A Comparative Analysis of the US Coast Guard Dental Emergency Visits

Identifying and analyzing dental emergencies among United States Coast Guard (USCG) personnel is critical, as the USCG is tasked with responding to natural disasters, narcotics interdiction, terrorism, and search-and-rescue missions. Dental Readiness Classifications (DRCs) are used by the USCG to monitor the dental health of personnel and assess force availability for USCG, Department of Homeland Security, and Department of Defense (DoD) missions. The goal of this study was to investigate the nature of dental emergencies in the USCG.

A retrospective review was conducted of DEs documented in the USCG's electronic dental record (MHS GENESIS) between January 1, 2022, and January 31, 2024. A dental emergency encounter was defined as any clinical visit coded with Current Dental Terminology code D9110 (palliative emergency treatment) or W0199 (dental emergency visit). Each dental emergency was assigned to one of nine treatment categories based on procedures rendered. The DRC recorded at the previous dental encounter, along with the time to the dental emergency visit were analyzed. Each DRC (1-3) was assessed to determine whether the diagnosis at the previous appointment was related to the dental emergency visit. Total relative value units and treatment locations were also recorded.

A total of 283 dental emergency encounters were identified across 29 USCG dental clinics. Oral surgery-related emergencies accounted for 53.4%, followed by restorative caries (12.7%), prosthodontic (9.5%), endodontic (7.8%), and periodontic (6.0%) categories. Among these, 82.8% of oral surgery, 60.0% of oral medicine-oral pathology-temporomandibular disorder, 54.5% of endodontic, and 51.9% of prosthodontic emergencies were associated with a previous diagnosis. Oral surgery emergencies most often involved post-operative pain from third molar extractions (85.4%) and had the shortest median time from the previous appointment (5.5 days). Prosthodontic emergencies were primarily due to fractured teeth requiring crowns (33.3%) or fractured temporary crowns (29.6%). Before their emergency visit, patients were most categorized as DRC 2 (41.7%), followed by DRC 1 (33.6%) and DRC 3 (24.7%). Overall, 82% of dental emergencies were treated in a USCG dental treatment facility. The mean RVU for all dental emergencies was 3.17 per visit (on-base: 3.00; off-base: 3.99). Endodontics (63%) and prosthodontics (41%) emergencies accounted for the highest off-base referrals. The most common duty stations for dental emergencies were at Training Center Cape May (37.8%), the USCG Academy (25.1%), and Training Center Yorktown (13.1%).

This study indicates that oral surgery, restorative caries, prosthodontics, and endodontics account for the majority of DEs in the USCG. Service members with DRC 2 treatment needs in these categories, if left untreated, face a high risk of developing DEs within four months of their last dental visit. These findings suggest that these areas of dentistry require additional staffing, training, and resources to sustain mission readiness. Given the risk to both patient health and operational capability, DRC 3 status alone is not a reliable predictor of dental readiness.