1. Results From The 2000 Tri-Service Recruit Oral Health Survey CAPT Andrew K. York, DC, USN CDR Thomas M. Leiendecker, DC,USN Lt Col Gary “Chad” Martin, USAF, DC LTC Bruce B. Brehm, USA, DC Tri-Service Center for Oral Health Studies Uniformed Services University of the Health Sciences

2.  Epidemiological Studies Evaluating Oral Health  Department of Health and Human Services (DHHS)  National Health and Nutrition Examination Survey (NHANES II) began 1976  The National Survey of Oral Health in US Employed Adults and Seniors:1985 - 1986  Department of Defense (DoD)  The 1994 Tri-Service Comprehensive Oral Health Survey ­ Contained a recruit component ­ Congress mandated a Comprehensive Study of Military Medical Care System. National Defense Authorization Act for Fiscal Years 1992 and 1993 PUBLIC LAW 102-190 (SEC.733) 2000 Tri-Service Recruit Oral Health Survey Background

3.  Cross-Sectional Study Design for both 1994 and 2000 Recruit Surveys  Same basic study design for both surveys allows for comparability  Comparisons of cross-sectional surveys conducted at different times can demonstrate trends in disease prevalence and distribution 2000 Tri-Service Recruit Oral Health Survey Study Design

4.  Determine the prevalence of various oral diseases, specific treatment needs and tobacco use  Assess their impact on DoD Dental Readiness Classification  Compare findings to those from the 1994 Tri- Service Oral Health Survey 2000 Tri-Service Recruit Oral Health Survey Objectives

5.  Recruits randomly selected to participate in Survey  4,346 recruits for the 2000 Survey  2,711 recruits for the 1994 Survey  Survey included a comprehensive oral examination by a calibrated dental officer and a patient questionnaire  Samples were weighted prior to analysis, the statistical software program SPSS v10.0 was used for all calculations  Significance was calculated to the 0.01 level (CI=99%)  A single asterisk (*) will appear next to a value or item when statistically significant changes are noted. 2000 Tri-Service Recruit Oral Health Survey Methods

6.  Simple stratified random sampling  Stratified by gender and race/ethnicity  Sample size of 4,346 DoD Recruits (about 5% of pop.)  Time frame - 6 months with quotas for each month ­ Variations by month evident in 1994 data ­ Why not 12 months?  Data Collection  Clinical exam data recorded on laptop computer ­ Data recorded for each tooth down to the surface level  Patient questionnaire completed on scannable form 2000 Tri-Service Recruit Oral Health Survey Sampling and Data Collection

7.  Eight examiners attended 3 day course (Dec 1999)  Calibrated on Caries Diagnosis, PSR and Dental Readiness Classification  Not calibrated on treatment planning  Scientific evidence of re-mineralization of early carious lesions ­ Created dilemma on which technique to use in 2000 Survey  Inter-examiner reliability  Determining the Kappa statistic ­ Very misleading to report “percent agreement” ­ Agreement beyond chance divided by amount of agreement possible beyond chance  Calibration checks during site visits 2000 Tri-Service Recruit Oral Health Survey Calibration of Examiners

8.  Patients used for the calibration course get sick or child has an emergency at school  Unexpected difficulty in recruiting individuals into the military results in weeks where very few recruits enter basic training  Brand new lap top computer had significant power problems  Unexpected TDY or PCS of examiner  Access and Excel unable to accept data base in total due to number of fields exceeding the limit of 256, total fields = 258 2000 Tri-Service Recruit Oral Health Survey Fog of War

9. 2000 Tri-Service Recruit Oral Health Survey Dental Readiness @ Navy and Marine Corps combined has significantly more Class 3s and less Class 2s compared to all DoD. @ No significant changes in Navy/Marine or DoD Incoming Recruit Class 2 or 3 percentages since 1994.

10. 2000 Tri-Service Recruit Oral Health Survey Dental Readiness @ Navy (Great Lakes) recruit Class 3 percentage is far higher than Marine Corps recruits (Paris Island and San Diego). @ Marine Corps recruit Class 3 percentage is more in line with Army and Air Force. @2000 dental classification relationships are consistent with 1994 findings.

11. 2000 Tri-Service Recruit Oral Health Survey Dental Readiness @ No significant difference between Class 3 and Class 2 percentages of Navy recruits compared to Marine Corps, Army, and Air Force recruits when 3rd molar classification is ignored. @ Either the 3rd molars of Navy recruits are in markedly worse condition than those of other service recruits or standardization of 3rd molar classification criteria among our boot camps is poor.

12. 2000 Tri-Service Recruit Oral Health Survey Missing Teeth  DoD-wide increase in the percentage of recruits with no missing teeth.  92.6 percent of Navy and Marine Corps recruits have no missing teeth with only 2.5% having more than 1 missing tooth.

13. 2000 Tri-Service Recruit Oral Health Survey Missing Teeth  Marine Corps recruits have significantly less missing teeth in 2000 vs. 1994.  Navy, Marine Corps, Army, and Air Force recruits have statistically the same percent distribution of missing teeth.

14. 2000 Tri-Service Recruit Oral Health Survey Restorations Needed Per Recruit @ Significant increase in percentage of 2000 Navy/Marine Recruits who have no restorative needs compared to 1994 Recruits @46.7% of Navy/Marine Recruits have no restorative needs, compared to 32.3% (AF) and 23.1% (Army). Is this real or a standardization issue? @2000 DoD Recruits have significantly less restorative needs compared to 1994 DoD Recruits

15. 2000 Tri-Service Recruit Oral Health Survey Restorations Needed Per Recruit @Navy and Marine Corps recruits have a statistically identical level of restorative treatment needs in 2000 data. @Navy and Marine Corps recruits have significantly less restorative treatment need in 2000 compared to 1994.

16. 2000 Tri-Service Recruit Oral Health Survey Restorations Needed Per Recruit By Number of Surfaces @ Significant decrease in mean number of 1, 2, and 3 Surface Restorations required by 2000 Navy/Marine Corps Recruits compared to 1994 Recruits @Both Navy and Marine recruits had fewer 1, 2 and 3 surface restorations compared to the other services.

17. 2000 Tri-Service Recruit Oral Health Survey Restorations Needed Per Recruit (By Type) @ Marine Recruits had significantly more 1 surface and 5 surface restorations compared to Navy Recruits.