Evaluation of field dental equipment in a deployment environment

Dental officers and technicians must have reliable, durable, well-performing field dental equipment to enable them to provide dental care to deployed troops in operational environments. Unfortunately, no organized program exists to test such equipment before its purchase and use in the field. This article presents the results of a project conducted by the Naval Institute for Dental and Biomedical Research and the Air Force Dental Evaluation and Consultation Service to evaluate commercially available field dental equipment through laboratory testing and clinical-user evaluations in theater. The purpose of this 2-year project was to identify the best-performing and most cost-effective field dental equipment for possible future procurement. Initial laboratory testing was performed at the Naval Institute for Dental and Biomedical Research, and the equipment was then shipped to Kuwait for in-theater environmental and clinical-user testing. A seven-member scientific team of military dental officers and technicians was deployed for 1 month to perform in-theater testing under regional environmental conditions and to coordinate clinical-user evaluations. The testing provided beneficial results by identifying equipment that performed properly and equipment that exhibited shortcomings serious enough to render it inadequate for operational use. It is recommended that the project serve as a model for future testing and evaluation of medical/dental equipment by all of the military services.     

Clinical user evaluation of field dental equipment under military deployment conditions

The purpose of this work was to evaluate the clinical performance of a number of types of field (i.e., portable) dental equipment used under actual military deployment conditions. This equipment is often used under demanding field conditions where temperature, humidity, and air quality are not controlled. This article presents the results of a project conducted by the Naval Institute for Dental and Biomedical Research and the Air Force Dental Evaluation and Consultation Service to evaluate commercially available field dental equipment through laboratory testing and clinical user evaluations at military deployment sites. The purpose of the study was to identify the best-performing and most cost-effective field dental equipment for possible operational use by the U.S. Navy. Initial laboratory testing was performed at the Naval Institute for Dental and Biomedical Research and the equipment was then shipped to Okinawa, Japan, where it was tested by military dentists and assistants under deployment conditions. The testing provided beneficial results by identifying equipment that performed properly and equipment that exhibited shortcomings serious enough to render it inappropriate for field use.     

The U.S. Army Institute of Dental Research dental materials shelf-life survey: questionnaire results

To define the nature and the extent of problems that can be related to the storage stability of perishable dental materials in the U.S. Army, questionnaires were sent to each U.S. Army Dental Corps Officer, supply NCO, and laboratory technician. Results reveal that two-thirds of dentists believe that the deterioration of perishable materials is a significant (28%) or occasional (39%) problem in their practice; the most common problem noted by dental clinicians is loss of efficacy of local anesthetics. One-half of clinicians and supply personnel report that they frequently receive perishable supplies at or near the expiration date.     

A model for investigation of mechanisms of cervical spine trauma

A simple and inexpensive method is described whereby models of normal cervical vertebrae may be obtained for investigation of mechanisms of injury. The models may be remelted for reuse after they have been fractured and radiographed. The material for construction of these models is available through any dental supply company or maxillofacial prosthetic laboratory. This process is applicable to other bones of the body     

Improving the dental fitness of the British Army by changing the strategy for dental care provision for recruits from a vertically equitable model to a horizontally equitable model

BACKGROUNDd: The dental health of the British Army has been reported as being in decline for the past 10 years, and this is having a significant impact on operations. One of the major factors in the decline is the increasing number of recruits who enlist with outstanding dental treatment needs. The current policy for provision of routine dental care to recruits targets resources toward those with the worst dental health and provides only emergency dental care for the remainder.AIMSs: The goal was to review recruit dental care provision, to determine whether improvements in the overall dental health of the trained Army could be made during recruit training.RESULTSs: It was found that >85% of recruit dental treatment need could be met with the routine provision of 2 hours of dental treatment during training.CONCLUSIONn: A horizontally equitable model of recruit dental care, whereby all recruits access routine dental care during training, has been recommended to and accepted by the chain of command.     

