Background Dental emergencies experienced during military operations may render individuals unable to operate effectively. To minimise this risk, UK Armed Forces (UKAF) recruits receive a prevention-focused dental care intervention during military training (known as 'Project MOLAR') before their entry to the trained strength of the Armed Forces.
Aim To evaluate whether Project MOLAR is effective in preventing future dental emergency events and subsequent oral disease in UKAF recruits.
Methods This is a retrospective cohort analysis of UKAF recruits who enlisted between 1 January 2011 and 31 December 2011, conducted by analysing electronic primary dental care records. Adverse outcomes were defined as: i) incidence of dental emergency events during the five-year follow-up period; and ii) further oral disease at 18 months measured by an increase in Decayed, Missing and Filled Teeth (DMFT).
Results In total, 7,361 recruits met the inclusion criteria. The total follow-up time for the cohort was 31,957 person-years (mean follow-up 4.3 years/recruit). Individuals whose treatment was completed under Project MOLAR were found to experience a 30% reduction in dental emergency incidence (RR: 0.70-95% CI: 0.63-0.76) (p <0.001) and a 64% reduction in the odds of DMFT increase at 18 months (OR: 0.36-95% CI: 0.28-0.47) (p <0.001) compared to individuals whose treatment was incomplete.
Conclusions Defence dentistry's focus on delivering prevention-focused dentistry early in a recruit's military career confers a downstream benefit to personnel who complete the intervention, such that dental emergency occurrences and DMFT progression are significantly reduced.
Demonstrates that a focus on preventive dentistry early in a recruit's career confers a downstream reduction in the risk of adverse dental outcomes.
Highlights that prevention-focused dental care can reduce the oral health inequality between those that enlist dentally fit and those that do not; however, treatment does not reduce the morbidity risk to the level of those who join with no dental treatment need.
Suggests that individuals who enlist dentally unfit may benefit from targeted preventive interventions to address behavioural factors in order to further reduce their risk of adverse outcomes.
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Combes J, Pepper T, Bryce G, MacBeth N. Dental care provision to UK military personnel serving on Operation Herrick in Afghanistan. Part 1: access to dental care. Br Dent J 2018; 225: 1068-1072.
NHS England. Definitions - Unscheduled Dental Care. 2015. Available at https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/74-dental-definitions.pdf (accessed August 2020).
Scottish Dental Clinical Effectiveness Programme. Emergency Dental Care: Dental Clinical Guidance. 2007. Available at http://www.sdcep.org.uk/wp-content/uploads/2013/03/EDC+Guidance.pdf (accessed August 2020).
Simecek J W. Dental classification and risk assessment prevention of dental morbidity in deployed military personnel. Consensus statements. Mil Med 2008; 173(1 Suppl): 59.
Mahoney G D, Coombs M. A literature review of dental casualty rates. Mil Med 2000; 165: 751-756.
National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. 2004. Available at https://www.nice.org.uk/guidance/cg19 (accessed August 2020).
Defence Medical Services. Joint Service Publication 950 Medical Policy. Leaflet 2-23-1: Primary Dental Care Policy. Annex A: Recording dental fitness categorisation, treatment needs and medical employment standards. 2018.(Internal publication).
Elmer T B, Langford J, McCormick R, Morris A J. Is there a differential in the dental health of new recruits to the British Armed Forces? A pilot study. Br Dent J 2011; 211: E18.
NHS Digital. Adult dental health survey 2009 - summary report and thematic series. 2011. Available at http://digital.nhs.uk/catalogue/PUB01086 (accessed August 2020).
Dermont M, Elmer T, McCormick R. A bridge too far? The relationship between interventive operative dentistry and future dental morbidity. Br Dent J 2019; 226: 498-502.
Hurley S J, Tuck J. 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. Mil Med 2007; 172: 1182-1185.
Defence Primary Healthcare (Dental). Project MOLAR Quarterly returns. 2015-20. (Internal publication).
Dermont M A, Field P, Shepherd J, Rushton R. Evidence into action: implementing alcohol screening and brief interventions in the UK Armed Forces. BMJ Mil Health 2020; 166: 187-192.
Office for National Statistics. Adult smoking habits in the UK: 2018. Available at https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2018 (accessed August 2020).
Broadbent J M, Thomson W M. For debate: problems with the DMF index pertinent to dental caries data analysis. Community Dent Oral Epidemiol 2005; 33: 400-409.
Buckman J E, Forbes H J, Clayton T et al. Early Service leavers: a study of the factors associated with premature separation from the UK Armed Forces and the mental health of those that leave early. Eur J Public Health 2013; 23: 410-415.
Ministry of Defence. Annual Medical Discharges in the UK Regular Armed Forces. 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/627223/20170713-MedicalDisBulletinFinal-O.pdf (accessed August 2020).
Richardson P S. Dental morbidity in United Kingdom Armed Forces, Iraq 2003. Mil Med 2005; 170: 536-541.
Dunn W J, Langsten R E, Flores S, Fandell J E. Dental emergency rates at two expeditionary medical support facilities supporting operations enduring and Iraqi Freedom. Mil Med 2004; 169: 510-514.
Simecek J W, Colthirst P, Wojcik B E et al. The incidence of dental disease nonbattle injuries in deployed U.S. Army personnel. Mil Med 2014; 179: 666-673.
Simecek J W, McGinley J L, Levine M E, Diefenderfer K E, Ahlf R L. A statistical method to evaluate dental classification systems used by military dental services. Mil Med 2008; 173(1 Suppl): 51-55.
Colthirst P M, Berg R G, Denicolo P, Simecek J W. Operational cost analysis of dental emergencies for deployed US Army personnel during operation Iraqi freedom. Mil Med 2013; 178: 427-431.
Wojcik B E, Szeszel-Fedorowicz W, Humphrey R J et al. Risk of dental disease non-battle injuries and severity of dental disease in deployed U.S. Army personnel. Mil Med 2015; 180: 570-577.
House of Commons Defence Committee. The Armed Forces Covenant in Action? Part 4: Education of Service Personnel. 2013. Available at https://publications.parliament.uk/pa/cm201314/cmselect/cmdfence/185/185.pdf (accessed August 2020).
Bernabe E, Suominen A L, Nordblad A et al. Education level and oral health in Finnish adults: evidence from different lifecourse models. J Clin Periodontol 2011; 38: 25-32.
Bernabe E, Delgado-Angulo E K, Vehkalahti M M, Aromaa A, Suominen A L. Daily smoking and 4-year caries increment in Finnish adults. Community Dent Oral Epidemiol 2014; 42: 428-434.
Sheiham A, Watt R G. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 2000; 28: 399-406.
The authors are indebted to Mrs Natalie Weaden and Mrs Elizabeth Gibson (Defence Analysis) for advice on data collection and generation of the dataset, and Dr Suzanne Bartington (Institute of Applied Health Research, University of Birmingham) for advice on study design and analysis.
The authors are HM Armed Forces Officers. There are no commercial interests and no payment has been received for conducting this research.
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Armstrong, S., Dermont, M. Does prevention-focused dental care provision during recruit training reduce adverse dental outcomes in UK Armed Forces personnel? A retrospective cohort analysis. Br Dent J 230, 400–406 (2021). https://doi.org/10.1038/s41415-021-2741-5
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