Lloro V, Lozano-de Luaces V, Lloro I, Manzanares M C
Odontology Hospital UB, Feixa Llarga Street, Barcelona, Spain.
Falculty of Medicine and Health Sciences, University of Barcelona, Feixa Llarga Street, Hospitalet, Spain.
Mil Med. 2019 Mar 1;184(3-4):e148-e155. doi: 10.1093/milmed/usy364.
Dental emergencies in isolated groups have always been difficult to treat. Especially in people or groups who cannot be evacuated and who need urgent dental assistance: long-term submarine missions, long-term spaceship trips, military or non-governmental organizations deployments in conflict areas, military maneuvers, etc. The dental and evacuation problems could put the success of the mission at risk, with relevant associated economic and strategic costs. Our study summarizes current evidence about dental problems in isolated personnel (submarines and Antarctic missions) compared to other non-isolation conditions (military deployment in conflict area, military maneuvers) with the objective to assess the need for specific dental equipment in special long-term isolation conditions.
We searched Medline, Cochrane Library, and Dentalgate between 1960 and 2017 for studies reporting dental disease in long-term isolation conditions (minimum 1 month) versus non-isolation conditions. We conducted the systematic review with all studies fitting the inclusion criteria. The comparison of the incidence rate was performed fitting a Poisson regression model to see the effect of the individual's condition on the incidence of dental event.
Thirty-eight studies were included in the systematic review. Antarctic missions showed a higher dental incidence rate compared to non-isolation conditions, but submarine missions showed the lowest dental incidence rate. In the sub-analysis of acute dental events, those with great impact on unit effectiveness, the incidence rates were higher. Caries and secondary decay events were the most prevalent dental problem in all conditions, followed by periodontal pathology and fractures of teeth or tooth problems not due to tooth decay in isolation conditions, and then by molar problems and endodontic problems in non-isolation conditions. The most common acute dental events were third molar problems and endodontic problems in all conditions.
This systematic review shows that the incidence of dental pathology in long-term isolation conditions may seem relatively infrequent but it exists and is relevant. Dental events are unpredictable, unrelated to trauma, and caused mainly by poor dental status. Preventive measures considerably reduce dental prevalence.
孤立群体中的牙科急诊一直难以治疗。特别是对于那些无法撤离且急需牙科援助的人员或群体：长期潜艇任务、长期太空飞船旅行、军事或非政府组织在冲突地区的部署、军事演习等。牙科和撤离问题可能会使任务的成功面临风险，并带来相关的经济和战略成本。我们的研究总结了与其他非孤立条件（冲突地区的军事部署、军事演习）相比，孤立人员（潜艇和南极任务）中牙科问题的现有证据，目的是评估在特殊的长期隔离条件下对特定牙科设备的需求。
我们在1960年至2017年期间检索了Medline、Cochrane图书馆和Dentalgate，以查找报告长期隔离条件（至少1个月）与非隔离条件下牙科疾病的研究。我们对所有符合纳入标准的研究进行了系统评价。通过拟合泊松回归模型进行发病率比较，以观察个体状况对牙科事件发生率的影响。
38项研究纳入了系统评价。与非隔离条件相比，南极任务的牙科发病率较高，但潜艇任务的牙科发病率最低。在对单位效能有重大影响的急性牙科事件的亚分析中，发病率较高。龋齿和继发龋事件是所有情况下最常见的牙科问题，其次是牙周病变以及孤立条件下非龋齿引起的牙齿骨折或牙齿问题，然后是非隔离条件下的磨牙问题和牙髓问题。所有情况下最常见的急性牙科事件是第三磨牙问题和牙髓问题。
这项系统评价表明，长期隔离条件下牙科病理的发生率可能相对较低，但确实存在且具有相关性。牙科事件不可预测，与创伤无关，主要由不良的牙齿状况引起。预防措施可大幅降低牙科患病率。