Narrowing of the inferior dental canal in relation to the lower third molars

OBJECTIVES: To assess narrowing of the inferior dental canal in the lower third molar regions using computed tomography (CT) and to determine the value of radiographic markers on rotational panoramic radiographs in assessing the true relationships of the inferior dental canal. METHODS: Patients referred for CT assessment of impacted lower third molars were used in this study. The lower third molars were assessed using CT to determine the position and morphology of the inferior dental canal relative to the roots and the cortical plates. The radiographic markers on rotational panoramic radiographs were correlated with the CT findings when rotational panoramic radiographs were available. RESULTS: The patients referred had 202 lower third molars. Inferior positioning of the inferior dental canal was the most common location on CT. Narrowing of the inferior dental canal was found in relation to the lower third molars in 66.8% of cases. The chance of narrowing of the inferior dental canal as shown using CT increased when at least one of the radiographic markers, superimposition, narrowing, deviation or reduction in density was present on the rotational panoramic radiograph. Deviation of the inferior dental canal on rotational panoramic radiographs was found to be the most significant predictor of narrowing of the inferior dental canal and a close relationship to the roots, as shown in CT. CONCLUSIONS: Narrowing of the inferior dental canal is a common finding when impacted lower third molars are assessed using CT. On rotational panoramic radiographs deviation of the inferior dental canal is the best predictor of narrowing of the inferior dental canal and a close relationship to the roots.     

A new technique for the postmortem detection of tooth-coloured dental restorations

Identification of unknown bodies is mainly made by dental examination and comparison with accurate dental records. Therefore it is necessary to examine the jaws carefully and to locate every tooth-coloured dental restoration. Overlooking dental fillings can make positive identification impossible. The technique described prepares the natural dental hard tissue by etching with 37% phosphoric acid. In the next step an indicator colours the roughened dental tissue but not the polished restoration material. In this way all 15 tested dental restoration materials could be detected with high sensitivity. Received: 18 November 1997     

Influence of oral health on combat readiness in the Croatian army

The impact of the acute stomatological conditions on the reducing of the combat readiness is an important responsibility for the military planners. Classification of dental health is the primary condition for research and assessment of the army dental readiness for combat. Clinical examination of teeth and mouth included 912 soldiers, 650 of whom were recruits and 262 active duty military personnel. According to their oral status, the examinees were divided into three classes. Class 1 included all those examinees that did not require any dental treatment or reevaluation within 12 months. Class 2 included all of the examinees whose oral health was such that if regularly controlled or followed up, they were not expected to have a dental emergency within 12 months. Class 3 included all of the examinees that required dental treatment to correct both their dental and oral health because the present condition was likely to cause acute stomatological conditions during the 12-month period. This survey designated 130 (14.3%) of the examinees to class 1,178 (19.5%) to class 2, and 604 (66.2%) to class 3. The combat readiness of the 604 (66.2%) examinees in the third class was reduced because a dental emergency can cause the need for dental treatment. The recruits do not have satisfactory dental status even at the beginning of their army service. Unfortunately, active duty military personnel do not have satisfactory dental status either, although they have access to cost-free dental care (prosthetics and orthodontics are not included). This increases the possibility for development of dental emergencies that would have a negative impact on combat readiness.     

Exercise Fatigue in Adolescents: Diagnosis of Athlete Burnout

In brief: When a young athlete complains of chronic fatigue, declining performance, and dental lassitude—symptoms of burnout syndrome—a comprehensive diagnostic approach is required. Identification of anthropometric, physiological, or psychological abnormalities that interfere with normal exercise capacity usually can be made by means of a complete medical history and physical lamination along with limited laboratory testing. In most situations, proper therapeutic intervention will reverse exercise impairment and restore the patient's normal ability to tolerate physical activity.     

快速上颌扩弓与直丝弓矫治器联合使用的临床研究

目的评价快速上颌扩弓和直丝弓矫治器联合使用对牙弓、基骨宽度的影响。方法对18例恒牙早期牙列中度拥挤患者以快速上颌扩弓和直丝弓矫治器进行联合治疗,通过对矫治前后牙腊石膏模型的测量比较,观察牙弓、基骨的宽度的变化。结果治疗后牙弓、基骨的宽度比治疗前增加,统计学分析有显著性差异。结论快速上颌扩弓和直丝弓矫治器联合使用能使牙弓、基骨宽度快速增加,对于治疗牙列拥挤的患者是一种安全、有效的方法。     

Dental and skeletal maturation as simultaneous and separate predictors of chronological age in post-pubertal individuals: a preliminary study in assessing the probability of having attained 16 years of age in the living

The goal of this paper is to explore whether combining dental and skeletal maturation data increases the reliability of determining whether an individual is 16 years old or older. This is tentatively done by building probabilistic models for age estimation based on dental and skeletal maturation using a longitudinal sample of eight males, with annual assessments between the ages of 13 and 19, totalling 56 observations. Skeletal maturity was assessed for the radius and ulna using the TW2 method, and dental maturity was assessed for the second and third molars using Demirjian’s scheme. Logistic regression was selected to determine the probability of an individual being 16 years of age and older, by combining dental and skeletal maturity scores and using them separately. The age estimation models combining dental and skeletal maturity scores seem to perform better than either dental or skeletal maturity in isolation. In addition, when in isolation or combination, models based on skeletal maturity scores seem to outperform models based on dental maturity scores. The findings seem to support the notion that dental development is less reliable than skeletal maturity for age estimation in adolescents, but these results have to be confirmed by further studies.     

