The Military's Proud History of Oral Disease Prevention

Dental health is a part of overall medical readiness. Over the past 100 years, advances in dentistry, and especially preventive dentistry, have made serious dental infections much more uncommon. Contrary to popular belief, the most common disqualifier for military service in the 20th century was not flat feet, but their dental health and dental complications, such as trench mouth, explains Col. William J. Dunn, DDS, USAF.

A dental examination was required to be a soldier in the infantry in the Civil War. If someone didn't have healthy front teeth, they couldn't be on the lines because they had to be able to hold a musket with one hand, with the other hand be able to reach into their pocket to get their shot and gunpowder; and rip it open with their teeth to put it into the barrel of the shotgun. If they didn't have those teeth, they weren't a soldier, Dunn elaborates.

In World War I, trench warfare was the way wars were fought. Those soldiers stayed in trenches for weeks at a time. The stress level was high, they all smoked, and that was a breeding ground for a condition known as acute necrotizing ulcerative gingivitis, or trench mouth, Dunn continues. Trench mouth is accompanied by a bad fever, and those inflicted with it feel terrible and can be totally incapacitated.

Today, the scenario is much different, with every active duty military member receiving an initial comprehensive examination, which includes a caries risk assessment, and military personnel are treated until they are in a state of dental health that requires no more treatment, including dental prophylaxis, Dunn says. Military personnel have a mandatory dental examination at least once per year, and programs are in place to ensure that no one falls between the cracks.

“They are told what their problems are, what is needed to reach a state of optimum dental health, and then the appropriate appointments are made before they leave,” Dunn continues. “If they don't make that appointment, it's noted in their record, and they're called and constantly called until they come in. If they don't come in to complete their dental treatment in a timely manner, their commanders are notified, and they can be boarded out of the military for their untreated dental condition.”

Interestingly, in 2008, the Tri-Service Center for Oral Health Studies looked at the oral health of incoming recruits, conducting more than 5,000 comprehensive examinations. According to Col. Jeffrey Chaffin, DDS, MPH, MBA, MHA, of the US Army Dental Corps and Chief of the Dental Care Branch of TRICARE Policy & Operations/TRICARE Management Activity (TMA), recruits come to the military with significant dental disease, which does vary by service. However, more than half of those individuals would be classified as dental class 3, meaning it's an emergent/urgent condition that must be taken care of before they can be deployed. Dental class 1 is an individual with no dental problems, while dental class 2 is an individual with some dental problems, but nothing that is expected to become an issue within a deployment of up to a year.

“It's a little alarming that more than 50% of them show up that first day with dental disease at such a level that they're not deployable. Most of that is due to an access-to-care issue,” believes Col. Gary Martin, DC, US Air Force. “Many of those individuals just have not been able to have regular dental care, or some have never had any dental care during their life, so they come in at 18 years of age never having seen a dentist. The better we do at improving access to care for all Americans, the better our recruits will be.”

“We understand that in the civilian world in our country, 20% to 25% of the people have the bulk of the dental disease, and we have seen a big reduction in our country of dental disease,” Chaffin acknowledges. “However, we still have this part of the population that has a lot of disease, and while I don't have the data to confirm this, the military probably gets a larger percentage of that 20% to 25% of the country coming in.”