United States Public Health Service

DENTAL NEWSLETTERA publication of the Dental Professional Advisory Committee

Volume V, Issue 2 July 2005

In this issue of the USPHS Dental Newsletter:

Click on the titles below to go directly to the articles.

COVER STORYOpen Letter to Surgeon General 1

REGULAR SECTIONSChief Dental Officer’s Column 1 DePAC Chair’s Column 3 DePAC Vice Chair’s Column 4Agency Update 9 Organizational Updates 11 DePAC Work Groups 13

FEATURESCOA 6 Clinical Perspectives 15 Senior Dental Spotlight 10Junior Dental Spotlight 12 Special Articles 17 Associate Recruiting Program 19 Upcoming Events 23 Editor CAPT Stephen P. Torna Editor CAPT Suzanne Saville

The USPHS Dental Newsletter is published 3-4 times annually, and is distributed electronically through the USPHS Dental Bulletin Board, agency distribution lists, and the USPHS Dental Directory.

The next issue of the newsletter will be published in September 2005. The deadline for submitting articles is August 13, 2005.

If you have suggestions or comments about the newsletter, or would like to submit an article, please contact the co-editors CAPT Steve Torna Steve.torna@mail.ihs.gov or CAPT Suzanne Saville ssaville@d11.uscg.mil

Dushanka Kleinman, DDS, M.Sc.D. RADM USPHS

Assistant Surgeon General

An Open Letter to Surgeon General Richard H. Carmona

Dear Surgeon General Carmona:

On behalf of the USPHS Dental Category I thank you for your active, creative and enthusiastic support of all activities directed towards improved oral health. Those of us in the dental profession are fully engaged in oral health; for us the importance and value of oral health to general health and well-being is second nature. It is our area of expertise and our ethical responsibility. However, our efforts are amplified a thousand times over by the personal involvement and commitment of the Surgeon General of the US Public Health Service to the nation’s oral health. When you step up to the podium and highlight the critical role of oral health, there is a fresh and revitalized visibility and importance given to oral health and to dentistry’s role in overall health promotion and disease prevention.

We are greatly benefiting from your leadership and vision. We appreciate your readiness to open new venues for oral health. We have had the good fortune to be part of your public health priority areas: prevention, preparedness, health literacy and health disparities. Let me reflect on just a few:

Prevention: We are proud that your participation in the release of A National Call to Action to Promote Oral Health represented the first Call to Action under your tenure. This document is stimulating a formal formation of a public-private partnership under the leadership of the Office of the Surgeon General.

Preparedness: Your support for and keynote at the first national conference on Dentistry’s Role in Bioterrorism and Other Catastrophic Events, held in Washington DC set the stage for a myriad follow-up activities by professional organizations and the USPHS. We also appreciate your strong support of expanding the services that can be provided by dentists during national disasters.

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Health Literacy: Your unwavering commitment to clear, accurate communication of science-based information to the public and your urging

of health care providers to improve health literacy has paved the way for a broad-Continued on page 4

By CAPT Gary Pannabecker , DDS

One of the primary functions of DePAC is to facilitate communication between dental officers in the field and the PHS leadership, including the Chief dental Officer, OCCO, OCCFM, and the Office of the Surgeon General. Recently, the Chief Professional Officers (CPO’s) and respective Category Professional Advisory Committee (PAC) Chairs committed to enhancing communication between the CPO’s and PAC’s. Also, the Chief Dental Officer, RADM Dushanka Kleinman, charged each PAC, including DePAC, to improve its effectiveness in communication of pertinent issues to and from dental officers. DePAC has formed an adhoc workgroup comprised of CDR Tim Ricks, CDR Jim Webb, CDR Arlan Andrews, and CDR Steve Torna to address this communication issue. Dental Officers can stay informed by paying attention to the Dental Listserve, subscribing to the OCCO listserve ( www.dcp.gov click on “services”, click on “Listserver Information”, follow instructions to subscribing to the listserve) and subscribing to the CC Bulletin, available online at www.dcp.gov, click on “Publications”, then click on Commissioned Corps Bulletins. .

Although the Transformation has been a period of uncertainty and anxiety for Commissioned Officers, it is also an opportunity to provide valuable input. CAPT Dean Coppola, Senior Policy Analyst in OCCFM, and CAPT Lee Shackelford, Director of Division of CC Training and Career Development in OCCO, have asked for suggested cross training opportunities of interest to dental officers that would be value added to the officer in meeting the mission of the PHS. To consolidate input to the leadership from dental officers, please e-mail your input to a DePAC member or myself (gary.pannabecker@mail.ihs.gov ) to forward for consideration.

CAPT Larry Furman, Director of OCCFM, has engaged in frank discussions with DePAC and other PACs regarding what has become known as the “3&Freeze” promotion policy, which indicates that an officer who has been passed over three consecutive times for promotion to a given grade (O-4, O-5, O-6) will remain at the officers current grade. DePAC has provided in depth analysis of the potential negative impact on retention within the Dental Category of “3&Freeze” for CAPT Furman and OCCFM’s consideration and review. CAPT Furman has also updated DePAC on the current status of the proposed 6 th promotion precept which is intended to recognize duty in isolated hardship, hazardous duty, and hard to fill assignments. He reported a workgroup has been formed to further develop specific criteria for the 6th precept, which is tentatively targeted to be in effect for PY 06.

These and many other issues will be addressed by panel members RADM Dushanka Kleinman, CAPT Denise Canton, CAPT Lawrence Furman, CAPT Lee Shackelford, CAPT Dean Coppola, CAPT Chris Halliday, CAPT Deborah Noyes, CAPT Nick Makrides, and CAPT Stan Bastacky during the Town Meeting 1545-1700 on Dental Category Day, Tuesday, June 7, 2005 at the COA meeting in Philadelphia. Please plan to attend. For those unable to attend, DePAC will provide a transcript of the meeting on the dental listserve. Hope to see you at COA.

“Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts.  It is that form of dental practice which serves the community as a patient rather than the individual.  It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis."

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By CDR Tim Ricks, DMD, MPH

“An avalanche begins with a snowflake” – Joseph D. Compton

Your Dental Professional Advisory Committee (DePAC) continues to work diligently on issues of importance to all of you. Elsewhere in this issue of the newsletter you will see some of the products arising from the countless hours of work by DePAC members, many of whom give up their lunch periods, some nights, and some weekends to address things that will benefit all of us. Some examples of DePAC products this year include:

The creation of a new Career Development Dentist Resource Manual, which, once completed, will hopefully, be your one source of career development information, from getting started in your USPHS career to promotions. This manual will compile information from many different sources, including OCCO, OCCFM, previous Dental Category orientation manuals, and will also include career development materials for Civil Service dentists. We expect that this manual will be released electronically to all of you around August of this year.

