Oral Health Disparities in the Royal Netherlands Armed Forces

INTRODUCTION

In the military, good oral health is essential for combat readiness. The Royal Netherlands Armed Forces (RNAF) Dental Service is responsible for delivering a high standard of dental care to soldiers to ensure that commanding officers can deploy dentally fit troops. Oral health inequalities are associated with lower socioeconomic status. Rank is reflective of social status within the military hierarchy. The aim of this study was to analyze differences in the oral health status of RNAF personnel in relation to ranks and other determinants.

MATERIALS AND METHODS

All soldiers of the RNAF who underwent a regular dental inspection between January 15, 2018 and February 2, 2018 were enrolled. The decayed, missing, filled permanent teeth (DMFT) index, Dutch Periodontal Screening Index, and Simplified Oral Hygiene Index (OHI-S) were used to assess their oral health. Dental fitness was categorized. Patients were questioned about their smoking behavior and perception of their oral health. Personnel were divided into the following three groups according to rank: officers, noncommissioned officers (NCOs), and enlisted ranks.

RESULTS

Nine hundred and eighty-four soldiers of the RNAF were included in this study. Enlisted ranks had significantly higher DMFT index and OHI-S scores than officers and NCOs (both P < .001), which was associated with smoking and older age. Enlisted ranks were also significantly more often determined to have unacceptable dental fitness than officers and NCOs after the examination (P = .033). There was also a difference in dental fitness classification between officers and NCOs, but this was not statistically significant (P = .103).

CONCLUSIONS

The lowest ranked military personnel are more frequently classified as dentally unfit for deployment than officers and NCOs due to oral health conditions. This is important when considering the allocation of dental resources to maximize the pool of deployable personnel.

Exploring the association of dental care utilization with oral impacts on daily performances (OIDP) - a prospective study of ageing people in Norway and Sweden

OBJECTIVES

To explore the association of dental health care utilization with oral impacts on daily performances (OIDP) across time focusing ageing Norwegian and Swedish adults adjusting for predisposing, enabling, and need related-factors as defined by Andersen's model.

METHODS

Data were based on Norwegian and Swedish 1942 birth-cohorts conducted in 2007 (age 65) and 2012 (age 70). In Norway, the response rates ranged from 54% to 58%. Corresponding figures in Sweden were from 72% to 73%. Self-administered questionnaires assessed OIDP, dental care utilization and predisposing, enabling and need related factors. Logistic regression with robust variance estimation was used to adjust for clustering in repeated data.

RESULTS

Significant covariates of OIDP were satisfaction with dental services, dental care avoidance due to financial constraints, frightening experience with dental care during childhood and patient initiated dental visiting. Frequency and regularity of dental attendance were associated with OIDP in the Swedish cohort, only.

CONCLUSIONS

In spite of country differences in the public co-financing of dental care, dental care utilization indicators were associated with OIDP across time in both cohorts. Encouraging regular and dentist initiated visiting patterns and strengthening beliefs in keeping own teeth could be useful in attempts to reduce poor oral health related quality of life in ageing people.