A bridge too far? The relationship between interventive operative dentistry and future dental morbidity

Background and aim Unscheduled dental attendances (UDA) and the associated morbidity can cause individual distress, disrupt military effectiveness and have broader societal impacts. Preventing future dental morbidity is an essential component of dentistry. This, the largest study of its type, aimed to examine the relationship between clinical and demographic variables and UDA, and to quantify how well military dental risk categorisation predicts subsequent UDA events. Methods This is a retrospective cohort analysis of a clinical dataset containing 175,558 service personnel over an 11-month period. Statistical methods examined: sensitivity and specificity of the existing NATO 'Dental fitness classification system' (NATO Cat) in predicting UDA, relative risk (RR) of UDA by selected variables, Kaplan-Meier failure analysis and multivariate analysis. Results A total of 16,722 UDA events were recorded, the majority (66.7%) were due to caries, periapical pathology and fractured teeth or restorations, or a combination thereof. NATO Cat yielded poor predictive sensitivity (sensitivity 10%, specificity 93%). NATO Cat 3 (RR 1.47), age group (RR 1.06-2.05), gender (RR 1.46) and DMFT category (RR 1.09-3.05), were all significantly associated with increased UDA. The RR of UDA increased by 5% (RR 1.05) for each additional DMFT increment in a logistic regression model. Conclusions After adjusting for confounding variables, DMFT was significantly associated with UDA events. This study indicates that, even when treatment need has been met, a residual risk remains that is directly related to exposure to dental disease and operative dentistry. Strategies which prevent downstream operative treatment need and increases in DMFT may also reduce future UDA. UDA may be a useful quality outcome indicator for the success of NHS dental services in securing oral health.