Readiness to serve includes dental fitness, good oral health

U.S. service members need to stay fit and ready for the fight at any time and at any place, and a big part of that is keeping all parts of the body healthy. That includes oral health.

Beneficiaries of Walter Reed National Military Medical Center (WRNMMC) have numerous services that they can use to ensure their oral health and remain ready for deployment. The Directorate of Dental Services at WRNMMC is responsible for the dental care and health readiness for primarily active-duty patients at WRNMMC and the surrounding areas.

Navy CmDr. Rasha Welch, DC, Dental Services director, and members of her team, including Army Lt. Col. Heather Olmo, DDS, of Oral and Maxillofacial Pathology, and Navy Lt. CmDr. Jason Burkes, MD, of Oral/Head and Neck Oncologic and Microvascular Reconstructive Surgery, explained that if not appropriately treated, oral diseases can result in dental emergencies, be a source of severe pain, and significantly impair the patient's ability to perform their daily tasks.

Oral disease left untreated can also be "of significant morbidity to the patient," they added.

While most dental emergencies can be easily treated when the patient is in a nondeployed setting, problems can arise when a dental emergency occurs when service members are deployed where access to dental services is limited, Burkes furthered. Such emergencies can lead to medical evacuation from theater for treatment, he added.

Since 2000, nearly 11% of all medical evacuations from combat environments were because of dental emergencies, according to numbers from a study by investigators at the Naval Medical Research Unit and the U.S. Army Institute of Surgical Research, both at Joint Base San Antonio/Fort Sam Houston, Texas.

"When you consider a single MEDEVAC (medical evacuation) can cost up to $200,000, not only do these MEDEVACS require numerous resources, it's obvious they come at a great cost," Burkes stated.

The Department of Defense (DoD) classifies service members in one of four categories based on their oral health, and all Military Health System beneficiaries are encouraged to practice good oral health and prevention, explained the dentistry team at WRNMMC. Service members who are dental patients are grouped in one of four categories determined by "the assumed likelihood of experiencing an emergent condition within a 12-month period," they added. The classifications include:

• Class 1 -- A current dental examination has been completed and no additional dental treatment is needed for 12 months
• Class 2 -- A current dental examination has been completed, but the member requires nonurgent dental treatment or reevaluation
• Class 3 -- A current dental examination as well, but requires urgent or emergent dental treatment
• Class 4 -- Indicates the member is overdue for an annual dental examination

Classes 1 and 2 are the groups that most service members should fall under, meaning that they are deployable and their oral health shouldn't cause any issues. The Department of Defense requires 95% dental readiness for all military personnel.

Department of Defense numbers indicate that approximately 50% of Class 3 patients will have a dental emergency within two months, while it can take on average nine months for 50% of Class 1 or Class 2 patients to experience a dental emergency. This means the majority of Class 1 or Class 2 patients should not experience a dental emergency during a six-month deployment, Burkes continued.

"WRNMMC offers premier quality dental care within an integrated health system providing patient centered care that prevents, restore health, and maximize readiness," Burkes stated. He explained that the Department of Primary Care Dentistry handles annual dental readiness exams, sick-call, and other primary dental needs.

"If a service member needs specialized care, referral to appropriate dental specialists can be completed since all the dental specialists are located at WRNMMC," he added.

Hospital Dentistry at WRNMMC provides referral specialty dental services to active-duty patients needing prosthodontics, orthodontics, pediatric dentistry and oral pathology services. Specialty services include pre/post-surgical orthodontics, restoring dental implants, fabricating oral sleep apnea appliances, ocular prostheses, treating special needs pediatric patients and intra-oral diseases. The clinic also supports the urgent dental needs of hospital inpatients, and the Emergency Department.

"Oral Maxillofacial Surgery Service provides a full range of Oral and Maxillofacial services of the highest quality to eligible beneficiaries in a hospital setting," Olmo added. "These services include orthognathic surgery, dental implants, facial cosmetic surgery, dentoalveolar surgery (wisdom teeth extractions), and oral/head and neck oncologic and microvascular reconstructive surgery," she continued.

Walter Reed Bethesda and the Navy Postgraduate Dental School, also on base, offer a variety of programs to promote optimal dental health, Burkes furthered. These services include comprehensive dentistry, endodontics, oral diagnosis, orofacial pain, oral and maxillofacial pathology, maxillofacial prosthetics, oral surgery, prosthodontics, periodontics, orthodontics and pediatric dentistry.

The WRNMMC dentistry team stressed that prevention is very important to good oral health. This includes not using products that can harm teeth, gums, and other parts of the body, such as tobacco. They explained that tobacco causes adverse oral conditions and diseases.

"Tobacco-induced diseases include, but is not limited to, cancer of the oral cavity, periodontal disease, which leads to tooth loss and congenital defects such as cleft lips and/or cleft palates," Burkes elaborated. "Additionally, tobacco exaggerates chronic conditions such as diabetes and cardiovascular disease. Tobacco and the by-products can cause both immediate and long-term damage to the body.

Along with alcohol, tobacco is the leading cause of oral cancer in the United States and globally. More than 20 million Americans have died because of smoking and an additional 2.5 million nonsmokers have died because of secondhand smoke, air polluted by other people's cigarette smoke," he added.

"Oral health provides a snapshot of overall general health," stated Olmo. "Early signs and symptoms of systemic diseases oftentimes first manifest in the oral cavity. This is especially true for autoimmune and infectious diseases. Although the bacteria in your mouth are generally harmless, lack of daily oral care, such as brushing and flossing, results in an overload of bacteria leading to an imbalance in the homeostasis of the body," Olmo stated.

"In fact, the relationship between oral and systemic health, has been linked as a risk factor for oral cancer, cardiovascular disease, low-birth weight, and aspiration pneumonia," Burkes added. "Studies have shown that oral health is interrelated with chronic diseases such as diabetes and stroke, and if left unchecked, it will exacerbate disease processes."

"Good oral health helps to protect the body by warding off and in most instances, decreasing some of the effects of systemic diseases," Olmo furthered.

Addressing the impact of poor oral health on readiness, the dental expert agreed that service members who fail to exercise good oral hygiene and develop oral disease risk becoming unfit for duty, which can impact unit readiness. They stated that while services are available to help beneficiaries maintain their dental health, it's ultimately service members' responsibility to practice good oral hygiene and stay current on any appointments.

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