The continuation and improvement of Dental Category communication tools such as the USPHS Dental Listserv, this newsletter, and our Dental Category web page (http://www.phs-dental.org/depac/newfile.html)

The creation of an additional Dental Category award to recognize the efforts and contributions of mid-career USPHS dentists, as well as the modification of our existing awards guidelines so that they are more inclusive of our Civil Service dentists.

The modification of the Promotion Benchmarks and the format for the Curriculum Vitae, both after receiving your input.

An analysis of our current recruitment strategies and the molding of a strategic plan to further improve the Associate Recruiter Program.

While we continue to work towards objectives designed to address your needs and concerns, whether they be filling critical vacancies or understanding and fitting into the Transformation of the Corps, we also continue to understand the importance of bringing in additional partners to help us to meet your needs. We have developed, over the course of several years, significant working relationships with organized dentistry, including the ADA, AGD, AAPHD, APHA, NDA, HDA, AAWD, and others, and we look forward to continued strong relationships with these dynamic organizations.

Finally, DePAC requests your help as we work for you. Over the next few months we will be soliciting your input on key issues such as the CV, promotion information, career development guidelines, etc. Some of you may be able to volunteer your time for DePAC, which we encourage through working in one of our workgroups or subcommittees; others of you may be better able to send your feedback to a DePAC member by e-mail or respond to questions posed on the listserv – that too is appreciated.

As the quote at the beginning of this column may describe, each of us may be nothing but a snowflake in the big picture, but through all of our collective ideas and work, we can create an avalanche of enthusiasm, knowledge, and participation within the Dental Category.

Links of Interest (click on links)

USPHS Dental Category Home Page Division of Commissioned Personnel2005 Dental Professional Advisory Committee Roster USPHS Dental Listserv HomeLinks to USPHS and Dental Organizations Links to previous newsletters

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Continued from page 1:

based movement, one that includes oral health literacy. Now you have asked for a Call to Action on health literacy and we are pleased to be an integral part of it.

Health Disparities: We are grateful for your support of the Healthy People 2010 objectives and your countless presentations to dental and related patient advocate groups. You have informed multiple audiences and the media with important actions that can be taken to ensure optimum health. Your Healthy Dozen series as part of “The Year of the Healthy Child” initiative has incorporated messages for oral health.

You provide a role model for us. You continually address new challenges, and open new vistas and roles. As you address global health, we stand ready to support you. For these and many other activities, we thank you for your personal sacrifices and dedication.

Sincerely,

RADM Dushanka V. KleinmanChief Dental Officer, USPHS (On behalf of the USPHS Dental Category)

PHILADELPHIA - 2005

DAVID SATCHER KEYNOTE SPEAKER:

DR. MARJORIE JEFFCOAT

Dr. Jeffcoat is Professor of Periodontics and Dean of the University of Pennsylvania School of Dental Medicine. A member of the National Institutes of Health-NIDCR Advisory Committee for Research on Women's Health, she has also served on the editorial boards of a variety of professional research journals for more than 20 years. Prior to joining Penn Dental Medicine in July 2003 as Dean, Dr. Jeffcoat served as Assistant Dean of Research and Professor and Chair of the Department of Periodontics at the University of Alabama

School of Dentistry. While at Alabama, she was also a professor of biomedical engineering, held the James Rosen Endowed Chair of Dental Research and served as interim chair for the Department of Oral Biology. A graduate of the Harvard School of Dental Medicine, she also taught Periodontology there for 10 years. Dr. Jeffcoat is President of the Academy of Osseointegration and a past president of both the American Association for Dental Research and the International Association for Dental Research.

2005 JACK D. ROBERTSON DENTAL AWARD

CAPT Chris Halliday received a DDS degree from the Marquette University School of Dentistry in 1987. He entered the Commissioned Corps in January 1988 and was assigned to the North Slope Borough Community Hospital in Barrow, Alaska. In 1990, he became Chief of the Service Unit Dental Program at that hospital. From January 1991 to November 1992 he served as chief of the basic dental satellite of the PHS Indian Health Center in Bloomfield, New Mexico. He served as the Area/Regional Dental Disease Prevention Officer and Acting Area Medical and Dental Recruitment Officer of the Navajo Area Indian Health Service Dental Program in

Window Rock, Arizona from November 1992 through 1998. He then moved to the Health Resources and Services Administration in Rockville, Maryland as a Senior Program Management Officer in the Bureau of Health Professions and served in that capacity from 1998 to 1999. While there he managed 59 dental public health and dentistry grant programs with a budget totaling $4.5 million and was instrumental in creating a Pediatric Residency Program Grants program. In the fall of 1999, Dr. Halliday assumed the position of IHS Assistant Headquarters Dental Consultant and deputy Director, Program Policy and Development. Within a year he

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was selected to become the acting Director, IHS Division of Oral Health (DOH). He continues in this O-7 billet administering the $101 million IHS Oral Health budget. With reassignment of 2 key staff, Dr. Halliday effectively utilizes the remaining DOH dentists and creatively employs field and Area staff to allocate workloads and innovatively manage the IHS Dental Program. The IHS Dental Program is currently experiencing difficulties recruiting adequate numbers of dentists. CAPT Halliday recognized quickly that loan repayment was the best recruitment tool available to IHS to attract dentists to the IHS. He has developed several innovative methods to maximize the resources for this program, resulting in 150 contracts being awarded to dentists and dental hygienists during FY04. CAPT Halliday worked with the PHS Chief Dental Officer and the Immediate Office of the Secretary as HHS attempted to address the concerns of the American Dental Association regarding the Alaska Dental Therapist Program. In this role CAPT Halliday has met with the ADA repeatedly, accompanying both the IHS Director and the Chief Dental Officer. He also accompanied the ADA Task Force to Alaska to examine access to care issues in rural Alaska villages.

CAPT Halliday completed a Master of Public Health degree from the University of North Carolina, Chapel Hill, in December 2002, and currently is working on his dental public health residency. He has represented the Chief Dental Officer at numerous meetings, regularly presents at the ADA Council of Governmental Affairs, serves as the dental category representative to the District of Columbia Commissioned Officers Association, and has been an active member of DePAC. He was personally deployed for two weeks to World Trade Center site as part of DMORT Region III; New York City’s Chief Medical Examiner was so impressed with his work that officials requested to retain him past his scheduled tour.

