier's unique experience and knowledge in team tactics and crew-served weapons.3 In today's smaller, more efficient Army, every soldier is a critical asset. Therefore, the potential of dental emer-gencies to reduce combat effectiveness is more a concern than ever.1,4 Studies have shown that the primary causes of emergencies are either dental caries or oral maxillofacial pathological conditions, leading many to assert that most dental emergencies are preventable by proper diagnosis and early treatment.5 Estimates of preventable emergencies range as high as 74%.1,6

The Army Oral Health Maintenance Program (AOHMP) was initiated in 1968 after leaders recognized that there were large numbers of dental emergencies during the Vietnam War. The AOHMP mandated that every soldier less than 25 years of age report annually for a dental examination during his or her month of birth and offered appointments to eliminate adverse dental conditions. Oral hygiene instruction and professionally applied topical fluorides were emphasized, with caries control being the clinical goal of the program. Demand by line officers to further decrease dental emergencies resulted in the Oral Health Fitness Program replacing the AOHMP in March 1987 and established the term "dental readiness." The Oral Health Fitness Program required each soldier to receive an annual dental examination and a dental fitness classification (DFC).7 The DFC system offered a mechanism to identify and target soldiers at highest risk of being casualties from treatable dental conditions. The DFC system has served as a tool aimed at predicting dental emergencies and stemmed from a study conducted by Teweles and King4 for soldiers deployed to the Sinai. The troops received intensive treatment prior to the Sinai deployment and only emergency care was provided during the deployment. The study found that soldiers in DFC 1 experienced emergencies at a rate of 67 per 1,000 soldiers per year, DFC 2 at a rate of 145 per 1,000 per year, and DFC 3 at a rate of 530 per 1,000 per year. This dental classification system, regulated by Health Affairs Policy 02-011, has been standardized among the military services and is used to monitor dental readiness and is presented in Table I. Patients are placed in DFC 3 status if they have oral conditions that, if not treated, are expected to result in dental emergencies within 12 months.

Studies have shown that soldiers classified as a DFC 3 are at a significantly higher risk of experiencing a dental emergency while deployed. McClave and Brokaw8 found that 50% of DFC 3 patients reported to sick call within 12 months. Alien and Smith2 reported that 85% of deployment dental sick calls were previously identified as DFC 3. According to research conducted by Alien and Smith2 and King and Brunner,9 combat sick call can decrease by 50 to 80% with simple interception of DFC 3 conditions prior to deployment. Accordingly, patients identified as a DFC 3 should receive priority appointments before deployment to prevent eventual emergency visits. Examples of DFC 3 conditions include necessary treatment for dental caries, symptomatic tooth fracture or defective restorations that cannot be maintained by the patient, interim restorations or prostheses that cannot be maintained for a 12-month period, periodontal conditions that may result in a dental emergency within 12 months, unerupted, partially erupted, or malposed teeth with historical or clinical signs of pathosis that are recommended for removal and chronic oral infections.