DIRECTORATE OFHEALTH CARE STUDIES

AND CLINICAL INVESTIGATION

o•"

FLUORIDATION STATUSOF U.S. ARMY

CONUS INSTALLATIONS

September 1993CR 93-003

93-285121111111111 lIIl 11111 IE I 11 E ll U l H

UNITED STATES ARMYMEDICAL DEPARTMENT CENTER AND SCHOOL

FORT SAM HOUSTON, TEXAS 78234-6100

93 22 I 24

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Ia. REPORT SECURITY CLASSIFICATION lb RESTRICT:VE MARKINGS

Unclassified"2a. SECURITY CLASSIFICATION AUTHORITY 3. DiSTRIBUTION/AVAILABILITY OF REPORT

Distribution unlimited; Avaliable for2b. DECLASSIFICATION / DOWNGRADING SCHEDULE pu bli o use.

1public use.

4 PERFORMING ORGANIZATION REPORT NUMBER(S) S. MONITORING ORGANIZATION REPORT NUMBER(S)

CR 93-003NA

6a. NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION

Directorate of Health Care (If applicable)

Studies & Clinical Investigatio I HSHN-H Health Services Command

6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code)

Bldg 2268 Fort Sam Houston, TX 78234-6000Fort Same Houston, TX 78234-6100

8a. NAME OF FUNDING/SPONSORING Bb. OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBERORGANIZATION (If applicable)

8c. ADDRESS (City; State, and ZIP Code) 10. SOURCE OF FUNDING NUMBERS

PROGRAM PROJECT TASK WORK UNITELEMENT NO. NO. NO. ACCESSION NO.

11. TITLE (Include Security Classification)

(U) Fluoridation Status of U.S. Army CONUS Installations.

12. PERSONAL AUTHOR(S)

LTC James A. Lalumandier13a. TYPE OF REPORT 13b. TIME COVERED 114. DATE OF REPORT (YearMonthDay) 15. PAGE COUNT

Final FROM TOSep 93 30 Sep 1993 4016. SUPPLEMENTARY NOTATION

17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and Identify by block number)FIELD GROUP SUB-GROUP Fluoride, Fluoridation, U.S. Army, Dental services

19, ABSTRACT (Continue on reverse if necessary and Identify by block number)

(U) At the request of the Division of Oral Health of the Centers for Disease Controland the Directory of Dental Services, Health Services Command (HSC), a cross-sectionalstudy was initiated to determine the fluoridation status of Army community drinkingwater. All HSC DENTACs and the majority of the subcommands participated in the survey.

Fifty-eight installations reported fluoride levels within the optimal range (0.7 to1.2 ppm) while 16 installations reported fluoride concetrations below 0.7 ppm and 3reported levels above 1.2 ppm.

The results suggest that greater efforts must be employed to insure all installationwater supplies provide optimal levels of fluoridation in order to derive maximumeffectiveness and to prevent the development of dental fluorosis.

"20. DISTRIBUTION/AVAILABILITY OF ABSTRACT 21. ABSTRACT SECURITY CLASSIFICATION0 UNCLASSIFIED/UNLIMITED R SAME AS RPT. 0 DTIC USERS Unclassified

22a. NAME OF RESPONSIBLE INDIVIDUAL 22b. TELEPHONE (Include Area Code) 22c. OFFICE SYMBOLLTC James A. lalumandier (210) 221-0047 HSHN H

DD Form 1473, JUN 86 Previous editions are obsolete. SECURITY CLASSIFICATION OF THIS PAGEUnclassified

ii

TABLE OF CONTENTS

.Page

DISCLAIMER . . . . . . . . . . . . . . . . . . . . . . . . .i

REPORT DOCUMENTATION PAGE (DD 1473) . . . . . . . . . . . . . ii

EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . iv

BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . 2METHODS . . . .. . . . . . . . . ... .

RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . 2

CONCLUSION . .. .. ..... .... .... .... 2

RECOMMENDATION . . . . o . . . . . . . . . . . . . . . . . . . 3

REFERENCES . . . . . . . . ... . . . . . . . . . . . . . . 4

TABLESFluoridation Status of Army Installations in

Health Services Command ............... 7

FIGUREOptimal Fluoride Levels in U.S. . . . . . . . . . . . . 17

APPENDICESAppendix A: Data Collection Form for Each Water Source . . . 19

Appendix B: Tasking to HSC DENTAC Commanders RequestingCommunity Water Fluoridation Status . . . . . . . ° o . 23

Appandix C: Army Regulation 40-35 2 . . . . . . . , . . . 27

DISTRIBUTION . . . .. .. . . . . . . . . . . ° . . • . ° . 35

iBl

Preceding Pages Blank In DOCUMENT

EXECUTIVE SUMMARY

At the requests of the Division of Oral Health of theCenters for Disease Control and the Director of Dental Services,Health Services Command (HSC), a cross-sectional study wasinitiated to determine the fluoridation status of Army communitydrinking water. All HSC DENTACs and the majority of thesubcommands participated in the survey.