Dental CT: imaging technique,anatomy, and pathologic conditions of the jaws

In addition to conventional imaging methods, dental CT has become an established method for anatomic imaging of the jaws prior to dental implant placement. More recently, this high-resolution imaging technique has gained importance in diagnosing dental-associated diseases of the mandible and maxilla. Since most radiologists have had little experience in these areas, many of the CT findings remain undescribed. The objective of this review article is to present the technique of dental CT, to illustrate the typical appearance of jaw anatomy and dental-related diseases of the jaws with dental CT, and to show where it can serve as an addition to conventional imaging methods in dental radiology. Electronic Publication     

Dental diseases and radionuclide imaging of the jaws

The aim of this study was to compare the results of radionuclide bone scans of the jaws with data obtained at the nuclear medicine department from a brief and feasible dental history, taking special account of cases with a positive scan and no recent dental events. Ninety-eight patients undergoing radionuclide bone scan as part of their diagnosis in non-dental, oncological and non-oncological diseases were imaged with 99mTc-labelled oxidronate. Superior and inferior halves of the mandible and maxilla (392 quadrants) were regarded as normal or having an abnormally high uptake. A recent (1 year) dental history was also obtained through a brief questionnaire and data were referred to each quadrant of the jaws. The association between the bone scan and dental disease was assessed by means of the chi-squared test. The overall results of scintigraphy and history coincided in 66 patients (46 with abnormal and 20 with normal findings; P = 0.002). Twenty-five patients had a positive scintigram without any known dental disorder. Results of scintigraphy and history coincided in 254 quadrants (78 with abnormal and 176 with normal findings; P < 0.001). Eighty-three quadrants had hot spots in the scintigram without any known dental lesion. It can be concluded that abnormal jaw scintigrams are frequent in patients without known dental disease, and this may indicate silent osteoblastic activity. These observations should be reported to the dentist for several reasons. First, they may reveal asymptomatic dental lesions. Second, the use of oral prostheses and implants is increasing and they require the support of healthy alveolar bone.     

Osteometry of the mandible performed using dental MR imaging.

BACKGROUND AND PURPOSE: On cross-sectional and panoramic reformatted images from axial (dental) CT scans of the mandible it may be difficult to identify the inferior alveolar neurovascular bundle (IANB) in patients lacking a clear-cut bony delimitation of the mandibular canal. Dental MR images are comparable to dental CT scans, which directly show the IANB; however, measurements of length may not be reliable owing to susceptibility artifacts and field inhomogeneities in the oral cavity. Therefore, the accuracy of length measurements on dental MR images was compared with that on dental CT scans and direct osteometry. METHODS: Dental T1-weighted MR imaging using a high-resolution turbo gradient-echo sequence and dental CT were performed in six anatomic specimens. The axial scans were reformatted as panoramic and cross-sectional reconstructions on a workstation and characteristic cross sections were obtained from all mandibles. The longest axis in the bucco-lingual and apico-basal directions, the distances from the top of the mandibular canal to the top of the alveolar ridge and from the bottom of the mandibular canal to the base of the mandible, and the diameter of the bone cortex at the alveolar ridge were measured with direct osteometry on the cross sections and compared with measurements on corresponding MR and CT reformatted images. RESULTS: The correlation between direct osteometry and dental MR and CT was strong, except for the bone cortex diameter at the top of the alveolar ridge, where only a moderate correlation was found. Means of comparable length measurements were not significantly different among the three methods. CONCLUSION: The accuracy of length measurements in the jaw bones obtained using dental MR is comparable to that of dental CT and is not significantly different from direct osteometry. Thus, dental MR is a potential alternative to CT for dental imaging.     

Perceived initial clinical competencies of dentists at the start and completion of U.S. Air Force Advanced Education in General Dentistry residency programs

OBJECTIVE: The purpose of this study was to determine whether there was a difference in the perceived level of competence in recent dental school graduates before or after completion of a 1-year general dentistry residency program. METHODS: A survey instrument was administered to recent dental school graduates before or after completing a 1-year U.S. Air Force Advanced Education in General Dentistry (AEGD) residency program to evaluate their self-perceived competency in 60 selected diagnostic and clinical areas at the time of their graduation from dental school. Questionnaires were returned by 103 test subjects, for a response rate of 92%. RESULTS: Pearson's chi 2 test revealed a significant difference in self-perceived competence at the time of graduation from dental school between dentists just completing dental school and dentists who had just completed a 1-year postgraduate AEGD residency. Dentists completing a 1-year postgraduate general dentistry residency perceived themselves to be statistically less competent at the time of dental school graduation than dentists who had just completed dental school in 9 of 60 areas. CONCLUSIONS: A significant difference exists in the opinions of new dental school graduates compared with dentists with an additional year of training regarding their level of competence at the time of dental school graduation.     

