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.