Fifty-eight installations reported fluoride levels withinthe optimal range (0.7 to 1.2 ppm) while 16 installationsreported fluoride concentrations below 0.7 ppm and 3 reportedlevels above 1.2 ppm.

The results suggest that greater efforts must be employed toinsure all installation water supplies provide optimal levels offluoridation in order to derive maximum effectiveness and toprevent the development of dental fluorosis.

iv

Background

Water fluoridation has been the dominant factor in thedeclining prevalence of dental caries in the United States. Inthe most recent national survey of U.S. school children (1986-1987), nearly 50 percent of school children had permanentdentition that was caries-free (1). At approximately 51 centsper individual per year, community fluoridation is the most cost-effective approach to provide fluoride to children (2). Today,over 135 million people (54.5%) are drinking optimallyfluoridated water in the U.S. (3). The recommended optimal levelin the U.S. ranges from 1.2 parts per million (ppm) to 0.7 ppmbased on the annual average of maximum daily air temperature (4).(See Figure)

For the past 14 years the Division of Oral Health of theCenters for Disease Control (CDC) in Atlanta has monitored thefluoridation status of drinking water in the U.S. A reportingsystem forwards information from the states to CDC. However,similar data has not been reported by military installations.

This report provides the Army Dental Care System and CDCwith a cross-sectional study of the fluoridation status for themajority of Army DENTACs and subcommands.

Methods

To gather data on fluoridation status, a data collectionform (Appendix A) was sent to all HSC DENTACs. The tasking(Appendix B) requested the following information:

1. The source of water. Does the installation use waterfrom a civilian source or does it have its own sourceof water, such as a well?

2. The most recently available fluoride concentration perwater source and date the water was analyzed.

3. The process of fluoridating or defluoridating water.

a. Are chemicals used in the fluoridation process?The three most common chemicals are sodiumfluoride (NaF), sodium fluorosilicate (NaSiF6),and fluorosilicic acid (H2SiF6).

b. Is the water defluoridated? Some installationsare supplied water which is naturally fluoridatedabove optimal limits and there is need to remove aportion of the fluoride content for drinkingpurposes. The five most common types ofdefluoridators are coagulation/flocculation, ion-exchange, reverse osmosis, electrodialysis, andreversible adsorption onto activated alumina.

4. Type of fluoridation system. Does the water come fromthe ground or surface?

5. Post population. The number of people residing on theinstallation.

Results

All 37 DENTACs completed the tasking (Table). Of the 70Army installations, 45 are post and 23 community treated systems.Two installations have both base and community systems providingdrinking water to the post population.

Fifty-eight installations reported a fluoride level withinthe optimal range from 0.7 to 1.2 ppm. However, 16 installationsreported a fluoride concentration below 0.7 ppm while 3installations reported levels above 1.2 ppm.

Cf the chemicals used in treating drinking water supplies,12 posts reported using sodium fluoride (NaF), 19 sodiumfluorosilicate (NaSiF6), and 27 fluorosilicic acid (H2SiF6).Three installations used a combination of chemicals. Sevenreported using no chemicals with 4 recording below 0.7 ppm levelsof fluoride in the drinking water. Defluoridation was used attwo installations, one of which reported a fluoride concentrationbelow 0.7 ppm.

The source of drinking water among the installations wasnearly evenly divided with 31 reporting ground water and 34surface water. Five installations indicated the source ofdrinking water was from both ground and surface.

The final question was asked to capture the number ofsoldiers and their families residing on the installation. Thetotal post population was over 680,000 with approximately 100,000drinking water below the optimal range. Less than 5% of postresidents had drinking water supplies greater than 1.2 ppm.

Conclusion

There is ample evidence that water fluoridation, whethernatural or adjusted at the optimal concentration, willsignificantly reduce dental caries. However, water suppliesbelow optimal levels will reduce the effectiveness of waterfluoridation and those supplies above optimal levels may lead todental fluorosis. Although this report only informs thecommanders on fluoride concentrations for a specific date, itshould constitute the first step in obtaining more complete datain the future.

2

Army Regulation 40-35 (Appendix C) calls for preventivemedicine activity and post or installation engineers to regulateand monitor the fluoride concentration in drinking water for Armyinstallations. However, the dental fitness officer and/orcommunity health dental hygienist need to carefully review thefluoride status of post drinking water and advise the preventivemedicine officer if the concentration is not within the optimalrange.

Recommendation

1. A conference for all dental fitness officers and communityhealth dental hygienists should be held annually to updatethose individuals on the most current preventive dentistrytechniques.

3

References

1. National Institute of Dental Research. (1989). Oral Healthof United States Children: The National Survey of DentalCaries in U.S. School Children: 1986-1987, National andRegional Findings (NIH Publication No. 89-2247). Bethesda,Maryland: U.S. Department of Health and Human Services,Public Health Service.

2. Burt B.A. (1989). Workshop on cost-effectiveness of cariesprevention in dental public health. Journal of PublicHealth Dentistry, 49, 331-337.

