Class 3 Dental Treatment Time

Military Medicine, Sep 2004 by Chaffin, Jeffrey G, Mazuji, Nasrin

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.

Introduction

Dental emergencies are a threat to the military mission because emergency dental conditions take soldiers away from their assigned places of duty. The prevention and treatment of dental diseases are important factors in maintaining a combat-ready military force. Dental readiness is an integral component of the Army's overall readiness program. Soldiers are considered dentally ready if they are categorized in dental fitness category (DFC) 1 or 2. As outlined in the Health Affairs Policy on Standardization of Oral Health and Readiness Classifications and as shown in Table I, soldiers who are classified in DFC 1 do not require dental treatment or reevaluation within 12 months; soldiers in DFC 2 do require routine treatment, but the conditions present are not expected to cause a dental emergency within the next 12 months.1 Soldiers classified in DFC 3 require urgent or emergency dental care and are not considered deployable worldwide. Soldiers in DFC 3 are not considered deployable because previous studies demonstrated that these soldiers suffer dental emergencies during deployments at a significantly higher rate than do soldiers in DFC 1 or 2.2,3

The treatments required to correct DFC 3 conditions can range from a simple extraction of a third molar to multiple, time-intensive, endodontic procedures and restorations. When multiple teeth are involved, the treatment can be time-intensive and invasive from the patient's point of view. Recent reports indicated that approximately 20% of soldiers in DFC 3 have significant treatment needs, often with more than five involved teeth. These DFC 3 conditions cannot be corrected quickly and are time-intensive for the dental clinics and the soldiers receiving treatment. The only Army study on treatment time for DFC 3 conditions was performed at Fort Hood in 1992 and found that the average amount of treatment time needed to bring a DFC 3 soldier to a d�ployable status was 2.75 hours.4 That study was a retrospective review of 660 dental records and treatment plans and made estimates of the amount of time it would take to treat the conditions. No time-motion study of DFC 3 treatment times has been performed, to our knowledge.

Fort Hood, Texas, developed the concept of the Class Three Intercept Clinic (CTIC) in response to the large numbers of DFC 3 soldiers processing into the post. The mission of the CTIC is to convert as many inprocessing soldiers from nondeployable status (DFC 3) to deployable status (DFC 1 or 2) before they are assigned to their permanent units. Because the soldiers have not yet been assigned to their permanent units, their place of duty, if they are identified as DFC 3, is the CTIC for the next 2 duty days. The CTIC has been very successful in intercepting soldiers with severe dental conditions and providing the necessary treatment to render them dentally deployable. Once soldiers are assigned to their units, they become immersed in the training associated with assimilation into a new unit and often are not available for dental treatment. The objective of this project was to determine the average clinical treatment time needed to bring a soldier from a dentally nondeployable status to a deployable status, with the use of actual treatment times noted in the Corporate Dental Application (CDA) electronic scheduler.

Methods

Fort Hood was chosen as the location for this project because the installation had a proven method of identifying and treating DFC 3 soldiers. Its clinics had recently received the electronic scheduling system that was developed as part of the CDA. It is mandatory for all providers to use the system to schedule patients, enter patient workload data, and update soldiers' dental fitness classifications. Treatment times can be assessed retroactively by using the appointment module in the CDA.