CAPT Halliday has consistently performed at an outstanding level as indicated by superior Commissioned Officer Effectiveness Reports, numerous PHS and outside awards, and academic success. His distinctive accomplishments reflect great credit upon himself, the dental profession, and the Commissioned Corps of the United States Public Health Service. In recognition of CAPT Chris Halliday’s dedication, service and commitment to the advancement of oral health, he is awarded the 2005 Jack D. Robertson award.

2005 SENIOR CLINICIAN DENTAL AWARD

CAPT David Crain received his DDS degree from the University of California at San Francisco in 1986. He entered the Commissioned Corps in August 1986 as a staff dental officer at the Indian Health Service Hospital in Harlem, Montana. From there he transferred to the Fort Berthold IHS Service Unit in New Town, North Dakota where he stayed from July 1989 to July 1992. CAPT Crain then went to the Indian Medical Center in Phoenix, Arizona where he completed an Advanced General Practice Residency from July 1992 to July 1994. He subsequently served as a staff dental officer at the Center from July 1994 to October 1996, when he became a staff dental clinical specialist. In October 1997 CAPT Crain became the Director of the IHS Advanced General Practice Residency Program at Phoenix and has remained so to the present.

CAPT Crain has impressive clinical accomplishments. CAPT Crain has achieved both Fellowship (2000) and Mastership (2004) in the Academy of General Dentistry. With attainment of his Masters, CAPT Crain joins less than 2,000 North American dentists who have achieved this high honor. Furthermore, CAPT Crain has distinguished himself by attaining Diplomate status, Federal Services Board of General Dentistry in 1996, and in 2004 he received Board Certification in the American Board of General Dentistry. He is the only PHS dental officer to have done so. The latter is among the most rigorous of challenges for a general dentist, requiring an intense comprehensive examination, documented Continuing Education in all dental disciplines, and an oral defense of multiple case presentations. Clearly, CAPT Crain has

aggressively continued to pursue the highest levels of clinical excellence.

CAPT Crain facilitates the educational experience of the Phoenix Indian Medical Center’s (PIMC) dental residents – both GP and Pediatric – in clinical and didactic areas. He has presented lectures nationally, at the COA and annual IHS meetings, to his fellow PHS dental officers. Additionally, he provides CDE for the PIMC dentists, dental assistants, dental hygienists, and medical staff. He has authored numerous articles about a broad range of dental and medical subjects. CAPT Crain is an Adjunct Professor at the University of Iowa School of Dentistry, and is working with the new Arizona School of Dentistry and Oral Health.

In addition to his clinical duties at PIMC, CAPT Crain has, on numerous occasions, assumed the role of Acting Chief Dental Officer at PIMC; participated on local and national committees; and provided outstanding leadership Corps-wide, most notably as General Co-Chair for the 2003 COA Annual Conference. CAPT Crain also has fulfilled the OFRD (CCRF) readiness requirements and has deployed to CAMP Pendleton for several weeks.

CAPT Crain’s performance, creativity, initiative, and leadership testify to his dedication and superior service to the profession of dentistry and the United States Public Health Service. CAPT David Crain is awarded the 2005 Senior Clinician Dental Award to in recognition of outstanding achievements in clinical dentistry.

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2005 ERNEST EUGENE BUELL AWARD

LCDR Lynn Van Pelt graduated from the University of Mississippi School of Dentistry in 1996. She completed an Advanced Education of General Dentistry (AEGD) residency in 1997 at the University of Mississippi, and entered the Commissioned Corps in August 1997. Her first assignment was at the Yukon-Kuskokwim Health Center in Bethel, Alaska. From July 2001 to June 2003 she completed an Advanced General Practice Residency (AGPR) at the W.W. Hastings Indian Hospital in Tahlequah, Oklahoma. In July 2003 she assumed her present assignment as Deputy Chief of Dentistry at the Haskell Indian Health Center in Lawrence, Kansas.

Since entering the Commissioned Corps, she has served as one of three editors of the Indian Health Service Dental Explorer; functioned as the co-Administrator of the USPHS Dental Listerv and Dental Bulletin Board; helped moderate the 2003 COA Conference Dental Day; and made numerous presentations at local, regional and national meetings. In her seven years as a Commissioned Officer, LCDR Van Pelt has

been the recipient of four unit commendations, one PHS citation, and two Achievement Medals as well as numerous other federal and non-federal awards. She has been very active in the American Dental Association, Academy of General Dentistry, Alaska State Dental Society, Association of Military Surgeons of the U.S., American Society of Dentistry for Children and the American Student Dental Association.

The USPHS dental category needs junior officers to assume leadership roles. LCDR Van Pelt is a role model for all junior officers in the dental category. She is committed to the Commissioned Corps and US Public Health Service, to furthering her professional education, and to sharing her knowledge with others. She has performed in a sustained, consistent, and professional manner that represents the very best among junior USPHS dental officers. LCDR Lynn Van Pelt is awarded the 2005 Ernest Eugene Buell Dental Award for her significant contributions in oral health service by a Junior Dental Officer.

SPECIAL AWARD TO RADM JOHN BABB AT 2005 PUBLIC HEALTH PROFESSIONAL MEETING

The dental category is very pleased to recognize and make a special presentation to RADM John Babb, Director of Force Readiness and Deployment, Office of the Surgeon General. RADM Babb received a Bachelor of Science degree in Pharmacy from the University of Tennessee Center for the Health Sciences and subsequently obtained a Masters Degree in Public Administration with Health Services Emphasis from Memphis State University. He entered the Commissioned Corps in November 1989, serving as Chief of the Pharmacy Services at the Federal Correction Institution in Memphis, Tennessee. In 1993 he assumed responsibility as Director, Pharmacy Services, Federal Bureau of Prisons in Washington, D.C. He became Deputy Chief of the Health Programs

Branch, Federal Bureau of Prisons in 1997 and Chief of that Branch in 1999. He was appointed to his current position in 2000.

The dental category wants to recognize RADM John Babb for his major contributions to help meet national priorities and the health and safety needs of people both within and outside the United States, and in his realizing the important role that USPHS dentists play in these efforts. Therefore we are presenting a special award to RADM John Babb in deepest appreciation of your leadership and unwavering support of the dental category and the deployment of USPHS dentists to meet the needs of the American and international populations.