3. Centers for Disease Control. (1991). Fluoridation census1989: Summary. Atlanta: U.S. Department of Health and HumanServices, Public Health Service.

4. Centers for Disease Control. (1991). Water fluoridation-amanual for engineers and technicians. Atlanta: U.S.Department of Health and Human Services, Public HealthService.

4

TABLE

Fluoridation Status of Army Installationsin Health Services Command

5

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FIGURE

Public Health Service's Optimal Fluoride Levels in U.S.

15

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APPENDICES

APPENDIX A

Data Collection Form for Each Water Source

19

r_0

T .

00

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00

U 0 ca

APPENDIX B

Tasking to HSC DENTAC Commanders RequestingCommunity Water Fluoridation Status

23

DEPARTMENT OF THE ARMY

HEADQUARTERS. UNITED STATES ARMY HEALTH SERVICES COMMAND

FORT SAM HOUSTON, TEXAS 70Z34-6000

REPLY TO

ATTENTION OF: 04'ý

S: 29 March 1993

HSDS 3 March 1993

MEMORANDUM FOR Commander, HSC DENTAC

SUBJECT: Community Water Fluoridation Status

1. Request you provide the following data using the encloseddata collection form for each source of drinking water on Armyinstallations within your catchment. Please use one form foreach installation. For example, Fort Meade Dental Activity(DENTAC) has 4 subcommands (Aberdeen Proving Ground, CarlisleBarracts, Fort Detrick, and Fort Ritchie). Please use 5 separatedata collection forms for Fort Meade DENTAC. Each installationwill have one or more water sources as indicated on the form.Data to be collected includes:

a. The most recently available fluoride concentration perwater source, and date water was analyzed.

b. The source of the water. Does the installation use waterfrom the civilian community or does it have its own source ofwater, such as a well?

c. The type of chemicals used in the fluoridation. The threemost common chemicals are sodium fluoride (NaF), sodiumfluorosilicate (NaSiF6), and fluorosesilicic acid (H2SiF6).

d. Type of fluoridation system. Does the water come from theground or surface?

e. Defluoridation status. Some installations are suppliedwater which is naturally fluoridated above optimal limits andthere is need to remove a portion of the fluoride content fordrinking purposes. The five most common types of defluoridatorare coagulation/flocculation, ion-exchange, reverse osmosis,electrodialysis, and reversible sorption onto activated alumina.

f. Post population. The number of people residing on theinstallation.

2. Your DEH should be able to answer most of these questions.

25

HSDSSUBJECT: Community Water Fluoridation Status

3. Our point of contact is LTC James Lalumandier, U.S. ArmyHealth Care Studies and Clinical Investigation Directorate,Dental Studies Division, Fort Sam Houston, Texas 78234-6060,FAX (210) 554-4745, DSN 471-0331; COMM: (210) 221-0331.

Encl PATRICK D. SCULLEYColonel, DCDirector of Dental Services

26

APPENDIX C

Army Regulation 40-35

27

Army Regulation 40-35

Medical Services

PreventiveDentistry

HeadquartersDepartment of the ArmyWashington, DC26 March 1989

29

AR 40-35

Preventive Dentistry

This change 1 changes the--

o Dental fitness Class 4 classification (para 6).

o Preventive Dentistry Report (RCS MED-399) to a semiannualrequirement (para 10).

30

Headquarters *Army Regulation 40-35Department of the ArmyWashington, DC26 March 1989 Effective 25 April 1989

Medical Services

Preventive Dentistry

This publication was last revised on I March This UPDATE printing publishes a change t. By Order of the Secretary of the A.nm

1987. The portions being changed are highlighted. CARL E. VUONOGeneral, (kfted States ArmyC/0ef of staef

Officla"

MILTON H. HAMILTONAdministratve Assisant to 0teSecretary of tw Amry

Summary. This regulation on preventive Internal control systems. This regula- dates unless sooner superseded or rescinded.dentistry has been completely revised. It im- tion is subject to the requirements of AR Suggested Improvements. The propo-plements DODI 6230.3; defines the four 11-2. It contains internal control provisions nent agency of this regulation is the Officeprograms that comprise the Army Preven- but does not contain checklists for con- of The Surgeon General. Users are invitedtive Dentistry Program; fixes responsibility ducting internal control reviews. These to send comments and suggested improve-for administration and implementation of checklists are being developed and will b ments on DA Form 2028 (Recommendedthe Army Preventive Dentistry Program; published at a later date. Changes to Publications and Blank Forms)defines procedures for executing the Army Supplementation. Supplementation of directly to HQDA (DASG-DC), 5109 Lees-Preventive Dentistry Program; defines the this regulation and establishment of com- burg Pike, Falls Church, VA 22041-3258.dental fitness classification scheme and sets mand and local forms are prohibited with-forth procedures for assigning dental fitness oan and alpfor ae proh with Distribution. Distrbutin of this publica.classes; and fixes responsibilities and estab- Out prior approval from HQDA tion is made in accordance with the require-lishes procedures for completing and for- (DASG-DC), 5109 Lesburg Pike., Falls merits on DA Form 12-09-E, in blockwarding the Preventive Dentistry Report. Church. VA 22041-3258. number 2525. for Medical Activities only

Applicability. This regulation applies to Interim changes. Interim changes to this intended for command levels A for Active

the Active Army, Army National Guard regulation are not official unless they are au- Army and ARNG, and D for USAR. Dis-

(ARNO), and U.S. Army Reserve (USAR) thenticated by the Administrative Assistant tribution for all other command levels is Bto the Secretary of the Army. Users will de- for Active Army and ARNG, and D for

Impact on New Manning System. This stroy interim changes on their expiration USAR.regulation does not contain information thataffects the New Manning System.

