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Results From The 2000 Tri-Service Recruit Oral Health Survey

Results From The 2000 Tri-Service Recruit Oral Health Survey. Lt Col Gary “Chad” Martin, USAF, DC LTC Bruce B Brehm, USA, DC CDR Thomas M Leiendecker, DC,USN Tri-Service Center for Oral Health Studies Uniformed Services University of the Health Sciences.

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Results From The 2000 Tri-Service Recruit Oral Health Survey

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  1. Results From The2000 Tri-Service Recruit Oral Health Survey Lt Col Gary “Chad” Martin, USAF, DC LTC Bruce B Brehm, USA, DC CDR Thomas M Leiendecker, DC,USN Tri-Service Center for Oral Health Studies Uniformed Services University of the Health Sciences

  2. 2000 Tri-Service Recruit Oral Health SurveyBackground • Epidemiological Studies Evaluating Oral Health • Department of Health and Human Services (DHHS) • National Health and Nutrition Examination Survey (NHANES II) began 1976 • The National Survey of Oral Health in US Employed Adults and Seniors:1985 - 1986 • Department of Defense (DoD) • The 1994 Tri-Service Comprehensive Oral Health Survey • Contained a recruit component • Congress mandated a Comprehensive Study of Military Medical Care System. • National Defense Authorization Act for Fiscal Years 1992 and 1993 • PUBLIC LAW 102-190 (SEC.733)

  3. 2000 Tri-Service Recruit Oral Health SurveyStudy Design • Cross-Sectional Study Design for both 1994 and 2000 Recruit Surveys • Constraints of time, personnel and money • Same basic study design for both surveys allows for comparability • Comparisons of cross-sectional surveys conducted at different times can demonstrate trends in disease prevalence and distribution

  4. 2000 Tri-Service Recruit Oral Health SurveyObjectives • Determine the prevalence of various oral diseases, specific treatment needs and tobacco use • Assess their impact on DoD Dental Readiness Classification • Compare findings to those from the 1994 Tri- Service Oral Health Survey

  5. 2000 Tri-Service Recruit Oral Health SurveyMethods • Recruits randomly selected to participate in Survey • 4,346 recruits for the 2000 Survey • 2,711 recruits for the 1994 Survey • Survey included a comprehensive oral examination by a calibrated dental officer and a patient questionnaire • Samples were weighted prior to analysis, the statistical software program SPSS v10.0 was used for all calculations • Significance was calculated to the .01 level (CI=99%) • A single asterisk (*) will appear next to a value or item when statistically significant changes are noted.

  6. 2000 Tri-Service Recruit Oral Health SurveySampling and Data Collection • Simple stratified random sampling • Stratified by gender and race/ethnicity • Sample size of 4,346 DoD Recruits (about 5% of pop.) • Time frame - 6 months with quotas for each month • Variations by month evident in 1994 data • Why not 12 months? • Data Collection • Clinical exam data recorded on laptop computer • Data recorded for each tooth down to the surface level • Patient questionnairecompleted on scannable form

  7. 2000 Tri-Service Recruit Oral Health SurveyCalibration of Examiners • Eight examiners attended 3 day course (Dec 1999) • Calibrated on Caries Diagnosis, PSR and Dental Readiness Classification • Not calibrated on treatment planning • Scientific evidence of re-mineralization of early carious lesions • Created dilemma on which technique to use in 2000 Survey • Inter-examiner reliability • Determining the Kappa statistic • Very misleading to report “percent agreement” • Agreement beyond chance divided by amount of agreement • possible beyond chance • Calibrationchecks during site visits

  8. 2000 Tri-Service Recruit Oral Health SurveyFog of War • Patients used for the calibration course get sick or child has an emergency at school • Unexpected difficulty in recruiting individuals into the military results in weeks where very few recruits enter basic training • Brand new lap top computer had significant power problems • Unexpected TDY or PCS of examiner • Access and Excel unable to accept data base in total due to number of fields exceeding the limit of 256, total fields = 258

  9. 2000 Tri-Service Recruit Oral Health SurveyDental Readiness • The percent of 2000 USAF Recruits in dental readiness class 3 has significantly decreased compared to 1994 USAF Recruits • No real change in 2000 DoD Recruits vs. 1994 DoD Recruits

  10. 2000 Tri-Service Recruit Oral Health SurveyMissing Teeth • No real change in 2000 USAF Recruits compared to 1994 USAF Recruits • Significant increase in the percent of 2000 DoD Recruits who are not missing any teeth compared to 1994 DoD Recruits

  11. 2000 Tri-Service Recruit Oral Health SurveyRestorations Needed Per Recruit • Significant increase in percent of 2000 USAF Recruits who have no restorative needs compared to 1994 USAF Recruits • Significant decrease in percent of 2000 USAF Recruits who require 4 to 6 or > 7 restorations compared to 1994 USAF Recruits • 2000 DoD Recruits have significantly less restorative needs compared to 1994 DoD Recruits

