Page 88 - JSOM Summer 2023

challenges when needing immediate medical evacuation ser- patient needs, and evaluation and discussion of periodontal
vices, which studies have reported are crucial to both military disease risk factors.
and civilian populations alike.
Pre-assignment dental treatment could reduce the need for
As noted in this review, medical evacuations related to dental medical evacuations and be useful to all civilian and military
problems and OMF injuries occur rather frequently in both personnel working in remote environments.
military and civilian populations and have been shown to be
an international occurrence. Previous studies have shown that Conclusion
dental and OMF problems often account for one of most fre-
quently cited reasons for medical evacuation. The Macintosh, For both military and civilian populations, increased dental
Toner, and Nice studies have shown dental issues were a top support on site with appropriate equipment could help pre-
four reason for medical evacuation. 10,11,13 The Gunepin et al. vent medical evacuation use. Due to the limited study base of
study showed that dental issues were the number one reason DE/OMF evacuations, further research is needed to determine
for medical evacuation of deployed French troops. As stated their impact on the cost of health care delivery. Increased den-
earlier, the Gunepin et al. study demonstrated the highest den- tal care and prevention strategies should be targeted among
4
tal emergency evacuation rate. Studies have also shown that personnel who work or are deployed to austere environments.
a large percentage of offshore workers in the oil and gas are A key focus should be on applying good preventive dental
classified as medium to high risk for dental disease. Among the care and applying dental fitness standards to civilian workers
civilian population, particularly the offshore workers in the and foreign military prior to going remotely to work. These
oil and gas industry, dental pathology and preventable dental standards include dental treatment to reduce the number of
causes were more often the reason for DEs that led to medi- acute dental emergencies from potentially occurring. A sim-
cal evacuation, whereas among the military populations and ple application of dental fitness standards similar to the US
wilderness expeditions, a combination of injury and dental pa- military would reduce the numbers of DE needing evacuation
thology led to emergencies requiring evacuation. and acute treatment. Another focus should be continued mon-
itoring of US military dental fitness standards and procedures.
Preventive dental care is not going to affect roughly 60–80% If dental fitness of US military units appears to decrease, mea-
of medical evacuations of oral-facial medical evacuations sures should be addressed and utilized to correct the situation.
out of theater. Especially, US military pre-deployment dental
clearance will not have an effect on medical evacuation due to Author Contributions
craniofacial injuries and OMF injuries. However, as Duffy et IQ performed the literature review, organized and collected
al. described, dental fitness standards for civilian oil rig work- data, and wrote the manuscript. TM and JS conceived study
ers in the UK were in place but not enforced. Before going concept and provided critical revision. All authors read and
9
offshore to work, dental examinations and treatment must be approved the final manuscript
done to prevent potential acute dental issues from occurring
and necessitating the need for medical evacuation. Duffy et Disclaimer
al. also described providing additional dental training to “rig The views expressed in this manuscript are those of the au-
medics” assigned to oil rigs and to provide a robust “dental thors and do not necessarily reflect the official policy or posi-
first-aid kit.” Between the training and the kit, they may allay tion of the Department of the Navy, Department of Defense,
the need for costly medical evacuation. 9 nor the US Government. Some of the authors are military ser-
vicemembers and employees of the US Government. This work
Dental readiness is one of six criteria specified in the DoD was prepared as part of our official duties. Title 17 USC. 105
Instruction (DoDI) 6025.19, which determines the deploy- provides that copyright protection under this title is not avail-
ability of military personnel to environments in which dental able for any work of the United States Government. Title 17
care may be limited. Each Sailor, Soldier, Airman, and Marine USC. 101 defines a US Government work as work prepared by
must receive a periodic annual dental examination and have a military servicemember or employee of the US Government
all emergent dental conditions (any condition that is likely as part of that person’s official duties.
to cause a DE within 12 months of examination) treated be-
fore deployment. 22,23 Furthermore, all services have preventive Conflict of Interest
dentistry and health promotion programs. Navy and Marine The authors have no conflicts of interest to report.
Corps personnel are required to have a dental caries and peri-
odontal risk assessment at each annual dental examination to Funding
determine preventive treatment required to reduce the risk of This work was supported by the Defense Health Agency
DE in personnel who have had emergent conditions treated. (G1804).
High caries risk personnel are provided one or more of the
following, dependent on each individual’s risk and needs: oral References
hygiene instruction and oral disease education, fluoride den- 1. Bai G, Chanmugam A, Suslow VY, Anderson GF. Air ambu-
tifrice, sealants for pits and fissures, incipient caries reminer- lances with sky-high charges. Health Aff (Millwood). 2019;38(7):
alization, nutritional counseling, professional topical fluoride, 1195–1200.
home fluoride rinses, antibacterial mouth rinses, bacterial 2. Thibodaux DP, Bourgeois RM, Loeppke RR, et al. Medical evac-
testing (if available), and evaluation of salivary flow. Peri- uations from oil rigs off the Gulf Coast of the United States from
24
odontal disease risk assessment is also provided annually, with 2008 to 2012: reasons and cost implications. J Occup Environ
Med. 2014;56(7):681–685.
high risk members provided the following as needed: referral 3. Griffith DA. Epidemiology, cost, and aircraft choice for aero-
for comprehensive exam by a periodontist or equivalent and medical evacuation in AFRICOM. 2016. https://scholar.afit.edu/
prophylaxis by a dental hygienist, recall based on individual etd/364. Accessed 1 November 2022.

86 | JSOM Volume 23, Edition 2 / Summer 2023