Contents (uste d by pwagraph numtb•e 1. Purpose Surveillance of Water Supplies at Fixed In-This regulation provides guidance for the stallations. (Cited in paras 5i(3) and

Purpose * I development and conduct ofpreventive den- 9a(l)(c).)References e 2 tistry programs for all authorized bentf- b. Related publications. A related publi-Explanation of abbreviations * 3 ciaries of the U.S. Army Dental Care cation is merely a source of additional infor-Scope of the program e 4 System. It describes the Oral Health Fitness mation. The user does not have to read it toResponsibilities a S Program for active duty soldiers and other understand this regulation. The followingOral Health Fitness Program * 6 programs that benefit all members of the are related publications:Preventive Dentistry Program for Children Army community. (I) AR 40-3, Medical, Dental, and Vet-

(PDPC) a 7 erinary Care.Clinical Preventive Dentistry Program * 8 2. References (2) AR 4.-H.1, U,,f. w,,d S.. vice BCommunity Preventive Dentistry R publicationi o (Rescnded

Program * 9 (1) AR 40-, Preventive Medicine. (Cit- c. Referenced form. SF Form 603, HealthPreventive Dentistry Report (RCS ed in p 0-5 5g(2).) Record-Dental.MED-399) * 10 e npn g2.

(2) AR 40-66, Medical Record and I Explanation of abbreviationsQuality Assurance Administration. (Cited a. CHDH--community health dentalin parn 6e(2)(0.) hygienist

(3) AR 608-1, Army Community Service b. DENTAC--dentai activityProgram. (Cited in para 9c.) c. DFO--dental fitness officer

(4) TB MED 576, Occupational and En- d& DODDS-Department of Defense De-vironmental Health Sanitary Control and pendent Schools

*This reguiawon vqersedes AR 40-35. 25 Febnay 1972.

AR 40-35 * UPDATE

31

e- tlSC-LU S Arms, hIealth Serices (2) AppOin' on orders a dental officer as (5) Lncourag° all dental personric] to

Command the DENTAC/dental unit preventive den- take an actIc part in the Arm) P'rc•,ntie

/ PDl'C--'reventtve Dentistry Program istry/dental fitness officer (DFO) Dentistry Program Provide officer, enlisted.

for Children (3) Appoint, if appropriate, additional of- and civilian personnel with current informa-

g. TSG-The Surgeon General ficers to represent designated units. activi- lion on all aspects of preventive dentistrylies, or patient catchment areas on the and dental public health programs

4. Scope of the program installation. j The community health dental hygien-

(4) Advise unit commanders on a month- ist, where assigned. will assist the DFO as

The Arms Preventive Dentistry Program ly basis on the dental fitness of their com- requested P.esponsibilities will include theincludes the following separate programs:

a. Oral Health Fitness Program. (See mand by dental fitness classification, planning, development, and administrationg. Commanders, U.S. Army medical ac- of the Army Preventive Dentistr) Program.

para . tivities and commanders, U.S. Army medi- k. Officer, enlisted, and civilian dentalb. Preventive Dentistry Program for cal centers will- staff of all DENTACs/dental units will con-

Children. (See para 7.) (I) Provide the necessary administrative duct clinical operations consistent with"

c. Clinical Preventive Dentistry Program. and logistical support required to help en- good preventive practice and support corn-(See para 8.) sure a successful preventive dentistry munity preventive dentistry programs con-

d. Community Preventive Denistry Pro- program. ducted by the dental unit.

gram. (See para 9.) (2) Forward to higher headquarters a

copy of the Command Health Report (RCS 6. Oral Health Fitness Program

5. Responsibilities MED-3(R7)) to include the portion pertain- Responsibility for dental fitness is shared by

a. The Surgeon General (TSG) will es- ing to environmental sanitation concerning commanders, the dental care system, and

tablish policy concerning the Army Preven- the water supply per AR 40-5, paragraph the soldier. The primary focus of this pro-

tive Dentistry Program. 3-M(l). gram is to ensure that soldiers do not be-

b. The Assistant Surgeon General for (3) Advise the DENTAC commander come "noncombat dental casualties."

