Improving Preventive Dentistry to Maximize Air Force Readiness and Productivity

The Air Force Medical Services aims to support the mission by the implementation of full spectrum medical readiness. Air Force dentists should strive to deliver quality care and encourage healthy behaviors in order to maintain medically ready airmen. The best way to improve oral health is by focusing on low-cost prevention rather than high-cost treatment. Preventive dentistry aims to reduce the incidence and prevalence of disease by focusing on prevention. Every Air Force dental clinic has a preventive dentistry program that oversees caries/periodontal management and prevention, community outreach, tobacco cessation and counseling and trauma prevention. The impact of the preventive dentistry program is currently limited by time, cost, manning, and participation. By improving preventive care, we can take strides to maximize Air Force readiness and productivity.

The most efficient way to prioritize prevention is by utilizing dental population health metrics collected at annual dental exams, recorded in corporate dental system, and published in an annual Oral Health Report (OHR). Analysis of the OHR (FY01-17) has revealed that high caries risk (HCR) and dental readiness class 3 is most common amongst junior enlisted. Periodontal disease increases with age and is more common in males and certain career fields (logistics and support). Tobacco use was found to be higher in males, junior enlisted, unmarried personnel, and logistics and support career fields. This is important because tobacco use is positively associated with HCR, periodontal disease, and dental readiness class 3. Overall, there has been a decrease in tobacco use from 2001-2017, but smokeless tobacco use has increased. There is currently no option to track vaping but an update is in the works. By using this information, we are able to identify and target at-risk populations/units.

The preventive dentistry program faces many problems. The success of prevention relies heavily on patient compliance, which is currently not enforced by the squadrons. Broken appointments act as a double blow by not treating the patient or a patient who could have been treated. The dental corps is also undermanned by dentists, registered dental hygienists, and prophy techs resulting in fewer appointments available. Currently at LRAFB, there is a lack of squadron briefings conveying our issues and providing education. Lastly, there is no clear pathway for patients who are interested in quitting tobacco products, which contribute to many health problems. The preventive dentistry program can be greatly improved by focusing on our high-risk junior enlisted, increasing squadron support, offering squadron briefings, increasing manning, and developing a clear tobacco cessation plan.

I believe our first efforts should focus on our junior enlisted. When young airmen first attend basic military training, they are taught about military bearing. They are expected to hold themselves to a certain standard and represent the Air Force. I believe this should extend to their health. Upon arrival to Lackland AFB, incoming members are required to pass through dental for a panoramic X-ray. During this time, we should take a few minutes to review oral hygiene instructions, which shouldn’t be a problem at Lackland AFB, home to every specialty of dentistry. In addition to that, I believe implementing brushing for two minutes twice a day should be enforced at BMT. This small addition could be pivotal in teaching disciplined airmen how to conduct themselves on a daily basis. In addition to that, an airman's first introduction to a new base is through FTAC. In the past, dental would give a 5 min briefing to inform airmen of the services available. This segment was cut from FTAC briefings and I believe it should be re-implemented. The effect of focusing on junior enlisted will be an improvement in oral hygiene resulting in a decrease in oral disease, treatment expense, and lost man-hours. This plan can potentially backfire if some airmen relate brushing their teeth to BMT and try to avoid it. Overall, I believe the net effects will result in healthier, more disciplined airmen.

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Individual squadron support will be crucial to increasing compliance and ensuring their young airmen stay disciplined. I propose implementing squadron report cards that will report dental readiness stats, lost man-hours, and money lost by broken appointments. By seeing how much work time high-risk individuals are missing, squadron commanders will be more likely to hold their members accountable. We need squadron commanders to support and enforce mandatory participation in the HCR program and discipline their members for broken appointments that could have been used to treat other members. The effects of implementing squadron report cards may increase squadron support resulting in overall healthier squadrons. Some negative effects may be increasing busy work/annoying squadron leaders leading to resentment and loss of support. However, I think seeing improving numbers in squadron report cards will help keep commanders invested.

Offering squadron briefings can help educate and may increase compliance. The formation of medical briefing teams can also be advantageous in promoting overall health and readiness. We can use population health metrics to identify the high-risk squadrons and offer the deployment of a medical briefing team comprised of various clinics such as dental, mental health, physical therapy, and others who can contribute. This will ensure that all healthcare teams are working together and can improve multidisciplinary issues. For example, a dentist, psychologist, and physician can work together to develop an efficient plan for tobacco cessation and counseling. The dental team member would focus on self-care such as oral hygiene instructions, nutritional counseling, tobacco education, and/or trauma prevention. This will also be beneficial in advertising the resources that different clinics offer. Squadron briefings will result in more educated airmen and hopefully lead to higher compliance and improved health. A negative result is that these briefings can, and probably will, be seen as just another briefing/waste of time and may result in less productivity if an extra meeting is added. However, these briefings can be conducted on training days, during classes, or even during roll call to minimize the impact on performance.

Currently the dental corps is getting smaller, but I believe it should be growing the number of prophy techs and dental hygienists to ensure adequate coverage. Civilian practices promote two cleanings a year and currently the Air Force only strives for one. The effects of improving periodontal health will result in healthier teeth/gums and lead to lower incidence of disease and save money/treatment over time. A negative effect of offering more cleanings is more appointments resulting in an initial decrease of productivity, but will likely result in fewer appointments over a career. Also, the Air Force will have to spend a lot of money to hire/train personnel. With the transition to DHA taking place this is unfortunately the least likely change to take place.

Last but not least, improvements must be made to the current tobacco cessation plan. There is no clear avenue for a patient to quit tobacco products. At this point in time, dental and mental health only provide tobacco counseling and encourage patients to seek assistance (nicotine replacement therapy) from their PCM. Dentists can be credentialed to manage tobacco cessation medications but currently lack training opportunities. I believe getting dental more heavily involved in tobacco management will lead to more successful tobacco cessation. This will also free up more medical appointments by freeing up PCM’s. A potential problem with this is potentially increasing the work for dentists who are already facing manning issues. However, I believe that investing that time now will result in less disease in the future.

The preventive dentistry program can be improved in many ways requiring the support of the Air Force, patients, supervisors, and dental teams. There will be an initial investment in time and money, but the results will be healthier more disciplined airmen leading to an increase in productivity and readiness. The increased presence of dental may lead to resentment/annoyance that could decrease compliance, but outreach will likely result in a favorable outcome. There have been a lot of proposed changes making implementation difficult. However, if at least one of these changes sticks, I believe we will see a positive net result.