USPHS PROFESSIONAL CONFERENCE DENTAL CATEGORY DAY 2005

BY CAPT Dave LaBadie

Congratulations to the Category Day Committee and its chairman, CDR Dan Hickey, for an outstanding program in Philadelphia. Monday, June 8, saw six excellent Dental Scientific papers presented. Tuesday started early with a breakfast hosted by RADM Dushanka Kleinman for the distinguished speakers presenting later that day. Those attending included Dr. Richard Haught, ADA President; Dr. Bernard McDermott, ADA 4th District Trustee; Dr. Dianne Rekow, NYU College of Dentistry; and Dr. Marjorie Jeffcoat, Dean of the University of Pennsylvania School of Dental Medicine. The Category day program was opened by CDR Hickey and began with an address by RADM Kleinman.

CAPT. Ron Bajuscak then moderated a Force Readiness Panel consisting of CAPT Dean Coppola, CDR Renee Joskow, LCDR Cristian Morazan, and Dr. Rekow. RADM John Babb was in attendance and was surprised by a plaque awarded to him in appreciation of his strong historical support for the dental category. Dr. Jeffcoat delivered the Surgeon General David Satcher Keynote Lecture on periodontal disease as a risk factor in prematurity. The dental category then was honored by a visit from Surgeon General Richard Carmona, who delivered some brief remarks. The morning session, assembled by CAPT Monina Klevens, was followed by a working luncheon during which Drs. Haught and McDermott

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made presentations. It was also during the luncheon that this year’s recipients of the Jack D. Robertson, E. Eugene Buell, and Senior Clinician Awards were recognized. Congratulations to CAPT Chris Halliday, LCDR Lynn Van Pelt, and CAPT David Crain, respectively. On behalf of DePAC, Chair CAPT Gary Pannabecker announced that a contribution to the AAPHD Foundation was made in the name of RADM Dushanka Kleinman to honor her as CDO. The afternoon session, assembled by LCDR Van Pelt, was opened by Vice Chair CAPT Dave LaBadie, beginning with a presentation by CAPT Kevin Hardwick on global health issues. Following that presentation, CDR Tim Ricks and CAPT Ray Lala moderated a panel about the Surgeon General’s National Call to Action to Promote Oral Health. Panel members included Dr. Alice Horowitz, CAPT Mark Nehring, CAPT Tim Lozon, CAPT Isabel Garcia, CAPT Scott Presson, CAPT Gail Cherry-Peppers, and LCDR Phillip Woods. The afternoon program ended with a Dental Town Hall Meeting. A distinguished panel that consisted of RADM

Kleinman, CAPT Denise Canton (OCCO), CAPT Lee Shackelford (OCCO), CAPT Larry Furman (OCCFM), CAPT Dean Coppola (OCCFM), CAPT Chris Halliday (IHS), CAPT Nick Makrides (BOP), CAPT Deborah Noyes (USCG) and CAPT Stan Bastacky (NHSC) addressed issues and questions. A summary of the Town Hall discussion immediately follows this article. RADM Kleinman closed the session with thanks to all involved and attending.

The category day program ended with a dinner cruise social on the good ship Spirit of Philadelphia.

Dental Category Planning Committee: CDR D. Hickey (Chair); CAPT D. LaBadie (Vice Chair); LT J. Bleuel; CDR J. Colton; CDR B. Dye; CAPT M. Klevens; CDR R. Lloyd; CAPT R. Mayberry; LCDR C. Morazan; CAPT D. Noyes; CDR T. Ricks; LCDR M. Robinson; CDR L. Van Pelt; LCDR B. Bucur.

TOWN HALL MEETING7 JUNE 2005

COA ANNUAL CONFERENCE

1. Have the Agency directors met with the DHHS Secretary, Michael Leavitt?

Secretary Leavitt has met with both Surgeon General Carmona and Acting Assistant Secretary for Health (ASH) Beato. It was reported that the discussions included Transformation of the Corps. It is not clear when a final decision about the Transformation will be announced. It was indicated that the Secretary has a 500-Day Plan for the Department. The Plan states that the Corps will be re-aligned, and describes how the Corps will be seen both inside and outside the Department. It was also announced that RADM Higgins, US Coast Guard, has met with the Surgeon General and the ASH to discuss Readiness as it relates to the USCG and the Department of Homeland Security.

2. Have the levels (percent total) of the Temporary Grade promotions been decided?

The levels were set, and announced on 8 June 05. The T-Grade results will be released 1 Jul 05.

3. Does the Secretary’s 500-Day Plan include Oral Health?

It does not currently include Oral Health. However, the Secretary apparently revisits the 500-Day Plan every six to seven months.

4. How can/should we recruit in times of budget cuts?

Recruitment is still strongly encouraged to strengthen the pool of applicants for the time when hiring freezes currently experienced by some agencies are lifted. Also, there are certain categories (i.e. dental) that still have many vacancies and in which targeted recruitment is continuing. It was also

announced by the Office of Commissioned Corps Force Management (OCCFM) that there is currently a ‘Recruitment Policy’ or a ‘Public Relations Plan’ that is being developed by a contractor, with specific strategies in mind. For example an EIS Officer could start with a detail to the Indian Health Service and then assignment with the CDC, such that field experience is incorporated into research, etc.

5. How is the Office of Commissioned Corps Operations addressing the issue of educating non-Commissioned Corps supervisors on hiring, rating and promoting Commissioned Officers?

OCCO has provided information to managers of the Agencies/Operating Divisions (OPDIVs) explaining the Commissioned Corps personnel management system, and has provided education material on how to rate annually Commissioned Officers through the Commissioned Officers Effectiveness Report (COER). It was noted by OCCO that with the implementation of the Electronic COER they would be able to get better feedback on the Raters in a timelier manner. There is a Civilian Supervisor’s Guide that is available on line; in addition, the Commissioned Officers Training Academy (COTA) will also be offering an agency specific supervisor’s course. The USCG has a PHS Orientation Guide available to the Line Officers within the Coast Guard. In addition, the Bureau of Prisons Central Office developed a web-based program for their supervisors (SENTRA). It was announced that there does not appear to be any difference in promotion rates among officers who have either a Commissioned Officer or a Civilian as their supervisor. OCCO has also been looking at the categories and agencies/OPDIVs independently, being mindful of the workforce as there has been a decrease in Commissioned Officers in key categories, and as the agencies have changed.

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There is also a concern that the Regular Corps of the Commissioned Corps is quickly reaching the ceiling of 2800 officers. Congress dictates the ceiling for PHS Regular Corps Officers. 6. Why does the PHS have temporary and permanent grades, while the DoD only has the permanent grade?

The Department of Defense calculates Training and Education differently than the PHS does. It does not give credit for undergraduate training.

7. When will the “Three and Freeze” go into effect?

The policy that enacted "Three and Freeze" became effective in 2003, yet the effects (being "frozen") could be felt as early as the PY 06 results.

