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NEWS | Oct. 23, 2019

JBSA-Fort Sam Houston researchers author paper on military dental emergencies

By David DeKunder 502nd Air Base Wing Public Affairs

Researchers at Joint Base San Antonio-Fort Sam Houston have authored a research paper analyzing data of dental emergencies and traumatic facial and head injuries among servicemembers that could be utilized in improving troop outcomes and mission preparedness.

The six-page research paper, “The Burden of Dental Emergencies, Oral-Maxillofacial, and Cranio-Maxillofacial Injuries in U.S. Military Personnel,” was published in the July/August issue of Military Medicine. Co-authoring the paper were Col. Tim Mitchener, U.S. Army Institute of Surgical Research public health dentist and oral maxillofacial injury epidemiologist; Dr. John Simecek, Naval Medical Research Unit San Antonio director of craniofacial health and restorative medicine; and Dr. Sylvain Cardin, Naval Medical Research Unit San Antonio chief science director.

A dental emergency is any oral or dental problem that requires a servicemember to seek treatment.

Simecek said the research paper reviewed 30 previous studies, both published and unpublished, covering reported dental emergencies and oral- and cranio-maxillofacial injuries of U.S. military personnel serving in combat environments, who were deployed, serving in stabilization operations and training exercises and those in garrison.

An oral-maxillofacial injury is an injury to hard and soft tissues of the oral cavity, the maxillofacial area and the orbital floor (eye socket), formed in part by the maxilla, and parts of the neck closest to the mandible (lower jaw). A cranio-maxillofacial injury is an injury to the head and neck.

The studies reviewed were published between 1955 and 2017, with data used in the studies collected between 1941 and 2014. From the comprehensive review of those studies, the paper compared the rate of dental emergencies and oral- and cranio-maxillofacial injuries among servicemembers in the late 20th century to those rates reported in the early 21st century. Studies reviewed in the paper covered World War II, the Vietnam War, Desert Storm and conflicts in Iraqi and Afghanistan.

Simecek said the data reviewed in the paper determined that out of 100,000 servicemembers deployed, approximately 12,000, or 11.7 percent, are going to have a dental problem and will need to go to a dental facility. He noted that the Department of Defense has instituted measures to reduce dental emergencies, most notably the Individual Medical Readiness, or IMR, system established in 2006, which set up several medical requirements, including dental readiness, servicemembers must pass before they are classified as medically ready to serve.

“Since 2000, there was an emphasis on some policy changes to insure optimal readiness,” Simecek said. “One of our goals was to see if that actually improved or reduced the number of dental problems in the theater.”

Simecek said based on the data reviewed for the research paper, researchers noticed a decrease in the number of dental emergencies among servicemembers since 2000. But he said the researchers could not make a conclusion because the reason for the decrease was unknown, as the data from each of the studies reviewed were collected in different ways.

He said to make a determination for the reason for the drop in dental emergencies among servicemembers since 2000, there needs to be a standardization for data collecting in future studies.

“In order to better evaluate some of these policy changes, you need the data to be standardized so that you could tell whether money or policy issues have made a difference,” Simecek said.

Cardin said the research paper can serve as a guide for military leaders to determine how and where dental resources can be utilized for the dental readiness of servicemembers.

“The idea is to produce data that will help the leadership for policy and clinical practice guidelines, learning from the lessons we have encountered, and guide the future of policy and clinical practice guidelines,” Cardin said. “That is the goal of this paper.”

Even if the military is enforcing the IMR, Simecek said dental emergencies among servicemembers will still occur in combat zones or in areas where troops are deployed. He said the military will need to devote resources to serve the dental needs of servicemembers so as to avoid medically evacuating them if possible.

“You need to have dental capacity, dental support there,” he said. “If you don’t have it, you’re going to be medically evacuating these people when a dentist or oral-maxillofacial surgeon can usually take care of the problems.”

The researchers are continuing their research on dental emergencies and oral- and cranio-maxillofacial injuries by working on another paper that will find out how often servicemembers with dental emergencies and/or oral- and cranio-maxillofacial injuries are medically evacuated. Simecek expects that paper to be completed in a month and then sent for publication.

Simecek said the objective of that paper will be to determine if medics or corpsman can be able to treat servicemembers with dental emergencies and, if so, determine what equipment they will need for treatment instead of having to medically evacuate the servicemember, if possible.

“The vast majority of dental emergencies can be treated quickly by a dental officer, medic or corpsman and the person returned to duty,” Simecek said.

Simecek said based on the findings from both papers the researchers will be able to come up with a recommendation to pass on to military policy makers on ways to treat servicemembers with dental emergencies while not having to medically evacuate them, and to provide the best treatment for oral-and cranio-maxillofacial injuries incurred during deployments.

Mitchener said treating oral-maxillofacial injuries and diseases is more complex than treating a dental emergency and that a servicemember with those type of injuries needs access to a trained surgeon.

“Many oral-maxillofacial injuries involve bone that support the teeth,” Mitchener said. “If the teeth do not properly function for the patient, the patient suffers a lower quality of life. The oral-maxillofacial surgeon is the one best trained to deal with that and make sure the teeth are properly placed and functioning.”