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Eat an apple a day, but don't keep the dentist away

A child eats an apple during a Trunk-or-Treat event, which featured a healthy snack station as an alternative to candy, at Ramstein Air Base, Germany. (U.S. Air Force photo by Senior Airman Jimmie D. Pike) A child eats an apple during a Trunk-or-Treat event, which featured a healthy snack station as an alternative to candy, at Ramstein Air Base, Germany. (U.S. Air Force photo by Senior Airman Jimmie D. Pike)

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Deployment Health | Health Readiness | Nutrition | Preventive Health

FALLS CHURCH, Va. — From sodas and desserts to fruits and vegetables, sugar can be found in just about anything that’s consumed. While it’s part of almost any diet, sugar can impact more than weight and well-being. It can affect oral health, too.

Army Lt. Col. Paul Colthirst, deputy consultant for Dental Public Health and commander of the Fort Polk Dental Health Activity, said the oral cavity, which includes teeth, tissues, and gums, can tell the entire story of a patient’s overall health. Since everything passes through the mouth, proper nutrition is critical for good oral health, he said.

“Oral health is a big part of mission readiness, so it’s important for service members and their families to take care of their teeth, but it takes more than brushing,” said Colthirst. Tooth decay, a primarily diet-based disease, is one of the main causes for dental emergencies among deployed service members – and it’s preventable.

Colthirst said eating a poor diet filled with carbohydrates, sugars, and starches can lead to various dental health issues, including gum disease and tooth decay. Tooth decay is caused by the breakdown of the enamel – the tooth’s protective layer. When these foods are consumed, they produce sugars and plaque, a sticky film filled with oral bacteria. While consuming the sugars, these bacteria release acids that then break down the enamel, which leads to decay, he added. As the enamel weakens, cavities are formed.

According to the Centers for Disease Control and Prevention, tooth decay is the most common chronic disease for young people ages six to 19 and affects nine out of 10 adults older than the age 20 to some degree.

“People tend to believe that as long as they brush their teeth a couple of times a day that their dental health is assured, but there’s a lot more that goes into having good dental health and strong teeth that comes from nutrition,” said Army Maj. Susan Stankorb, a dietitian at Blanchfield Army Community Hospital at Fort Campbell, Kentucky.

Stankorb said tooth decay can be caused by sugar- and starch-filled substances, such as candy, juice, soda, and energy drinks. Snacking frequently and drinking beverages other than water in between meals causes the acidity in the mouth to increase and prolongs the amount of time the teeth are in breakdown mode, she added. 

“If you’re more of a grazer and you tend to eat fermentable carbs – crackers, anything sticky, chewy, sugary – that will sit in your mouth, you’re going to be more prone to having cavities or dental issues if this habit is consistent over time,” said Stankorb. The average acidity, or pH, of saliva is 7. On a scale of 0 to 14, this is considered neutral. Sticky or sugar-filled foods tend to bring the pH level down to about a 5.5 – the level where the cavity process begins.

While some nutritious foods containing natural sugars, including milk and fruit, should be included in the diet regularly, foods with added sugars should be limited. Reading labels helps keep track of the amount of sugar, carbohydrates, and starch in food and drinks. However, it’s important to also consider the serving size and number of servings per package. Stankorb recommends eating on a regular meal and snack schedule with at least three hours in between meals, and limiting non-nutritious snacks high in added sugars.

“If something acidic like soda or juice was consumed, we recommend not brushing immediately afterward because that can be very hard on the enamel,” said Stankorb, who recommends waiting at least 20 minutes to brush teeth; in the meantime, drink water to rinse the mouth. Staying hydrated with water produces saliva, which neutralizes pH in the mouth, prevents decay, and hardens teeth, she added. 

Foods that can help with dental health include nuts, raw vegetables, yogurt, and cheese. Hard cheese, such as cheddar, helps neutralize decay-causing acids that are produced by bacteria in the mouth. Army Maj. Akeele Johnson, a general dentist at the Fort Polk Dental Health Activity, recommends these steps to help maintain or improve dental health:

  • Drink sugary or acidic drinks quickly to limit exposure to teeth, and drink them through a straw to minimize contact with the teeth.
  • Replace sugary beverages with sugar-free drinks, water, or unsweetened coffee or herbal tea.
  • Limit juice to 6 ounces of calcium-fortified juice per day.

Teeth should be brushed twice a day in circular motions with fluoride toothpaste and the mouth should not be rinsed after brushing, said Johnson. By not rinsing or consuming anything for 20-30 minutes after brushing, fluoride is able to stay on the teeth for protection.

“Oral health is a showstopper,” said Johnson. “We want people to have good health, and we’re here to help.”

