1. Results From The 2000 Tri-Service Recruit Oral Health Survey Lt Col Gary “Chad” Martin, USAF, DC LTC Bruce B Brehm, USA, DC CDR Thomas M Leiendecker, DC,USN 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  Constraints of time, personnel and money  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.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  The percent of 2000 USAF Recruits in dental readiness class 3 has significantly decreased compared to 1994 USAF Recruits  No real change in 2000 DoD Recruits vs. 1994 DoD Recruits

10. 2000 Tri-Service Recruit Oral Health Survey Missing Teeth  No real change in 2000 USAF Recruits compared to 1994 USAF Recruits  Significant increase in the percent of 2000 DoD Recruits who are not missing any teeth compared to 1994 DoD Recruits

11. 2000 Tri-Service Recruit Oral Health Survey Restorations Needed Per Recruit  Significant increase in percent of 2000 USAF Recruits who have no restorative needs compared to 1994 USAF Recruits  Significant decrease in percent of 2000 USAF Recruits who require 4 to 6 or > 7 restorations compared to 1994 USAF Recruits  2000 DoD Recruits have significantly less restorative needs compared to 1994 DoD Recruits

12. 2000 Tri-Service Recruit Oral Health Survey Restorations Needed Per Recruit (By Type)  Significant decrease in mean number of 1 Surface Restorations required by 2000 USAF Recruits compared to 1994 USAF Recruits  Significant decrease in mean number of 1&2 Surface Restorations required by 2000 DoD Recruits compared to 1994 DoD Recruits

13. 2000 Tri-Service Recruit Oral Health Survey Dental Readiness Classification Based Only On Restorative Needs

14. 2000 Tri-Service Recruit Oral Health Survey Percent Distribution Of Class 3 Teeth Among Those Who Are Readiness Class 3 For Restorative Reasons  Significant decrease in percent of 2000 USAF Recruits who have 5 or more Class 3 Teeth compared to 1994 USAF Recruits  Significant increase in percent of 2000 DoD Recruits who have 1 Class 3 Tooth compared to 1994 DoD Recruits

15. 2000 Tri-Service Recruit Oral Health Survey Number Of Teeth Requiring Extraction  Significant increase in percent of 2000 USAF Recruits who require 3 or 4 teeth extracted compared to 1994 USAF Recruits  Significant decrease in percent of 2000 USAF Recruits who require “No” teeth to be extracted and “1 or 2” teeth extracted compared to 1994 DoD Recruits  Identical findings for DoD Recruits

16. 2000 Tri-Service Recruit Oral Health Survey Types Of Surgical Extractions For Recruits With OS Treatment Needs  Significant increase in mean number of “Impaction” Surgical Extractions for 2000 USAF Recruits compared to 1994 USAF Recruits  Significant increase in mean number of “Simple” Surgical Extractions for 2000 DoD Recruits compared to 1994 DoD Recruits

17. 2000 Tri-Service Recruit Oral Health Survey Dental Readiness Classification Based Only On Oral Surgery Needs

18. 2000 Tri-Service Recruit Oral Health Survey Percent Distribution Of Recruits By PSR Code  Significant decrease in percent of 2000 USAF Recruits with PSR Code 0 compared to 1994 USAF Recruits  Significant decrease in percent of 2000 DoD Recruits with PSR Code 2 & 3 compared to 1994 DoD Recruits

19. 2000 Tri-Service Recruit Oral Health Survey Dental Readiness Classification Based Only On Periodontal Needs

20. 2000 Tri-Service Recruit Oral Health Survey Periodontal Sextant Readiness Classification  The mean number of Class 3 sextants has decreased significantly for 2000 USAF Recruits compared to 1994 USAF Recruits  The mean number of Class 2 sextants has increased significantly for 2000 USAF Recruits compared to 1994 USAF Recruits  No change in 2000 DoD Recruits compared to 1994 DoD Recruits

21. 2000 Tri-Service Recruit Oral Health Survey Fixed Prosthodontic Needs  No real change in 2000 USAF Recruits compared to 1994 USAF Recruits  The percent of 2000 DoD Recruits who do not require any Fixed Pros Units has significantly increased compared to 1994 DoD Recruits

22. 2000 Tri-Service Recruit Oral Health Survey Endodontic Needs  No real change in 2000 USAF Recruits compared to the 1994 USAF Recruits  No real change in 2000 DoD Recruits compared to the 1994 DoD Recruits

23. 2000 Tri-Service Recruit Oral Health Survey Percent Distribution Of Endodontic Needs By Type

24. 2000 Tri-Service Recruit Oral Health Survey DWV’s By Discipline

25.  Significant decrease in percent of 2000 USAF Recruits identified with pericoronitis and TMD Findings compared to 1994 USAF Recruits  Significant decrease in the percent of 2000 DoD Recruits identified with TMD Findings compared to 1994 DoD Recruits 2000 Tri-Service Recruit Oral Health Survey Oral Soft Tissue/TMD/Malocclusion Conditions

26.  Cumulative caries experience measured using DMFT Index  Simple count of the (D)ecayed, (M)issing and (F)illed Teeth for each patient  Usually reported as the mean DMFT for a given population  The DMFT for 2000 Air Force Recruits is significantly lower compared to 1994 Air Force Recruits  Similar findings for DoD Recruits 2000 Tri-Service Recruit Oral Health Survey DMFT Index

27. 2000 Tri-Service Recruit Oral Health Survey Other Findings  Three fold increase in percent of 2000 Marine Recruits who had a smokeless tobacco lesion (5.3%) compared to 1994 Marine Recruits (1.6%)  Significant increase in percent of 2000 DoD Recruits who smoked at least 100 cigs in their lifetime (47.2%) compared to 1994 DoD Recruits (37.2%)  Significant increase in percent of 2000 DoD Recruits who smoked daily prior to entering the military (35.0%) compared to 1994 DoD Recruits (16.7%)  Of those Recruits who smoked daily prior to entering the military there was a significant increase in percent of 2000 DoD Recruits who had made a serious attempt to stop smoking cigarettes (61.3%) compared to 1994 DoD Recruits (49.4%)