Dental Services will- when water supply fluoridation standards Within this program, the dental care system

(I) Make recommendations to TSG con- are not met. has responsibilities for fitness classification,

cerning the Army Preventive Dentistry h. Commanders of units supported by a yearly 100 percent audit of records to en-

Program. the Oral Health Fitness Program will- sure accuracy of classification, and dental

(2) Appoint a dental officer as consultant (1) Monitor dental appointments within treatment of soldiers to achieve a satisfacto-

in public health dentistry. their units and attempt to reduce failed ry dental fitness level. The responsibility for

(3) Advise TSG on the dental fitness of appointments. personnel accountability, notification, and

the Active Army. (2) Make personnel available to receive patient availability rests with installation

(4) Advise the Assistant Secretary of De- dental care. personnel support activities and unit

fense (Health Affairs) on the dental fitness (3) Make personnel in dental fitness commanders.

of the Army. Class 3 or 4 who are assigned to rapid de- a. Dental classification.

c. The consultant in public health den- ployment units available for expedited (1) Dental fitness Class I--soldiers who

tistry appointed by TSG will- treatment. require no dental treatment. (On esxamina- -1

(i) Advise on all matters pertaining to (4) Coordinate with the DENTAC/den- tion, no further dental appointments are

public health dentistry and preventive tal unit commander for available treatment given or recommended; for example, if there

dentistry. time. are missing teeth and no replacement is rec-

(2) Report annually on the status of the (5) Coordinate with the DENTAC/den- ommended, the patient is in Class 1.)

Army Preventive Dentistry Program. tal unit commander to audit and monitor (2) Dental fitness Class 2-soldiersArm Pre Demmantistry Prram, U.S. Ar dental health records and accountability of whose existing dental condition is unlikelymy therCommanding General, U.S. Ar- ecords to result in a dental emergency within 12

my Health Services Command (CG, HSC) (6) Coordinate an'd establish with the months.and coandnders of major overseas cam- DENTAC/dental unit commander dental (3) Dental fitness Class 3-soldiers whomands will-- fitness goals consistent with mission require dental treatment to correct a dental

(1) Assume responsibility for the admin- requirements. condition that is likely to cause a dentalistration of policies in this regulation. L The dental fitness officer will- emergency within 12 months.

(2) Appoint a dental officer as consultant (I1) Assist DENTAC commanders/dental (4) Dental fitness Class 4--soldiers whoin preventive dentistry for the command. unit commanders/directors of dental ser- require a dental examination and--those

e. Preventive dentistry consultants for vices in implementing the Army Preventive wo, fitness sau is ,•- o,,/or thoseHSC and major oversea commands will- Dentistry Program. soldiers who do not have confirmation of a

(I) Repor q,, ..... l ....on..the..d..l fit (2) Plan. organize, implement, and evalu- duplicate panograph on file at the centralstatus. of A.,f" "... A s.od, ...... t ... ate the activities of the Oral Health Fitness panographic storage facility. Active duty

pCi7.-1a bed by this sea6 ton. Program, the Preventive Dentistry Program soldiers who miss a second annual examina-Semiannually consolidate Preventive Den- for Children, the Clinical Preventive Den- tion are automatically placed in fitness Classtistry Report information from all tistry Program, and the Community Preven- 4.subordinate units and submit it to the TSG tive Dentistry Program. Where appropriate, b. Procedures.Consultant for Dental Public Health. the DFO may seek the assistance of the (I) Soldiers' records will be screened on

(2) Advise the Assistant Surgeon General community health dental hygienist arrival at a new permanent duty station-for Dental Services on their command's pre- (CHDH) in implementing these programs. (a) Those soldiers whose records indicateventive dentistry program. (3) Coordinate with the preventive no examination in the past year or who are

(3) Monitor and evaluate their com- medicine activity and post or installation classified in Class 3 or 4 will have a dental

mand's operation of the Preventive Dentist- engineers in monitoring the post or installa- fitness examination within 60 days followingry Program for Children, the Clinical tion water fluoridation system. (See TB the records screening. Once a newly arrivedPreventive Dentistry Program, and the MED 576.) soldier classified in Class 3 or 4 is examined

Community Preventive Dentistry Program. (4) Submit through DENTAC com- and removed from Class 3 or 4, his or her

f Commanders of dental activities manders/dental unit commanders/directors next annual examination will be I year from(DENTACs) and dental units will- of dental services a qumrsrryemiannual re- the last treatment.

(I) Ensure that the policies in this regu- port on the Army Preventive Dentistry Pro- (b) Those soldiers whose records indicate

lation are followed, gram. (See para 10.) they are in Class I or 2 will have their next

2 AR 40-35 - UPDATE32

annual examinration I )erCJ trolli thle COHpic- I 1'ro~ide current ro,r'.tcr of sliuci mn 13UD4)5) ol.11i c-01 1-1 witiidci jition of their last course of (reatment or last the unit to the dental facilht th1at supptirr\ dicuon that hadS a OC1enia Iftlinelit c.t'

examination the soldier, (Y and ihiat iý lo.'tcd in an area h J

(c) Records will also be screened to en- 2 Notify soldiers of the suspense for populatiOn of eligible children

sure a panographic radiograph is present in their annual dental examination and renoti- (2) With tie consent of the childd. p.iieitthe record, to ensure it is of adequate quali- fy them in case of noncompliance. or guardian and vithin the consiraiiis ofty for identification purposes, and to ensure 3. Make soldiers identified as Class 3 or available space and resources,, DENTACithat a duplicate has been forwarded and re- 4, or soldiers who require an annual denial dental units/dental clinics will provide-ceived by the central panographic storage examination, available for compliance with (a) To each child, at least annuall), anfacility. If no panographic radiograph is the program. oral screening examination, topical applica-

present, one will be taken and placed in the 4. Establish procedures to deal with (ion of an anticartogenic agent, and oraldental record, and a duplicate forwarded. soldiers who are in repeted noncompliance. health instruction.