  12. 2000 Tri-Service Recruit Oral Health SurveyRestorations Needed Per Recruit (By Type) • Significant decrease in mean number of 1 Surface Restorations required by 2000 USAF Recruits compared to 1994 USAF Recruits • Significant decrease in mean number of 1&2 Surface Restorations required by 2000 DoD Recruits compared to 1994 DoD Recruits

  13. 2000 Tri-Service Recruit Oral Health SurveyDental Readiness Classification Based Only On Restorative Needs

  14. 2000 Tri-Service Recruit Oral Health SurveyPercent Distribution Of Class 3 Teeth Among Those Who Are Readiness Class 3 For Restorative Reasons • Significant decrease in percent of 2000 USAF Recruits who have 5 or more Class 3 Teeth compared to 1994 USAF Recruits • Significant increase in percent of 2000 DoD Recruits who have 1 Class 3 Tooth compared to 1994 DoD Recruits

  15. 2000 Tri-Service Recruit Oral Health SurveyNumber Of Teeth Requiring Extraction • Significant increase in percent of 2000 USAF Recruits who require 3 or 4 teeth extracted compared to 1994 USAF Recruits • Significant decrease in percent of 2000 USAF Recruits who require “No” teeth to be extracted and “1 or 2” teeth extracted compared to 1994 DoD Recruits • Identical findings for DoD Recruits

  16. 2000 Tri-Service Recruit Oral Health SurveyTypes Of Surgical Extractions For Recruits With OS Treatment Needs • Significant increase in mean number of “Impaction” Surgical Extractions for 2000 USAF Recruits compared to 1994 USAF Recruits • Significant increase in mean number of “Simple” Surgical Extractions for 2000 DoD Recruits compared to 1994 DoD Recruits

  17. 2000 Tri-Service Recruit Oral Health SurveyDental Readiness Classification Based Only On Oral Surgery Needs

  18. 2000 Tri-Service Recruit Oral Health SurveyPercent Distribution Of Recruits By PSR Code • Significant decrease in percent of 2000 USAF Recruits with PSR Code 0 compared to 1994 USAF Recruits • Significant decrease in percent of 2000 DoD Recruits with PSR Code 2 & 3 compared to 1994 DoD Recruits

  19. 2000 Tri-Service Recruit Oral Health SurveyDental Readiness Classification Based Only On Periodontal Needs

  20. 2000 Tri-Service Recruit Oral Health SurveyPeriodontal Sextant Readiness Classification • The mean number of Class 3 sextants has decreased significantly for 2000 USAF Recruits compared to 1994 USAF Recruits • The mean number of Class 2 sextants has increased significantly for 2000 USAF Recruits compared to 1994 USAF Recruits • No change in 2000 DoD Recruits compared to 1994 DoD Recruits

  21. 2000 Tri-Service Recruit Oral Health SurveyFixed Prosthodontic Needs • No real change in 2000 USAF Recruits compared to 1994 USAF Recruits • The percent of 2000 DoD Recruits who do not require any Fixed Pros Units has significantly increased compared to 1994 DoD Recruits

  22. 2000 Tri-Service Recruit Oral Health SurveyEndodontic Needs • No real change in 2000 USAF Recruits compared to the 1994 USAF Recruits • No real change in 2000 DoD Recruits compared to the 1994 DoD Recruits

  23. 2000 Tri-Service Recruit Oral Health SurveyPercent Distribution Of Endodontic Needs By Type

  24. 2000 Tri-Service Recruit Oral Health SurveyDWV’s By Discipline

  25. 2000 Tri-Service Recruit Oral Health SurveyOral Soft Tissue/TMD/Malocclusion Conditions • Significant decrease in percent of 2000 USAF Recruits identified with pericoronitis and TMD Findings compared to 1994 USAF Recruits • Significant decrease in the percent of 2000 DoD Recruits identified with TMD Findings compared to 1994 DoD Recruits

  26. 2000 Tri-Service Recruit Oral Health SurveyDMFT Index • Cumulative caries experience measured using DMFT Index • Simple count of the (D)ecayed, (M)issing and (F)illed Teeth for each patient • Usually reported as the mean DMFT for a given population • The DMFT for 2000 Air Force Recruits is significantly lower compared to 1994 Air Force Recruits • Similar findings for DoD Recruits

  27. 2000 Tri-Service Recruit Oral Health SurveyOther Findings • Three fold increase in percent of 2000 Marine Recruits who had a smokeless tobacco lesion (5.3%) compared to 1994 Marine Recruits (1.6%) • Significant increase in percent of 2000 DoD Recruits who smoked at least 100 cigs in their lifetime (47.2%) compared to 1994 DoD Recruits (37.2%) • Significant increase in percent of 2000 DoD Recruits who smoked daily prior to entering the military (35.0%) compared to 1994 DoD Recruits (16.7%) • Of those Recruits who smoked daily prior to entering the military there was a significant increase in percent of 2000 DoD Recruits who had made a serious attempt to stop smoking cigarettes (61.3%) compared to 1994 DoD Recruits (49.4%)

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