8. Why doesn’t the current PHS billet system have career tracks based on clinical, research and administration?

OCCFM is looking at agencies as to how they have used Corps officers and how many they need in the near future, i.e. due to retirement of officers. It was stated that if agencies force manage their personnel then OCCFM would provide information on hiring and billet structure. It was announced that the current personnel structure of the Public Health Service resembles an hourglass. With the lower General Service (GS) levels (5-7) making up the base, GS 9-11 and O-2, O-3s making up the center, and GS-12 and above, and O-4s and above making up the top portion of the hourglass. It was also reported that the Commissioned Corps makes up 10% of the DHHS personnel, and that 38% of the COs are O-6, 30% are O-5 and 20% are O-4.

PHS ENSEMBLE/CHOIR

By CAPT Randall Mayberry

Instruments were tuned, voices warmed up, and nerves settled as the PHS Ensemble and Choir prepared for their stellar performance on Monday evening, followed by a well-deserved standing ovation.

Surgeon General Carmona (SG) entered and was seated front and center for the PHS Music Ensemble Performance at this year's COA Conference held in Philadelphia, the largest gathering of Ensemble members since the Ensemble’s inception just 4 years ago. The instrumental section of the Ensemble included three dentists at this year's performance. The SG strongly supports the Music Ensemble and we would like to see a larger Dental Corps presence in the Ensemble. See the contact information at the end of this article if you play an instrument or sing and

would like to join the Ensemble or Choir. The dentists among the band members were CAPT William Stenberg (clarinet), CAPT Suzanne Saville (Trumpet), and CAPT Randall Mayberry (Sop Saxophone). CAPT Mayberry also contributed to the performance by transposing the chorus of the USPHS March into a key that the choral group could comfortably sing along with and arranging two of the pieces performed.

RADM Moritsugu directed the Band and Choral group in performing God Bless America and the PHS March to end the concert. The SG then mingled with the Ensemble as photographs were taken.

To obtain information about joining the Ensemble, Contact CAPT John Bartko at: JJBartko@Starpower.net.

DISTINGUISHED SERVICE AWARDAt the recent American Association of Public Health Dentists meeting in Pittsburgh, PA, our own RADM Kleinman was the recipient of the Distinguished Service Award for excellence and service to Public Health Dentistry. Congratulations to RADM Kleinman on the award and thank you for all the great service that you do.

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FEDERAL BUREAU OF PRISONS UPDATE

By CAPT Nicholas S. Makrides

2005 will bring many new changes to the Bureau of Prisons (BOP) Dental Program. The most significant of which is the new Dental Program Statement. For those BOP dentists reading this for the first time your eyes are not deceiving you. The BOP Dental Program Statement (policy) has finally been approved and released.

BOP dentists can now access the new policy via the intranet on Sallyport. Dentists needing assistance in accessing the policy should contact their respective Regional Dentists. All Bureau dentists are expected to make modifications to their existing local policies to reflect the new Program Statement.

Perhaps the most anticipated and discussed change for 2005 is the new staffing guidelines for the Health Services Division. Many dentists have expressed concern regarding the proposed dentist to inmate ratios. These concerns have been heard and appropriate changes are being made to correct the ratios.

While change is often difficult, this next proposed change should be well received by most BOP dentists. Recent meetings between the Health Services Division (HSD) and the Program Review Division (PRD) has resulted in a streamlined Program Review process. For those dentists not assigned to the BOP, Program Review is an agency audit that examines the compliance laws, rules, regulations, and policy. BOP dental managers can expect an abbreviated Program Review. Only policy compliance (ACA) will be reviewed by the Program Review team. Issues relating to clinical care will be addressed by the Peer Review process.

Those dentists needing further clarification regarding current and proposed changes should call their respective Regional Dentists. E-mail updates will be sent to the field as they become available.

The DePAC OFRD workgroup chair, CDR Renée Joskow organized a team of 7 dentists (6 Commissioned Officers, 1 Civil Service) to provide oral and pharyngeal cancer screenings at the NIH “Share the Health” healthfair, on May 15, 2005 in Montgomery County, Maryland. This collaborative effort between the Office of the Surgeon General and the National Institute of Dental and Craniofacial Research was a huge success in increasing awareness about head and neck cancer and offering cancer screenings to the approximately 35,000 people who were present. During a 4-hour period, we screened 92 individuals, who were 7 - 80 years of age (mean = 44). Participants self reported race/ethnicity included Asian/Pacific Islander, Black/African American, Hispanic/Latino, Mexican American, Native American/Alaskan Native, White/Caucasian. In addition, information was collected regarding risk factors such as alcohol and tobacco use. The dentists who participated in this event were:

CAPT Bill Atwood, CAPT Dean Coppola, Dr. Demetrio Domingo (NIDCR Clinical Research Fellow), CAPT Andrea Feight, CAPT Chris Halliday, CDR Renée Joskow, CAPT Deborah Noyes.

CDC

By CAPT. R. Monina Klevens

“ADA and CDC Celebrate 60th Anniversary of Community Water Fluoridation”

Community water fluoridation, cited as one of 10 great public health achievements of the 20th century by the Centers for Disease Control and Prevention (CDC), celebrates its 60th birthday this year.

To help recognize this public health milestone, the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC), will host a National

Fluoridation Symposium at the ADA headquarters in Chicago from July 13–July 16, 2005. The symposium will recognize the impact of community water fluoridation for improving oral health and overall health.

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In addition, CDC developed a resource poster for water facility operators. The poster provides key information, including optimal fluoridation level for their states, how to monitor fluoridation levels at the plant to ensure optimal levels, operational and maintenance guidance, and benefits to the community. The poster has been endorsed by key partners in expanding community water fluoridation including the American Water Works Association, the National Rural Water Association, and the Association of State and Territorial Dental Directors.

Dental officers interested in learning more about the symposium can visit http://www.ada.org/prof/events/featured/fluoridation/index.asp The site has information about registration and the meeting agenda. Additional information about this and other oral health topics is available at http://www.cdc.gov/nccdphp/bb_oralhealth/index.htm.

AMERICAN ASSOCIATION OF PUBLIC HEALTH DENTISTS/NATIONAL ORAL HEALTH CONFERENCE

By Christine Forsch, RDH

The 2005 National Oral Health Conference was held in Pittsburgh, Pennsylvania on May 2 through May 4, 2005. The conference, which is sponsored by the Association of State and Territorial Dental Directors (ASTDD), the American Association of Public Health Dentistry (AAPHD), the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA), attracted approximately 650 participants.