(2) Soldiers in basic training or advanced (d) Emphasis will be placed on ensunng (b) To children, when deemed appropri-individual training will not be required to that soldiers being newly assigned to ate by a dental officer, mouthguards andhave a dental fitness examination until they recruiting duty, full-time manning programs placement of pit and fissure sealants.have reached their first permanent duty for the Reserve Components, Reserve Of- (c) To DODDS, materiel support andstation. ficers' Training Corps duty, and Military technical direction for a weekly program of

(3) Soldiers will have their dental fitness Assistance Group or Embassy duty are in 0.2 percent sodium fluoride mouth rinses.classification updated annually by a clinical Class I or 2 before departing for their new (d) Technical direction in the establishexamination. Soldiers who miss a second assignments. merit of safety procedures and monitoringannual examination will be placed in dental (e) Emphasis will be placed on ensuring procedures for the use and storage of fluo-fitness Class 4. that soldiers in rapid deployment forces are ride solutions.

(4) Appointments for dental treatment maintained in a Class I or 2 status. (e) Weekly fluoride mouth rinses under

required to achieve a satisfactory dental fit- (2) DENTAC/dental units. DENTAC/ the administrative supervision of DODDS.ness status will be provided, dental unit commanders are responsible for (3) To be eligible for participation in the

(a) Soldiers in dental fitness Class I re- assisting supported units in maintaining the PDPC( a child will be covered by section

quire no treatment. oral fitness of soldiers. DENTAC/dental 1072(2)(D), title 10o United States Code.

(b) Soidiers in dental fitness Class 2 will unit commanders will perform the following Participation will be voluntary.

be counseled in their dental needs and giv- functions: n (4) The operation of the PDPC will noninterfere with necessary dental services foren an opporwtcity for dental treatment as (a) Serve as advisors to unit commanders active duty soldiers or with emergency care.requested. in determining appropriate dental fitness

(c) Soldiers in dental fitness Class 3 will levels for the unit. 8. Clinical Preventive Dentistryhave the condition causing the potential (b) Screen dental recoras of newly ar- Programdental emergency described in the narrative rived soldiers to establish their dental fitnessportion of their SF Form 603 (Health Re- classification- The Clinical Preventive Dentistry Program

( cord-Dental) so they may be reclassified to (c) Assist unit commanders to ensure usually accomplished within the dental

Class I or 2 as soon as the condition is cor- that newly arrived soldiers do not remain in treatment facility and for. hospital

rected. Personnel in dental fitness Class 3 Class 4 for over 60 Jays after arrival or in treatmentf.

will receive expedited treatment to remove Class 3 for over 6 months after arrival. Ap- inpatients.

them from this unsatisfactory dental classifi- pointments will be made available on a pn- .ntive dentistry counseling. Patients shouldcation. The immediate goal of expedited ority basis for soldiers in Class 3 and 4. be counseled on their dental health needs.treatment is to take care of the patient's (d) Make appointments available to sup- Patient counseling may include themost urgent dental fitness needs and elimi- port the requirement for annual dental following:nate a probable dental emergency. examinations. (l) Self-evaluation methods.

c. Organizational responsibilities. (e) Provide monthly updates to the unit (2) Plaque control techniques.(1) Units. The unit commander is respon- or its supporting personnel activity on (3) Adjunctive oral hygiene devices.

sible for the dental fitness of his or her changes in soldiers' dental classification and (4) Diet and nutrition.soldiers. The unit commander will establish date of last dental examination. (5) Interrelationship of oral health andprocedures to carry out the requirements of (0) Conduct a 100 percent audit of dental general health.the Oral Health Fitness Program. Com- records at least once a year (in conjunction 6. Dental prophylaxis. Active dutymanders will make their personnel available with one of the semiannual records screen- soldiers and other eligible beneficiariesfor participation in the Oral Health Fitness ings required by AR 40-66, para 5-9) to en- should be provided with a thorough dentalProgram and maintain surveillance over the sure accuracy of the dental fitness prophylaxis if needed. Unless contraindi-program to ensure the following: classification on the unit's Oral Health Fit- cated, an approved topical anticariogenic