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Since 1999, the Medical Surveillance Monthly Report (MSMR) has published periodic updates on the incidence of malaria among U.S. service members. Malaria infection remains an important health threat to U.S. service members, who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. This update for 2017 describes the epidemiologic patterns of malaria incidence in active and reserve component service members of the U.S. Armed Forces. Findings •	A total of 32 service members were diagnosed with or reported to have malaria, which is the lowest number of cases in any given year during the 10-year surveillance period. •	Health records documented the performance of laboratory tests for malaria for 22 of the cases. The tests for 17 of the 22 were positive for malaria ( stick figure graphic visually depicts this information). •	In 2017, 75.0% (24 of 32) of malaria cases among U.S. service members were diagnosed during May – October (calendar graphic showing the months visually). •	Of the 32 malaria cases in 2017, more than 1/3 of the infections were considered to have been acquired in Africa. Two bar charts display the following information: •	Bar chart 1: Numbers of malaria cases by Plasmodium species and calendar year of diagnosis/report, active and reserve components, U.S. Armed Forces, 2008 – 2017  •	Bar chart 2: Annual numbers of cases of malaria associated with specific locations of acquisition, active and reserve components, U.S. Armed Forces, 2008 – 2017  The majority of U.S. military members diagnosed with malaria in 2017 were: •	Male (96.9%) •	Active component (81.3%) •	In the Army (75.0%) •	In their 20’s (56.3%) Access the full report in the February 2018 MSMR (Vol. 25 No. 2). Go to www.Health.mil/MSMR  Picture of a mosquito displays on the graphic.

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Outbreak of Influenza and Rhinovirus co-circulation among unvaccinated recruits, U.S. Coast Guard Training Center Cape May, NJ, 24 July – 21 August 2016

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On 29 July 2016, the U.S. Coast Guard Training Center Cape May (TCCM), NJ, identified an increase in febrile respiratory illness (FRI) among recruits who were unvaccinated against seasonal influenza as a result of the annual vaccine’s expiration. This report characterizes the outbreak and containment measures implemented at TCCM during the outbreak period. In 2016, respiratory infections affected more than 250,000 U.S. service members and comprised approximately 22% of medical encounters among military recruit populations – who are highly susceptible to respiratory infections. Seasonal influenza and rhinovirus are two of the leading respiratory pathogens. During the Surveillance Period: 115 recruits reported respiratory infection symptoms. Pie chart 1 shows the following data: •	41 (35.7%) suspected cases •	74 (64.3%) confirmed cases Among confirmed cases, lab specimens tested positive for: •	Influenza A 34 (45.9%) •	Rhinovirus 28 (37.8%) •	Influenza A and rhinovirus co-infection 11 (14.9%) •	Rhinovirus and adenovirus co-infection 1 (1.4%) Data above depicted in pie chart 2. •	24 July – 6 August, Influenza predominated •	7 August – 20 August, Rhinovirus predominated Although the outbreak significantly affected operations at TCCM, a timely and comprehensive response resulted in containment of the outbreak within 5 weeks. Key Factor for Outbreak Control •	Rapid detection through FRI sentinel surveillance •	Quick decision-making •	Streamlined response by using a single chain of command •	Rapid implementation of both nonpharmaceutical and pharmaceutical interventions Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

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Department of Defense Global, Laboratory-based Influenza Surveillance Program’s Influenza vaccine effectiveness estimates and surveillance trends, 2016 – 2017 Influenza Season

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Each year, the Department of Defense (DoD) Global, Laboratory-based Influenza Surveillance Program performs surveillance for influenza among service members of the DoD and their dependent family members. In addition to routine surveillance, vaccine effectiveness (VE) studies are performed and results are shared with the Food and Drug Administration, Centers for Disease Control and Prevention, and the World Health Organization for vaccine evaluation. This report documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season VE results. The analysis was performed by the U.S. Air Force School of Aerospace Medicine Epidemiology Laboratory, and the DoD Influenza Surveillance Program staff at Wright-Patterson Air Force Base, OH. FINDINGS: A total of 5,555 specimens were tested from 84 locations: •	2,486 (44.7%) negative •	1,382 (24.9%) influenza A •	1,093 (19.7%) other respiratory pathogens •	443 (8.0%) influenza B •	151 (2.7%) co-infections The predominant influenza strain was A (H3N2), representing 73.8% of all circulating influenza. Pie chart displays this information. Graph showing the numbers and percentages of respiratory specimens positive for influenza viruses, and numbers of influenza viruses identified, by type, by surveillance week, Department of Defense healthcare beneficiaries, 2016 – 2017 influenza season displays. The vaccine effectiveness (VE) for this season was slightly lower than for the 2015 – 2016 season, which had a 63% (95% confidence interval: 53% - 71%) adjusted VE. The adjusted VE for the 2016 – 2017 season was 48% protective against all types of influenza.  Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

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Insomnia and motor vehicle accident-related injuries, Active Component, U.S. Armed Forces, 2007 – 2016

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1/25/2018
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Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

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This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

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Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

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