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Commander's introduction.

This special issue of the AMEDD Journal celebrates an event that is truly significant, not only for the milestone itself, but also for what it represents for the Army Medical Department as an institution. On March 3, 1911, President Howard Taft signed legislation creating the United States Army Dental Corps as a permanent corps of the Army Medical Department, thus establishing the profession of dentistry as the third essential element, along with physicians and nurses, in maintaining a healthy, effective fighting force. Now, 100 years later, the Army Dental Corps has grown from a specified, limited niche in Army medicine to a corps of medical professionals, not only highly skilled in all aspects of oral healthcare, but also contributing as full partners in diverse responsibilities throughout the entire spectrum of today's Army Medical Department, including research, training, planning, and command. Army dental officers are also serving in a variety of assignments and positions across the Department of Defense, representing both their profession and Army medicine with pride and distinction.

I congratulate the Army Dental Corps for 100 years of devoted service to our Nation and am proud to have the opportunity to present this centennial tribute. This issue of the AMEDD Journal was scheduled and created especially for this occasion, and I know you will find its contents both informative and truly impressive. It recognizes the splendid past of Army dental care, and provides examples of the current state of science practiced by today's Army Dental Corps. The breadth and scope of the capabilities of Army dental professsionals, both past and present, are shown with clarity and detail. The reader will fully understand their indispensable role in accomplishing and maintaining the superior level of total healthcare provided to today's American Warrior, wherever he or she may serve.

I warmly welcome the Chief of the Army Dental Corps, MG Ted Wong, to this special publication. His opening article conveys the pride and dedication demonstrated daily by not only the men and women of the Dental Corps, but the other dental professionals working with them throughout the Army Dental Care System. I join MG Wong in calling for all military medical professionals to celebrate this milestone, not only for what it represents today, but also as the starting point for another century of continued growth and excellence dedicated to the overall health and wellbeing of our gallant Warfighters.

EDITORS' PERSPECTIVE

As mentioned by MG Rubenstein above, this special issue of the AMEDD Journal opens with a commentary by MG Ted Wong, the Chief of the Army Dental Corps. He proudly introduces us to his Corps with an overview of the past and present, and insight to the broad range of skills and capabilities of the men and women dedicated to the dental health and readiness of today's Soldiers.

COL Samuel Passo and COL (Ret) John King have contributed an abridged, updated version of their Dental Corps pamphlet, Highlights in the History of Army Dentistry. This is an excellent, chronological collection of snapshots of the events and people involved in the evolution of dental services for military personnel. It is an informative, revealing look at not only the advances in technology and education which drove the progress of dental science, but also how the influences of politics, economy, and social norms affected various aspects of the development of the dental care structure within the Army.

COL Jeffrey Hodd's article quickly brings us to the cutting edge of the practice of modern dentistry. He describes the adaptation of computer-aided design and computer-aided manufacturing technology into the process of tooth restoration. He focuses on the evolution and application of one of the currently available systems in use at some Army dental facilities. His clear, technically detailed article clearly describes the capabilities of the system and how it is used to create a finished restoration component, such as a crown, at the dental clinic during a single patient visit. This is in contrast to the normal process of the use of a latex molding material to create an impression of the patient's teeth, from which a ceramic cast is created, which is then sent to a laboratory, usually geographically distant, where a crown or other restoration item is constructed and sent to the dental clinic. Of course, this process involves multiple steps, several days, and at least 2 patient visits over a period of time. The system described in COL Hodd's article eliminates all the interim steps. In the hands of a skilled dental staff, it generates a digital map of the teeth patient's, designs the crown for restoration, and constructs that crown, which the dentist then puts into place. The article contains 2 illustrated case studies which clearly demonstrate this advanced capability.

Another approach to the use of digital dental impressions is described by COL Michael Craddock and COL Richard Windhorn. In their article, they discuss another system which creates the digital map of the patient's teeth, which is then transmitted electronically to the Army Dental Laboratory at Fort Gordon, Georgia. Using that digital map, the Laboratory creates the cast model of the patient's teeth, and from that creates the restoration crown, which is sent to the dental clinic. As is the case described in the earlier article, this process eliminates all laboratory preparation work by the treating dentist, and markedly expedites the process of creating the restoration item, but a return visit by the patient is required for completion of the restoration. However, the tradeoff is a smaller, less expensive suite of equipment at the dental facility, which is an important factor for facilities in remote, undeveloped locations, or for units which may be called to deploy at any time.

