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Does prevention-focused dental care provision during recruit training reduce adverse dental outcomes in UK Armed Forces personnel? A retrospective cohort analysis

Abstract

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.

Key points

  • 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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Acknowledgements

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.

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Correspondence to Sarah Armstrong.

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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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