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The Burden of Dental Emergencies, Oral-Maxillofacial, and Cranio-Maxillofacial Injuries in US Military Personnel.

INTRODUCTION
High numbers of dental emergencies (DE) in military service members (approximately 15% per annum) prompted the inclusion of Dental Readiness as one of six conditions that determine service members' Individual Medical Readiness (IMR). Additionally, even with the advances in body armor and helmet design, Cranio- and Oral-maxillofacial (CMF, OMF) injuries continue to occur in hostile environments. The objectives of this report are (1) to provide a comprehensive review of the incidence of DE and CMF/OMF injuries in US military personnel deployed in multiple environments and (2) to compare the rates of DE and CMF/OMF injuries occurring in the 20th century with the rates observed in the early 21st century.


MATERIALS AND METHODS
Published and unpublished studies, as well as military reports of DE, OMF, and CMF injuries occurring in US military personnel were evaluated. Study publication dates included 1955 to 2017, with data collection periods from 1941 through 2014.


RESULTS
The results of 30 investigations were reviewed. Overall, the reported annual DE rates varied widely among US military personnel between 1966 and 2012, ranging from 26 to 324 (mean 152.2) DE per 1,000 personnel per year (PPY). The average annual incidence of DE for personnel in hostile environments was 125.1 per 1,000 PPY. Thirteen studies reported rates of OMF-CMF injuries from 1941 to 2014. The overall mean OMF injury rate in Operation Enduring Freedom (OEF) was 2.8 per 1,000 PPY, while the mean rate during Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) was 3.2 per 1,000 PPY. A mean of 22.3 CMF injuries per 1,000 PPY was calculated from two reports during OIF.


CONCLUSIONS
The percentage of DE and OMF casualties that can be expected in hostile environments is approximately 12%. Using the most recent data since 2000, the mean DE rate was 118.2 per 1,000 PPY and the OMF rate was 3.0 per 1,000 PPY. Future research should yield information which is representative of the evolving military environment. This information should be used to enhance military-specific dental therapies and to guide protection of the craniofacial region. More importantly, quality data are necessary (1) to enable the accurate prediction of DE, CMF, and OMF casualties to insure that troop levels are sufficient for mission success and (2) to insure that all outcome variables are available to measure policy success or failure.