One of the most critical considerations of the process of endodontic, or root canal, treatment is achieving a complete seal of the root canal space to prevent later bacterial contamination, and resulting infection. LTC John McKissock and his team conducted an extended (10-month) laboratory study of 2 common products used by endodontists to seal the canals to determine if either was superior in preventing leakage over time. This is an excellent example of a carefully designed and documented scientific study which established identical procedures and environment for each individual sample, included a representative control group, and followed precise, controlled evaluation methodology for the results. The article by LTC McKissock et al is yet another illustration of the extent of the knowledge, technical expertise, and initiative that is characteristic of today's military dental professionals.

The benefits and uses of digital technology in healthcare seem to be limitless, not only in research and direct patient care, but also in areas of support, resulting in markedly enhanced productivity. LTC Jeffrey Marks and MAJ Thomas Strohmeyer describe the evolution of one the most significant of such tools in military dental care, the Army Dental Command's Corporate Dental Application (CDA). Originally conceived and developed as a standard solution to replace an array of locally implemented scheduling and workload applications, the flexible, modular design of the CDA has allowed adaptation and growth into a tool that supports numerous functions at many levels of Army dental care. Their article is an excellent overview of a true success story--a "home grown" enterprise application developed, implemented, and maintained by the Dental Command's own Information Management and Technology Division. The CDA has been successfully extended far beyond its original concept, and continues to be adapted by innovative units to assist them in providing the best possible dental care, wherever they may be. One such significant initiative is the subject of the next article.

Accurate, current examination and treatment records are a necessity for all medical practitioners. The Department of Defense has pursued development of a standard electronic military medical record for a number of years, and a dental record module has been a part of that effort. However, to date no satisfactory, military-wide application has been fielded. Consequently, over time the Dental Command has increasingly turned to the existing CDA which, although not originally designed to capture treatment data, has been modified several times to accommodate such use. As described by COL Steven Eikenberg et al in their article, during 2 deployments to Iraq, the 502nd Dental Company Area Support developed methodologies and practical protocols to use the CDA as their electronic dental record in-theater, with excellent results. Their work led to further modification of the CDA to improve its utility, as well as the development of Army policies and guidelines to establish uniformity of the recorded data. This excellent article contains the impressive treatment encounter and diagnosis data collected by the 502nd during their latest deployment. The data clearly demonstrates the significant utility and value that this adaptation represents, not only to healthcare in a deployed environment, but in potential garrison applications as well.

The extended combat operations since 2001 have involved extensive mobilization of Army Reserve and Army National Guard units. Similarly to previous major activations of Reserve Components, during the early years of these mobilizations, a large percentage of activated Soldiers were deemed not dentally ready for duty. COL Mark Bodenheim addressed this situation in the January-March 2006 AMEDD Journal, where he described the aggressive actions taken by the US government to mitigate the problem. In this issue, he provides an update on the implementation of programs and electronic records and reporting systems which have dramatically improved the readiness of reporting Reserve Component Soldiers. His article is an eye-opening look at the extensive efforts that were involved in coordinating, synchronizing, and standardizing the dental reporting systems that existed across the 3 Army components. Also, he discusses steps taken to support dental care to Reserve Component Soldiers outside of alert and activation status, a critical element in reducing the extent of dental readiness problems upon mobilization. COL Bodenheim's article provides valuable insight into the complexities and extent of coordinated work involved in contending with this serious aspect of national military readiness.