The conference was preceded by three days of pre conference activities. These included meetings of ASTDD, AAPHD, the American Association of Community Dental Programs (AACDP), and the newly established Medicaid/SCHIP Dental Program Representatives Association (MSDPR). In addition, pre conference activities included full day Medicaid and AACDP Symposiums, a Dental Public Health Residency workshop, a Military Session and the administration of the American Board of Dental Public Health board examination. The conference itself featured four plenary sessions and 18 concurrent sessions. The round table luncheon had 40 round tables and 77 abstracts were presented during the poster session.

While the focus of the conference is educational, it was not all work and no play. Evening receptions were hosted by Stone Pharmaceuticals, Aseptico, the American Dental Hygienists’ Association and the Children’s Dental Health Project and Oral Health America coordinated the fun run. The AAPHD Foundation held a reception at the Carnegie Museum and one night was set aside for a buffet dinner, dancing and games.

Numerous individuals were involved in the planning and implementation of the conference. In addition to MRSI, the

conference planning company contracted for the conference, planning and implementation required the work and input of a twenty-member program committee. The success of the pre conference and conference sessions themselves relied on the work of session planners, moderators, co-moderators, and presenters. Members of AAPHD and ASTDD volunteered to serve as coordinators for the fluoridation, AAPHD, ASTDD, and student awards as well as for coordination of the round table luncheon and the contributed papers/poster sessions. Finally, members of ASTDD and AAPHD acted as photographers and created the opening session photo montage.

Each year everyone involved in the planning and implementation of the conference works hard to build on the success of previous meetings and this year was no exception. Based on evaluations from previous conferences, more time was set aside between sessions. A new feature this year was the submission of round table luncheon presentation applications on-line. In response to suggestions received after previous conferences, a General Poster Session was held during which no other competing events were scheduled. This resulted in a large number of attendees taking time to view and visit with the poster presenters.

Of course, the NOHC is successful in large part because of the sponsorship of many partners. The CDC and the HRSA provided significant financial and planning support. Other corporate partners who made significant contributions to the conference included Aseptico, OMNII Oral Pharmaceuticals, Software of Excellence, Stone Pharmaceuticals and the Xylitol Information Center. Additional sponsorship was provided by the numerous exhibitors.

For further information on AAPHD, contact: American Association of Public Health Dentistry National Office, PO Box 7536, Springfield, IL 62791-7536, Phone: 217-391-0218, Fax: 217-793-0041, email: natoff@aaphd.org, or go to the website:

http://www.aaphd.org/

 

Page 11 USPHS Dental Newsletter June 2005

 

By CAPT Jeanine TuckerIn 1985 Dr. Mohamed Awad graduated from one of the oldest dental schools in Egypt, Cairo University. Upon completion of his Bachelor of Dental Surgery (BDS), he attended a year of training at Ain Sham University.

During this time Dr. Awad worked with a department that treated facial deformities. This in turn, sparked an interest in oral surgery.

Oral surgery became his motivation for moving to the United States to continue his education in this field.

In 1994 Dr. Awad graduated from Dental School at New York University. After graduation, he joined the Advanced Education in General Dentistry Residency program at Lutheran Medical Center in Brooklyn, New York. For one year Dr. Awad worked under the supervision of a highly motivated teaching staff and the leadership of a board certified oral surgeon.

In 1995 Dr. Awad joined the General Practice Residency Program at Lincoln Hospital. Lincoln Hospital is a Trauma Level One hospital. During this time Dr. Awad was on call every third night, admitting and treating all kinds of oral and maxillofacial trauma cases. Dr. Awad worked with the Pediatric ER, the Surgical ER, and the Intensive Care Unit. He also managed patients who needed daily follow-up care.

At the end of his second year of post-graduate training, Dr. Awad proudly joined the United States Public Health Service to serve the Native Americans in remote, under-served communities. Dr. Awad joined in August of 1996 and has worked in Montana and the remote North Slope bureau in Barrow Alaska.

Dr. Awad currently serves at Southeast Alaska Regional Health Consortium as the Deputy Chief SUDP Complex, in Juneau Alaska. S.E.A.R.H.C. is one of the largest dental programs for the Indian Health Service. Dr. Awad also serves as the Alaska Area caries risk trainer. He is pursuing a long-term training in Oral Surgery sponsored by the Oklahoma City Area.

In his personal life, he is the father of three children. His wife has her degree in preschool education. Dr. Awad enjoys sports, especially soccer. In Egypt he was on the National Soccer Team. Since that time, Dr. Awad has enjoyed coaching many soccer teams in the various communities in which he resided.

Applications for 2006 DePAC members found on page 20. Follow links to applications.

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By CAPT Jeanine Tucker

LT Jennifer Lombrano was well prepared for the challenges she faced when she took her first Indian Health Service assignment in Western Alaska. She grew up sharing part of the year in sunny Southern California and the other part in rural Alaska. In 1987 she graduated from Barrow High School, 340 miles north of the Arctic Circle and the nations farthest northern community. Barrow was the exact opposite of Southern California and is a harsh Polar environment. It offered a rich blend of traditional Inupiat Eskimo culture with modern western amenities.

After high school, at the age of 18 she wanted to see the world and enlisted in the Navy. She pictured herself on a ship of titanic proportions pulling into exotic ports around the world. Actually, she spent her entire two-year Navy career arming and disarming underwater mines in a large warehouse in Charleston, South Carolina. It was also here that she met her husband John, a special operations member of the U.S. Marine Corps. They were married in 1989 and moved to San Antonio, Texas where LT Lombrano and John had their children Melissa and James. As the kids went off to kindergarten, she had plans of her own. She attended St. Mary’s University in San Antonio where she excelled in the field of science and was awarded an academic scholarship for non-traditional students to study Biology. After earning her Bachelor degree in 1998 she was accepted to dental school at the University of Texas Health Science Center in San Antonio. During each summer break in dental school, LT Lombrano worked in several Tribal dental clinics around Alaska. She went to Barrow, Anchorage and Nome her first two summers. During her junior year she participated in the Junior COSTEP program in Bethel. She found Bethel to be a familiar culturally enriching environment with a state of the art dental clinic and multiple dentists with decades of clinical experience.