(a) Newly arrived soldiers' dental records ness Program roster, agent should be applied as recommended bywill be submitted to the supporting dertal TSG's consultant in public health dentistry.unit as part of the in-processing procedure. 7. Preventive Dentistry Program forThe supporting dental unit will be requested Children (PDPC) 9. Community Preventive Dentistryto screen dental records to establish the a. Objective. This program establishes Programdental fitness status (classification) of each policy, procedures, and responsibilities for a, Fluoridation of community water sup-newly arrived soldier, establishing and operating preventive den- ply. Controlled fluoridation of the commu-

(b) Soldiers identified in dental fitness tistry services for children. nity water supply is the principalClass 3 or 4 will be made available to the b. Policy. The most advanced, standard- community dental public health measure.dental facility for expedited treatment, so ized program of preventive dental care will (i) Fluoridation of post water suppliesthey do not remain in Class 4 for over 60 be provided for children throughout the Ar- should take place when-days after arrival or in Class 3 for over 6 my community. (a) The level of natural fluoridation ismonths after arrival. c. Procedures, less than one-half the optimal concentration

W (c) All soldiers in the unit will receive an (1) Each DENTAC/dental unit will es- for that climate.annual dental examination. The unit (or its tablish and operate the PDPC at Depart- (b) There are an appreciable number ofsupporting personnel activity) will- ment of Defense dependent schools children residing on post.

AR 40-35 - UPDATE 3

33

(c) The fluoridation process is otherwise the four major areas of tie Army Plevenltl'c

considered practical and feasible. (See TH Dentistry Program as outlined inMED 576.) paragraphs 6 through 9. lo provide um,

(2) It is the responsibility of the DFO to formity, the following headings will be usedadvise he preventive medicine officer and (1) Oral Health Fitness Program. T'hisinstali , engineer concerning the proper paragraph should be a narrative statementconcenf.-tion of fluoride. Where natural flu- of how the Oral Health Fitness Program isoridation eAceeds acceptable levels, being complied with by the units served bydefluoridation measures should be the DENTAC/dental unit. It should in-recommended. clude the date or the annual 100 percent au-

b. Alternative fluoride administration. dit of records and the total number andPrograms for alternative fluoride adminis- percent in each classification.tration, such as fluoride supplements and (2) Preventive Dentistry Program for Chil-schools rinse programs, should be available dren. This paragraph should include a list offor family nembers who are not drinking DOD schools, by name, that are complyingfluoridated water. The DFO will advise with the Preventive Dentistry Program forphysicians and dentists on professional Children (DODI 6230.3). and a list of thoseguidelines for prescribing fluorides. schools not complying. It should also in-

c. Child neglect. A system for reporting clude the number of sextants of pit and fis-identified dental conditions that involve sure sealants applied by the DENTAC/child abuse or neglect will be coordinated dental unit during the reporting period.with the local Family Advocacy Program (3) Clinical Preventive Dentistry Program.per AR 608-1. An example of child abuse This paragraph should include the numberwould be head or facial injuries inconsistent of prophylaxes and number of topical fluo-with the stated cause. If parents have been ride applications performed by theinformed of dental abscesses, large carious DENTAC/dental unit by category of pa-lesions, or extensive periodontal disease, but tient (active duty, family member, retired,have not taken corrective action, referral for other).child neglect may be indicated. Highest pri- (4) Community Preventive Dentistry Pro-ority for space available care should be giv- gram. This paragraph should include aen to these children. statement concerning compliance with the

d. Community education. The DFO and community water fluoridation program (ifCHDH will actively seek as many avenues applicable), and all Community Preventiveof public health education as possible, using Dentistry Program educational efforts par-methods appropriate to the target audience, ticipated in by the DENTAC/dental unitthe objectives of the program, and the avail- during the reporting period.able media. 0

10. Preventive Dentistry Report (RCSMED-399)

a. A preventive dentistry report will besubmitted q, ziy). "9 r t o

vvill be submu&itte totheHeA*, o.

annually.. It will be in a format presciieby the major medical command. Data forthe reporting period of I October to 31March will be submitted from theDENTAC or dental unit level to the majormedical command preventive dentistry con-sultant by 30 April. The 1 April to 30 Sep-tember report will be due by 31 October.

b. A copy of the report wil be furnishedto the installation commander.

c- The :iff,/aC,• -n.. .......

p .....)s .d ep.ot t.o TS;G' cnesultantpt,,-, health ,,, jo medical com-mand preventive dentistr consultant willconsolidate subordinate units' preventivedentis-trreports; and reort to "S($ Con-sultant inDental Public Health in a formatprescribed by TSG. These consolidated re-ports are due by 31 May and 30 November.

d. In cases where a DENTAC/dentalunit's major command has no preventivedentistry consultant, the report will be for-warded directly to TSG's consultant in pub-lic health dentistry.

e. The reports will contain commentsand data as appropriate to reflect efforts in4 AR 40-35 * UPDATE *u.s.COVIH:ENT PRIXITtn orrtIs198g9g.2-416,oo0o7

34

DISTRIBUTION:

Chief, U.S. Army Dental Corps, ATTN: DASG-DC, Bldg 5, Rm 629,5109 Leesburg Pike, Falls Church, VA 22041-3258 (1)

