Are soldiers at increased risk of third molar symptoms when on operational tour in Iraq? A prospective cohort study

Abstract

Introduction Acute pericoronitis is a painful, debilitating infection that is most commonly found among young adults with erupting mandibular third molars. Pathology related to third molar teeth represents a significant cause of morbidity for soldiers deploying on operations. Amongst British and American troops in the first Gulf War and on deployments to Bosnia and Kosovo, symptoms from third molars were the second most common cause of emergency dental attendances (1). Upper respiratory tract infections and stress are the important predisposing factors for pericoronitis (2, 3). The potential of dental emergencies to reduce combat effectiveness is a major concern to the U.S. Army; dental emergencies have been shown to loose duty time, decrease unit effectiveness, disrupt routine care and cause hindrance to the military mission (4). In the 1960s a policy of prophylactic removal of third molars in all military personnel was advocated (5). However, the benefits of preventing third molar pathology by prophylactic removal must be weighed against the risks of complications. These include pain, infection, bleeding, swelling, and permanent lingual nerve and inferior alvelolar nerve paraesthesia (6). Over the past decade, National Institute of Clinical Excellence (NICE) (7) and Royal Colleges have published a number of guidelines on indications for the extraction of third molar teeth. (7, 8, 9). They advise not to remove asymptomatic teeth and to avoid prophylactic removal of lower third molars. These guidelines have led to a significant reduction in the number of referrals and the numbers of third molar teeth extracted in civilian practice (10). In general, these guidelines have been adopted by the Armed Forces. However, each case is assessed individually and the serviceman’s accessibility to dental care and the effects of the potential third molar pathology on their military duties are taking into consideration. To compare the incidence of third molar symptoms and assess if pre-deployment screening could be improved, we undertook a prospective cohort study between soldiers on operations in Iraq on Operation Telic (OP TELIC) with those stationed in the United Kingdom (UK). Northern Ireland (N. Ireland) was chosen to represent the UK as although it is still a theatre of operations, in the current political environment, a posting there gives a period of relative stability. No other units currently serving in the United Kingdom or Germany are likely to experience a similar period of uninterrupted time without being deployed elsewhere either on operations or on exercise. Correspondence to: Major J Breeze Trainee in Oral and Maxillofacial Surgery, King’s College Hospital, London SE1 9RT Email johno_breeze@hotmail.co.uk 102 JR Army Med Corps 153(2): 102-104 102-104 Are Soldiers 26/7/07 13:55 Page 102