The members of the Bethel dental team were eager and willing to mentor dental students and new graduating dentists. During her senior year the Yukon-Kuskokwim Heath Corporation through the Senior COSTEP program sponsored her. After graduating from dental school in June 2002 she returned to Bethel with her family. During her two years in Bethel, LT Lombrano was deployed 12 weeks per year to small communities surrounding Bethel providing dental care to residents of these remote villages. Because these villages are only accessible by small planes, boats and the occasional sled tow behind the back of a snow machine in 20 degrees below zero weather, she earned her hazardous duty and isolated hardship ribbons in 2003. In 2004 she was accepted to the Advanced General Practice Residency at the Alaska Native Medical Center in Anchorage, Alaska. Working with some of the nations most talented specialists and faculty members, it was a chance to build her clinical skills that would benefit the Indian Health Service.

In addition to meeting the full time demands of a family and a residency, Recently, LT Lombrano has spent her weekends with several of her co-workers at the Alaska Army National Guard. Since November of 2004, this group of dentists from the Alaska Area has examined over 600 soldiers who will deploy in early 2006 to Kosovo, Iraq, Afghanistan, and the Horn of Africa. This is a bittersweet effort for LT Lombrano since one of the soldiers facing deployment is her own husband. In February of 2005, she and several other USPHS dentists received the Alaska Army Commendation Medal for their support in assuring Alaska Army National Guard soldiers were ready for deployment in Operation Enduring Iraqi Freedom.

In July of 2005 LT Lombrano will enter the second phase of her General Practice Residency. She continues to be a positive member of her dental team at the Alaska Native Medical Center and credits her success to her supportive family and friends. LT Lombrano takes pride in her work and maintains a positive attitude even when faced with professional or personal challenges.

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MINORITY ISSUES

UPDATE ON DePAC MINORITY AFFAIRS SUBCOMMITTEE

By LCDR Philip Woods

The DePAC Minority Affairs Subcommittee (MAS) serves as a voice for and represents the interests of minority USPHS Dental Category members. Last January the Minority Affairs Subcommittee held an introductory meeting to provide an opportunity for new and former subcommittee members, and the new chair, LCDR Phillip Woods to get acquainted. Several new members including LCDR Scott Brown, LCDR Marlon Brown and CDR Jeff Gaskin were added to the MAS roster. A brief questionnaire was sent to subcommittee members to gather information regarding their areas of interest relative to potential projects for the 2005 year agenda. Following a review of the responses from the January questionnaire, the 2005 MAS Strategic Plan was developed.

Six activities which comprise our 2005 Strategic Plan include the following: 1) Conducting a survey of Dental Category minority officers to see what issues may be unique to them; 2) Mentoring of minority Dental Category PHS officers to better prepare for promotions and for increased visibility in the Corps; 3) Partnering with the Recruitment and Retention Subcommittee to enhance entry of new minority Officers into the Corps, and to ascertain why fewer minority officers may be staying with the USPHS; 4) Partnering with the American Society of Indian Dentists in their efforts to increase the representation of Native Americans in the dental profession and in the Dental Corps; 5) Continuing our relationship with the National Dental Association, working to increase the representation of African Americans in the dental profession and in the Dental Corps; and 6) Partnering with the Hispanic

Dental Society in their efforts to increase the representation of Hispanic Americans in the dental profession, and in the Dental Corps.

Over the last four months great progress has been made towards meeting our 2005 objectives. Survey questions have been formulated, and the survey is expected to be ready by July. Work has been initiated to develop a means by which minority officers might mentor and support their minority colleagues in their pursuit of successful PHS careers. Collaboration with Recruitment and Retention Subcommittee through participation of two MAS subcommittee members should also prove helpful to our shared goals. Retired PHS Officer George Blue Spruce has been contacted, and welcomes our involvement; we hope to send a MAS representative to the annual American Society of Indian Dentists meeting in July. Dr. Algernon Bolden, the current NDA president, has been contacted and looks forward to working with the MAS. We hope to send a representative to the annual meeting this summer. Finally, we have recently initiated contact with the Hispanic Dental Society to express our support of their work to accomplish our shared mission.

Participating 2005 MAS Members include CDR Wilnetta Sweeting, Dr. Jay Anderson, CDR Gail Cherry-Peppers, LCDR Scott Brown, LCDR Marlon Brown, CDR Alan Peterson, LCDR Stephanie Burrell, CDR Tamieka Lewis-Baker, LCDR Earlena Wilson, LCDR Marlon Brown, CDR Jeff Gaskin and LCDR Phillip Woods, Chair.

OFRD

By CDR Renée Joskow, DDS, MPH, FAGD

As of May 1, 2005, 74.62% of the dental category meets Basic Readiness. From October 2004 to March 2005, the II Marine Expeditionary Force (II MEF) at Camp LeJeune had reached 94.6% Operational Dental Readiness (ODR) with the assistance of dental officers from five Navy Dental Commands and the U.S. Public Health Service. II MEF has already begun another round of deployments that is scheduled through October 2005. OFRD will be deploying a total of 27

dental officers to support the current dental needs of II MEF at Camp LeJeune.

USNS Mercy deployments included 2 dentists (1 from CG and 1 IHS) who went to remote villages and set up a dental clinic outside a local hospital. They treated 20-30 patients per day and provided approximately 60-100 extractions per day. In addition, PHS pharmacists sorted donated pharmaceuticals

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from foreign governments. Also deployed were 2 physicians, 3 Environmental Officers and 2 Engineers.

OFRD continues to perform weekly updates of the roster of trained USPHS Forensic dentists. We currently have 55 dentists who have submitted documentation of Forensic training to OFRD.

The Office of the Surgeon General supported an OFRD effort to provide oral and pharyngeal cancer screenings at the May 15, 2005 NIH “Share the Health” healthfair in Montgomery County, MD. Seven dentists participated in the effort, six Commissioned Corps Officers and one NIH/NIDCR Clinical Center Fellow. The OFRD provided an in-service training of all participating dentists prior to the event.

CALL TO ACTION SUBCOMMITTEE

By CDR Robin ScheperThis workgroup has been tasked with developing input from DePAC to assist in implementation of the National Call to Action to Promote Oral Health. A National Call to Action to Promote Oral Health, referred to as the Call to Action, reflects the work of a partnership of public and private organizations that have specified a vision, goals, and a series of actions to achieve the goals. 

At the National Oral Health Conference, held May 2-4 in Pittsburgh, CAPT James Lipton presented a roundtable session on the National Call To Action to Promote Oral Health. During the discussion he described the inventory of current federal programs that address particular actions recommended in the Call to Action and solicited ideas from participants about how the private sector and state/local governments can participate in helping to implement the Call to Action. .

