The Joseph L. Henry Oral Health Fellowship Practicums 2001-20013 | Woods
Phillip D. Woods, DDS, MPH
Joseph L. Henry Oral Health Fellow in Minority Health Policy
"A Secondary Analysis of the DoD Year 2000 Tri- Service Oral Health Survey: Dental Readiness among Army Recruits"
The first-ever Surgeon General's Report on Oral Health in America recognized that despite improvements in oral health status over the past five decades, not all Americans have benefited. Profound and consequential disparities still exist for some population groups as classified by varying income, sex, age and race/ethnicity.
U.S. Dental Command (DENCOM) is responsible for providing oral health care for over 480,000 active-duty soldiers and 95,000 family members. Current Department of Defense dental fitness classification places all soldiers into one of four classes, based on the severity of their oral diseases, and the likelihood for interference with military unit operations. Class 1 and 2 soldiers have limited dental problems and as a result are deployable for military missions. However, class 3 and 4 soldiers display more pronounced dental disease, likely to present as an emergency within 12 months. As a result they must have their dental disease treated before they can be deployed.
To examine the impact of race and educational level on DoD dental readiness classification, a secondary analysis of the Tri-Service Center for Oral Health Studies (TSCOHS) 2000 Recruit Survey was undertaken. Findings were compared with NHANES III data to assess the generalizability of the Army recruit data to civilian data.
In the original TSCOHS survey, 4376 DoD recruits were randomly selected from the Army, Navy and Air Force for participation. Data was collected through a social history questionnaire and a 30-minute clinical oral exam performed by calibrated dental examiners and trained recorders. Direct Data entry onto notebook computers allowed for paperless data collection and transmission.
For this Practicum, only the Army portion of the data was considered, consisting of 1672 recruits from 3 different bases. The racial/ethnic composition of recruits was 1031 White, 389 Black, 158 Hispanic, 39 Asian and 55 recruits who self-classified as "Other". Over-sampling was done in the original survey to mirror actual proportions of each racial/ethnic group within the Army. Samples were weighted prior to analysis.
• Decayed, Missing, Filled Teeth (DMFT): Black recruits had statistically significant lower mean DMFT than that of white recruits (P<.0001). Blacks also demonstrated significantly fewer fillings than whites (P<.0001). Asian, Black and Hispanic recruits had less decay than did white recruits.
• Dental Utilization: Overall, Asian, Black and Hispanic recruits responded "last visit more than 5 years ago" more frequently than whites (P<.05). Asian, Black and Hispanic recruits were more likely to respond "never been to the dentist" than Whites (P<<.05).
• Tobacco Use: White recruits are greater users of tobacco products than other racial/ethnic group recruits (23.3% versus 29.7%).
• Percentage Dental Readiness Class 3: Forty-two percent (42%) of total recruits are dental class 3, meaning non-deployable. Black recruits comprised the racial/ethnic group with the largest proportion of class 3 (56%).
Secondary analysis of Army portion of DoD 2000 Recruit Survey provides evidence of striking oral health disparities between groups of varying race/ethnicity within a population of 1672 Army recruits. Findings are comparable to NHANES III; however, recruit tobacco use is higher than that of civilians.
The Army Dental Corps is currently 200 active duty dentists short of budgeted end strength. The implications of these findings should be clear in this period where America finds itself expanding its military involvement in additional theaters throughout the world. The findings have relevance to future policy and programs designed to help the Army better meet the oral health needs of its soldiers. Policy recommendations to DENCOM may help ensure that the Army and the larger DoD maintain troops that are free of dental emergencies, focused and ready to do their work.
Major Jeffrey Chaffin, D.D.S., M.P.H., Dental Corps Public Health Dental Officer, USA
DENCOM, San Antonio, TX