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Military Health System

Why Dental Health is Essential for Warfighters and Military Readiness

Image of U.S. Air Force Major Rachael Parrish, 20th Dental Squadron general dentist, performs an oral exam on Airman 1st Class Amie Bickford, 20th Equipment Maintenance Squadron munitions technician at Shaw Air Force Base, South Carolina, March 13, 2017. Airmen assigned to the 20th DS are tasked with ensuring airmen and soldiers on base meet all dental class requirements for deployment. U.S. Air Force Major Rachael Parrish, 20th Dental Squadron general dentist, performs an oral exam on Airman 1st Class Amie Bickford, 20th Equipment Maintenance Squadron munitions technician at Shaw Air Force Base, South Carolina, March 13, 2017. Airmen assigned to the 20th DS are tasked with ensuring airmen and soldiers on base meet all dental class requirements for deployment (Airman 1st Class Christopher Maldonado, 20th Fighter Wing Public Affairs).

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To help service members understand the importance of healthy teeth, some dentists use military-style terminology.

Tooth decay is an "enemy you are fighting" and you need to "execute a plan to eliminate that foe," said Air Force Col (Dr.) Robin Fontenot, a consultant to the Air Force Surgeon General for expeditionary dentistry.

Fontenot compares routine dental check-ups to aircraft maintenance.

"For our patients in the maintenance world, I like to relate these visits to PM (or preventive maintenance) on their equipment. It's a lot less costly to perform preventive maintenance on any piece of equipment than it is to wait until failure," Fontenot said.

By all criteria, dental health is a key component of "readiness," both for individuals and for units.

About one in five non-battlefield injuries reported by deployed service members are related to dental problems, Fontenot said.

And for those service members who are not up to date on their routine dental screenings, the risk increases significantly.

"A force that is not dentally prepared may see a five-fold increase in deployed dental emergencies," Fontenot said.

Among the greatest concerns is the risk of acute and painful teeth problems, ones that would make it difficult for a person to focus on their mission and might require immediate dental treatment.

More broadly, oral health is important for your whole body. Lack of good dental-oral health can lead to bacterial infections or other conditions that may be serious and affect readiness and mission capabilities.

A key responsibility for military dentists is to decrease the levels of dental emergencies and urgent care requirements during a deployment. That mission "gets at the very core foundation of why we have routine dental appointments" before deployments, Fontenot said.

"These appointments get a member to a best case state of oral health and set up an easier process of maintenance. By getting the annual dental exam and regular dental cleaning, we have established conditions that will lessen the likelihood of dental emergencies."

Linking Oral Health and Overall Health

The Centers for Disease Control and Prevention describes how cavities, also known as tooth decay or dental caries, are the greatest unmet health treatment need worldwide.

"As a dentist, I see dental health as a very fundamental need just like proper nutrition and physical fitness," Fontenot said.

He pointed to numerous studies that show the relationship between periodontal disease and systemic disease such as diabetes and coronary heart disease. "Not that people with systemic disease also have increased incidence of periodontal disease, but it is the fact that periodontal disease exacerbates the systemic conditions. So if you ask where the absence of dental health ranks as a problem—my opinion is 10 out of 10."

"Regular check-ups once a year and radiographs when required ensure treatment of dental disease early with the best materials and the best techniques," said Air Force Col Jay Graver, chief, Defense Health Agency Dental Clinical Management Team. Dental Readiness is a component of the Individual Medical Readiness program.

"The mouth is a gateway to the body," Graver said. "Bad oral hygiene can lead to systemic issues. Additionally, it can lead to problems with eating, which leads to poor or inadequate food intake." Those factors could negatively affect personal and mission readiness.

"If you don't keep up with your oral hygiene, it's a slippery slope to tooth decay, gingivitis, and abscesses," Graver said.

If decay progresses, "you are prone to more invasive treatment, such as root canals, crowns or tooth removal. If gum conditions such as gingivitis are not treated they can lead to periodontitis, or gum abscesses, he said.

The Remedy

Fontenot's main advice is to "master oral health."

"It is not enough to push the brush over your teeth once or twice a day in order to check the box. It is the understanding of the invisible enemy you are fighting, and to develop and execute a plan to eliminate that foe," Fontenot said.

"It is perfecting the art of brush and floss manipulation so that plaque and bacteria never have the opportunity to ruin your day."

Lower first molars are the most commonly restored teeth in the mouth, Fontenot noted. "As much as I would like to say that dentists are perfect, our materials are not. Restorations can fail and require replacement."

The most common tooth to require endodontic treatment, crowns, and the most common tooth (beyond wisdom teeth) that require extraction is the mandibular first molar. Those are the sixth tooth to the right and left of your front teeth.

"Extraction of any tooth within the arch demands properly timed replacement, so my second piece of advice is after you master oral health, put it to work on your mandibular first molars," Fontenot said.

Dental fitness is one of eight domains in the Department of Defense's Total Force Fitness framework. The framework builds healthy habits and improves the military's mission capabilities. Although dental issues make up less than 20% of patient visits, service members' medical readiness depends on healthy teeth.

Dental specialty training provides unique, readiness-focused capabilities such as dental forensics, osteo-stabilization, soft tissue suturing, treatment of maxillofacial infections, triage concepts, intravenous fluid or drug administration, environmental decontamination, and military working dog root canal therapy and prosthodontics.

"Our job as dentists in the military is to keep our soldiers, sailors, marines and airmen ready for deployment, and we have the full spectrum of care capabilities to support and optimize care of the armed forces' dental health," Graver said.

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