All military services face a situation similar to that described above with regard to their recruit training centers. Since new recruits are from the general population, their oral health conditions vary significantly, reflecting their pre-entry dental health care history which is dependent on financial factors, availability of care providers, and simple personal attention to oral hygiene. As with activated Reserve Soldiers, most new recruits require dental work to achieve operationally ready condition, and that work must be completed before the recruit reaches deployable status. Therefore, dental resources must be allocated to ensure those in the recruit pipeline receive the necessary care as they move through training. As part of the planning process, the Department of Defense periodically conducts a detailed survey of the oral health condition of arriving recruits. COL David Moss has provided the portion of that report presenting data on the Army's recruits in 2008. That data is compared to data from surveys in 1994 and 2000 to illustrate trends (or the lack thereof) and spotlight the areas of dental care that commonly require the most attention. This article is informative and interesting, not only for its application to support of operational readiness, but also for its insight into oral health conditions among the demographic of the civilian population from which the military draws recruits.

For years the Army Dental and Trauma Research Detachment was located at Great Lakes, IL, where it performed its mission with great dedication and effectiveness, in spite of the seemingly relative isolation from other Army medical and dental resources. However, in the past year that situation has improved dramatically. In their informative article, MAJ Davin Mellus and Ms Jacqueline Amaya describe the recent relocation of the Detachment to the new Battlefield Health and Trauma (BHT) Research Institute on the grounds of the Brooke Army Medical Center in San Antonio. In conjunction with the relocation, the Detachment has also been aligned under the Army's Institute of Surgical Research (ISR), which is one of the keystones of the BHT Research Institute, along with Navy and Air Force research units. MAJ Mellus and Ms Amaya detail how the relocation and realignment represent a major milestone in both the mission and capabilities of the Detachment. The relocation into state-of-the-art facilities provides significant opportunities for extensive onsite collaboration among top notch researchers in related fields. The markedly improved availability of resources and the alignment with ISR has allowed the Detachment to redefine its mission into areas that until now were impractical, or in some cases impossible, for them to pursue. For many readers, this article may be an introduction to a vitally important component of Army healthcare. For others, it presents valuable information about the evolution of an invaluable resource for information and assistance in the areas of craniofacial trauma and infectious dental diseases.

In discussions of the practice of medicine, one often hears the question "who heals the healers?" In Army medicine, the answer is simple: we do! In this special issue of the AMEDD Journal, we are pleased to include an article detailing a research project directed specifically at the health and well-being of those in the oral health profession who provide patient care. Dr David Greathouse and his research team have contributed a report on their study evaluating upper-extremity musculoskeletal disorders, including carpal tunnel syndrome, among experienced Army dental assistants as they underwent training to become preventive dental specialists. Their research sought to determine whether the 12 week intensive training course would instigate any physical problems, or exacerbate any such problems individuals may have had prior to entering the course. This study is one of several focused on dental caregivers which has been conducted within the Army-Baylor University Doctoral Program in Physical Therapy. The report is a very thorough, extensively researched and referenced, comprehensive presentation of the research team's study project, including detailed data of their results. Publication of this excellent report serves 2 important purposes; it highlights a potential area of concern for dental caregivers as they practice their specialties, and it demonstrates the level of professional expertise and capability within military medicine which is available to our personnel, including the best care for caregivers that can be provided.

This special tribute to the US Army Dental Corps closes with 5 clinical reports illustrating the broad range of skills and capabilities that is characteristic of Army dental professionals. Each of these articles presents a different facet of oral care, including fracture repair, total dental rehabilitation, and various types of tumor removals, all of which required significant reconstruction of bone structure and tooth replacement. These articles are but a few examples of the excellent work done every day by the dedicated members of the US Army Dental Corps and their associated dental support personnel in locations worldwide.

COL Karen Keith and CPT Tyler Clark present a somewhat unique case involving a penetrating wound to the roof a child's mouth which included a palatal fracture and displacement of the bone up into the nasal vestibule. Their article carefully describes the unusual circumstances surrounding the injury and the method used to repair the damage. They also use the unique situation and characteristics of this injury to discuss the broader considerations that clinicians should understand when presented with an injury of this nature. Their detailed literature search produced a wealth of information about undiagnosed associated injuries, neurologic concerns, and the efficacy of various diagnostic techniques. All dental professionals should be familiar with the information presented in this article because this type of injury is usually one of children, and therefore may not be seen by military clinicians very often.