Commander, U.S. Army Institute of Dental Research (USAIDR),Walter Reed Army Medical Center, Washington, DC 20307-5300 (1)

Command Dental Surgeon, U.S. Army Forces Command, ATTN: FCMD-DC,Fort McPherson, GA 30330-6000 (1)

Deputy Commander, U.S. Army Health Services Command, ATTN: HSDC,Rm 229, Fort Sam Houston, TX 78234-6000 (1)

Director of Dental Services, U.S. Army Health Services Command,ATTN: HSDS, Rm 121, Fort Sam Houston, TX 78234-6100 (1)

Deputy Commander, Headquarters 7th Medical Command, APO AE 09102-3304 (1)

Commander, 10th Medical Detachment (DS), Unit #15249, APO AP96205-0022 (1)

U.S. Army Military History Institute, ATTN: Dental Historian(Col. J.E. King), Carlisle Barracks, Bldg 22, Carlisle, PA17013-5008 (1)

Commander, U.S. Army Dental Activity, Fort Wainright, AK 99703-7300 (2)

Commander, U.S. Army Dental Activity, Fort Belvoir, VA 22060-5166(2)

Commander, U.S. Army Dental Activity, Fort Benning, GA 31905-6100(2)

Commander, U.S. Army Dental Activity, Fort Bliss, TX 79920-5001(2)

Commander, U.S. Army Dental Activity, Fort Bragg, NC 28307-5000(2)

Commander, 257th Medical Detachment (HA), Fort Bragg, NC28307-5000 (2)

Commander, U.S. Army Dental Activity, Fort Campbell, KY42223-1498 (2)

Commander, U.S. Army Dental Activity, Fort Carson, CO 80913-5000(2)

Commander, U.S. Army Dental Activity, Fort Devens, MA 04133-6401(2)

Commander, U.S. Army Dental Activity, Fort Drum, NY 13602-5005(2)

Commander, U.S. Army Dental Activity, Fort Eustis, VA 23604-5569(2)

Commander, U.S. Army Dental Activity, Fitzsimons, Aurora, CO80045-7000 (2)

Commander, U.S. Army Dental Activity, Fort Gordon, GA 30905-5660(2)

Commander, U.S. Army Dental Activity Hawaii, Tripler Army MedicalCenter, Honolulu, HI 96859-5000 (2)

Commander, U.S. Army Dental Activity, Fort Hood, TX 76544-5063(2)

Commander, U.S. Army Dental Activity, Fort Huachuca, AZ85613-7040 (2)

35

DISTRIBUTION: (cont'd)

Commander, U.S. Army Dental Activity, Fort Irwin, CA 92310-5065(2)

Commander, U.S. Army Dental Activity, Fort Jackson, SC 29207-5780(2)

Commander, U.S. Army Dental Activity, Fort Knox, KY 40121-5520(2)

Commander, U.S. Army Dental Activity, Fort Leavenworth, KS66027-5410 (2)

Commander, U.S. Army Dental Activity, Fort Lee, VA 28301-5270(2)

Commander, U.S. Army Dental Activity, Fort Leonard Wocd, MO65473-5575 (2)

Commander, U.S. Army Dental Activity, Fort Lewis, WA 98431-5020(2)

Commander, U.S. Army Dental Activity, Fort McClellan, AL36205-5082 (2)

Commander, U.S. Army Dental Activity, Fort Meade, MD 20755-5700(2)

Commander, U.S. Army Dental Activity, Fort Monmouth, NJ07703-5504 (2)

Commander, U.S. Army Dental Activity, Fort Ord, CA 93941-5000 (2)Commander, U.S. Army Dental Activity, Fort Polk, LA 71459-6050

(2)Commander, U.S. Army Dental Activity, Redstone Arsenal, AL

35809-7000 (2)Commander, U.S. Army Dental Activity, Fort Riley, KS 66442-5043

(2)Commander, U.S. Army Dental Activity, Fort Rucker, AL 36362-5350

(2)Commander, U.S. Army Dental Activity, Fort Sam Houston, TX

78234-6200 (2)Commander, U.S. Army Dental Activity, Fort Stewart, GA 31314-5225

(2)Commander, U.S. Army Dental Activity, Walter Reed Army Medical

Center, Washington, DC 20307-5400 (2)Commander, U.S. Army Dental Activity, West Point, NY 10996-1782

(2)Defense Technical Information Center, ATTN: DTIC-OCC

(Selection), Bldg 5, Cameron Station, Alexandria, VA 22304-6145 (2)

Director, Joint Medical Library, DASG-AAFJML, Offices of theSurgeons General, Army/Air Force, Rm 670, 5109 Leesburg Pike,Falls Church, VA 22041-3258 (1)

Stimson Library, Academy of Health Sciences, Bldg 2840, Fort SamHouston, TX 78234-6100 (1)

Defense Logistics Studies Information Exchange, U.S. ArmyLogistics Management College, Fort Lee, VA 23801-8043 (1)

36