How should we manage severe anxiety towards dental treatment in UK service personnel?

Anxiety towards dental treatment is a significant barrier towards care within the United Kingdom Armed Forces. Avoidance of dental treatment results in morbidity, and severe dental infections can lead to systemic disease, which in turn may require hospitalisation. Of greater concern are deployed phobic patients who may develop dental pathology or suffer dental trauma and will likely require evacuation to the UK or a suitable host nation. This has considerable financial implications and in a war setting may place everyone in the evacuation chain at greater risk especially considering that it is not possible to manage these patients in Role 1 or 2 environments. Managing anxiety using either sedation or a general anaesthetic as a long-term management strategy for anxious military patients is simply not practical. This is reflected by current Defence policy stating that service personnel who are unable to tolerate treatment under local anaesthetic (LA) alone should be medically downgraded. However, the situation should ideally be addressed at the time of first recruitment. Currently, despite regulations recommending that potential new military recruits who cannot tolerate routine dentistry under LA should be medically discharged, in reality the subjectivity of such an assessment means this rarely happens. We would instead recommend that following identification of dental phobic recruits in initial training, they be placed in a holding platoon while methods to address their anxiety are explored. This would potentially avoid them entering military service and ultimately being discharged.