外伤移位前牙两种固定方法的疗效比较

目的评估片段弓固定法与高强纤维夹板固定法在外伤移位前牙固定术中的临床效果。方法将34例因训练和运动导致上前牙移位和半脱位的门诊军人随机分成两组,分别采用片段弓固定法与高强纤维夹板固定法进行复位固定,8周后通过临床和X线检查,比较其临床应用效果。结果两组34例患者固位效果稳固、无松脱,牙龈组织健康;去除固定后检查外伤牙均无松动,无叩痛;X线检查未见牙槽骨及牙根吸收现象。在即刻效果的美观、舒适方面高强纤维夹板固定法优于片段弓固定法。结论对于外伤所致的上前牙移位和半脱位患者,两种固定法均可有效的固定松动患牙;高强纤维夹板固定法更为美观和舒适,是松动牙固定较为理想的选择。     

保留残根残冠在老年口腔龋病中的应用

目的:重点研究老年口腔龋病中残根残冠的治疗与保留。方法:对139例老年患者223颗患牙进行保存治疗,观察最长5年,最短9个月。结果:139例老年龋病患者的223颗残根残冠全部进行保存治疗,5年有效率为93.8%。结论:老年龋病患者的残根残冠是一种常见的牙体疾病,临床应用的保存治疗方法是有效的,对恢复咀嚼功能有重要的临床意义。     

Contrast-enhanced dental MRI for visualization of the teeth and jaw.

A technique for contrast-enhanced dental MRI is described that enables 3D visualization of the oral cavity, including the jaw and teeth. Since teeth are MR-invisible, the basic principle of this technique is that the teeth and jaw can be observed indirectly through contrast with a surrounding MR-visible medium. For this purpose, the oral cavity is filled with a nontoxic substance, such as water or MR contrast media, that gives a high MR signal. A 3D data set covering the entire buccal space is acquired, and the image intensities are inverted. Since isosurface reconstructions of the teeth and jaw, as well as panoramic views analogous to orthopantomography, can be extracted from these data, contrast-enhanced dental MRI may be useful as a flexible tool for dentistry and orthodontics. Moreover, contrast-enhanced dental MRI works without radiation exposure, and therefore it is an interesting alternative to X-ray-based imaging modalities such as conventional radiography and dental CT. In this article, some preliminary results obtained with contrast-enhanced dental MRI are shown in order to demonstrate the feasibility and performance of this new approach.     

Detecting the manipulation of digital clinical records in dental practice

IntroductionRadiography provides many advantages in the diagnosis and management of dental conditions. However, dental X-ray images may be subject to manipulation with malicious intent using easily accessible computer software.MethodsIn this study, we sought to evaluate a dentist's ability to identify a manipulated dental X-ray images, when compared with the original, using a variant of the methodology described by Visser and Kruger. Sixty-six dentists were invited to participate and evaluate 20 intraoral dental X-ray images, 10 originals and 10 modified, manipulated using Adobe Photoshop to simulate fillings, root canal treatments, etc.ResultsParticipating dentists were correct in identifying the manipulated image in 56% of cases, 6% higher than by chance and 10% more than in the study by Visser and Kruger.ConclusionMalicious changes to dental X-ray images may go unnoticed even by experienced dentists. Professionals must be aware of the legal consequences of such changes. A system of detection/validation should be created for radiographic images.     

Formula for success: the role of the MSC officer and the U.S. Army dental care system

The Army dental care system has seen significant improvements since the Dental Reform Bill of 1977-1978. This bill initiated changes that improved the management and the productivity of the dental care system. Among the many improvements initiated by these reforms was the addition of a Medical Service Corps (MSC) officer as the executive officer. This has been most noteworthy in the successful management of Dental Activities (DENTAC) and Area Dental Labs on Army installations. The job of DENTAC executive officer has become very prestigious and one of the best assignments an MSC officer can receive during his military career. The alliance between the Dental Corps and the MSC officer has been highly successful and rewarding to both parties. The object of this paper is threefold: (a) to review how the dental organization operated before the Reform Bill; (b) to discuss the present role of the dental Executive Officer; and (c) to provide recommendations for the future role of the MSC officer within the Dental Corps.