MAJ Thomas Johnson and his coauthors describe a case that was diagnosed as a not uncommon benign tumor on the gingival tissue, but, on further examination, led to a more involved treatment protocol. In this interesting case, the tumor was associated with a dental implant which itself had been positioned incorrectly when inserted. Further, the tumor normally develops in women during puberty and pregnancy, but this female patient was postmenopausal and undergoing hormone replacement therapy. The treatment involved removal of the tumor, but also removal of the implant, and placement of a new implant requiring some restoration of bone tissue. The authors performed a literature search to investigate the possible relationship of the tumor to the hormone replacement therapy. Their findings indicate that no locatable research has been conducted on that relationship. This is a clearly presented, well-illustrated article that completely documents all aspects and considerations of this diagnosis and treatment. It should be of interest to all dental practitioners who encounter similar tumors among women in similar age and therapy circumstances.

The military healthcare professional rarely ceases to apply his or her skill, talents, and knowledge to contribute to the health and wellbeing of society after leaving active duty for the last time. Such is the case with retired COL Richard Collins, who teamed with Dr Rafael Flores Asturias to present a case they encountered at a volunteer dental clinic in Guatemala. They discovered and treated a rare tumor, called benign cememtoblastoma. Their literature search revealed less than 100 reported cases of this particular type of tumor. Complicating the condition was a secondary, unusually rapid growing lesion. That rapid growth had been stimulated by a previous, fairly primitive treatment procedure. Correct treatment of this tumor ultimately involved significant surgical procedures, and resulted in removal of teeth, a nerve bundle, and portions of the jaw bone which required reconstruction. This article contributes a superbly presented, clearly documented and illustrated case study to the body of literature concerning this fairly rare condition. The careful diagnosis and extensive treatment performed under less than ideal clinical circumstances is yet another testament to the skill, knowledge, and, above all, dedication of the dental and medical professionals that wear the uniforms of the US military.

Almost everyone knows someone who, for whatever reason, has lost all of their teeth as they aged, usually from a lifetime of neglect of their oral hygiene and dental care. However, we would consider it to be unusual (outside of trauma) for a young person, especially a teenager, to have an advanced dental condition that endangered virtually all of their teeth. COL David Mott, LTC(P) Minaxi Patel, and LTC Dong Soo Park have contributed a clinical report documenting such a situation. They describe a 19-year-old Soldier's presentation with a condition known as dentinogenesis imperfecta, a genetic disorder that affects the majority of the teeth, which, without treatment, ultimately results in serious deterioration and tooth loss. In the case of advanced deterioration such as they encountered here, the only effective treatment is total rehabilitation, which is a multidiscipline endeavor involving prosthodontics, periodontics, and dental implant surgeries. The article is an excellent case study of careful research, thorough planning, close coordination, and a complex course of treatment over a period of time, during which 8 teeth were extracted, 7 implants were placed, and 16 teeth received crowns. The treatment not only resolved the complaints of oral pain and sensitivity, but also tenderness in the muscles of the jaw and the aesthetics of the appearance of the teeth. As depicted in the article's imagery, the process and results were indeed impressive, yet another example of the exceptional level of oral healthcare our Army Dental Corps professionals provide to Soldiers every day, wherever they may be.

This special issue of the AMEDD Journal closes with an excellent, clearly presented clinical report describing treatment of another type of oral tumor, an ameloblastoma. In their article, MAJ Michael Ryhn, COL Jeffrey Almony, and COL Albert Manganaro detail the potentially serious nature of this aggressive form of tumor, and present the concerns and complications of the corrective surgical procedures. As with some of the other procedures described in this issue, portions of the patient's jaw bone were removed, bone grafts inserted, and reconstruction with dental implants was performed to replace the lost teeth. This article portrays another team of skilled, dedicated military dental professionals who collaborate to create a total treatment plan, and then work over an extended period of time to restore the patient to full function and health. This informative article is well researched and illustrated, and provides further insight to the extent of the talents, skill, knowledge, and capabilities that are hallmarks of the members of the United States Army Dental Corps.
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Title Annotation:Perspectives
Author:Rubenstein, David A.
Publication:U.S. Army Medical Department Journal
Geographic Code:1USA
Date:Jan 1, 2011
Words:3369
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