Also, at the Commissioned Officers Association Meeting, held in early June, there was a National Call To Action panel discussion. The panel addressed the five Action Steps from the Call To Action: Action 1: Change Perceptions of Oral Health,Action 2: Overcome Barriers by Replicating Effective Programs and Proven Efforts,Action 3: Build the Science Base and Accelerate Science Transfer, Action 4: Increase Oral Health Workforce Diversity, Capacity, and Flexibility, and Action 5: Increase Collaborations.

For further information on the National Call to Action, please visit the following web site: http://www.phs-dental.org/ncta/For further information on the Call To Action Subcommittee, please contact CDR Robin Scheper at rscheper@tracencapemay.uscg.mil

CAREER DEVELOPMENT

BY CAPT Suzanne K. Saville, DDS, MPH, FAGD

The Career Development Subcommittee is enthusiastically undertaking the monumental task of creating a Career Development Resource Guide. Previously, members of the DePAC developed an orientation manual. The committee will incorporate the orientation manual and other resources to develop the resource guide. The resource guide is proposed to assist commissioned corps and civil service dentists find information such as: the history, mission and organization of the USPHS, the Surgeon General’s Report and a National Call

to Action papers, the Oral Health Coordinating Committee, military customs and courtesies, moving allowances, uniforms, leave issues, retirement, BOTC/IOTC, mentoring, curriculum vitae, and professional development. An outline is being developed with a rough draft of the guide planned for completion in August 2005. The Career Development Subcommittee meets on an as needed basis. For more information, please contact Suzanne K. Saville, DDS, Chair.

MENTORING WORK GROUP

By CDR Robin ScheperFor 2005, the DePAC Mentoring Workgroup is working on including Civil Service dentists as participants in the Program. This has proved somewhat challenging, as there is not a centralized database of new hires, as with Commissioned Officers. The workgroup is in the process of contacting the Area Dental Directors with the Indian Health Service, as well as the Bureau of Prisons to obtain contact information on new hires.

The workgroup has also recently updated a resource page that is sent out to all new mentors and protégées, in addition to reorganizing/updating our database of the active mentor/protégée pairs. For further information or an application, please check the PHS Dental Category Web Page at http://www.phs-dental.org/depac/newfile14.html or you may contact CDR Robin Scheper at rscheper@tracencapemay.uscg.mil

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PREGNANCY AND PERIODONTITIS

Todd Smith, DDS, MSDIHS Periodontal Consultant

Pregnancy can exacerbate gingivitis and accelerate attachment loss. During pregnancy, increases in prostaglandin synthesis, vascular permeability, gingival crevicular fluid flow, and gram negative anaerobic bacteroides species lead to increased gingivitis as well as aggravation of existing gingival problems. Miyazaki found that pregnancy increased the percentage of moderately deep pockets as the pregnancy progressed. Recently, Lieff found that pregnant women at less than 26 weeks, with moderate to severe periodontitis were more likely to have periodontitis progress (51%) in comparison to those initially periodontally healthy (9%).

Current evidence points to a 2-way relationship between periodontitis and complications of pregnancy including pre-term birth (PTB), low birth weight (LBW), and preeclampsia. 25% of pre-term low weight babies cannot be explained by accepted risk factors such as smoking, alcohol, nutrition, urinary tract infection, level of education and prenatal care. Is periodontitis also an independent risk factor for these complications of pregnancy?

Infections adversely affect pregnancy. In the hamster model, infection with the periopathogen Porphyromonas gingivalis increased prostaglandin and tumor necrosis factor alpha and appeared to be associated with decreased fetal birth weight. Porphyromonas gingivalis could also be detected in the placenta. Non-human species of Campylobacter are known to cross the placental barrier and induce abortion and preterm births in cattle and sheep. In humans, the chorioamnion can be infiltrated by neutrophils and positive bacterial cultures from amniotic fluid and membranes have been obtained. Clinically evident infections have also been found in pre-term neonates.

The Surgeon General’s Report on Oral Health in America describes the oral cavity as a portal of entry as well as the site of disease for microbial infections that affect general health status. In his Call to Action to Promote Oral Health, the mouth was cited as a source of disease or pathologic processes affecting other parts of the body, including the fetus. Pre term labor may be the result of the maternal immune response to periodontal infection. A proposed biologic mechanism implicates an increased inflammatory response with cytokines and prostaglandin synthesis that interferes with fetal growth

and triggers pre-term labor. Offenbacher, found prostaglandin levels in the gingival crevicular fluid to be significantly higher in mothers of low birth weight infants than in controls. He also noted that as prostaglandin levels increased, birth weight decreased. Four organisms associated with mature plaque and progressing periodontitis were detected at higher levels in pre-term low birth weight (PTLBW) mothers, as compared to normal birth weight mothers. Madianos found that in the absence of a protective maternal antibody response to periodontal pathogens, fetal exposure and preterm complications are likely to occur, with a pre-maturity rate approaching 67%.

In epidemiologic studies, Offenbacher found that if the mother had periodontitis, the risk of PTB and LBW infants was significantly higher than in those mothers with no periodontitis (Adjusted Odds Ratio 7.9 and 7.5 respectively). He estimated that 18% of all PTLBW cases may be attributable to periodontal disease. In a larger study where periodontal exams were provided at less than 28 weeks gestation and within 48 hours postpartum, a dose response relationship was seen. The prevalence of births in those periodontally healthy at less than 28 weeks gestational age was 1.1%. In pregnant women with mild periodontitis it rose to 3.5% and in those with moderate to severe periodontitis it was 11.1%. In regards to LBW deliveries of less than 1000 grams, the rates were 0%, 6.1%, and 11.4% for those mothers periodontally healthy, those with mild periodontitis, and those with moderate to severe periodontitis, respectively. It was concluded that maternal periodontitis was an independent risk factor for PTB, LBW, and fetal growth restrictions.

In 2001, Jeffcoat found that low birth weight and gestational age were closely associated with the severity of the mother’s periodontitis. Mother’s with the most severe class of prematurity were more likely to have severe periodontitis during the second trimester (Adjusted OR 4.45 at 37 weeks, 5.28 at less than 35 weeks, and 7.07 at less than 32 weeks).

Not all populations with periodontitis may be at risk for adverse pregnancy outcomes. In one contradictory case control study involving a population of mainly Bengalese women in the United Kingdom, no association was found

Page 16 USPHS Dental Newsletter June 2005

between maternal periodontal disease and increased risk for PTLBW infants.

Another complication of pregnancy is preeclampsia, which is the development of swelling of the hands and feet, elevated blood pressure, and protein in the urine during pregnancy. It is a major cause of maternal and fetal morbidity, and the cause remains unknown. In the United States it is a complication in approximately 5% of all pregnancies. As part of the Oral Conditions and Pregnancy Study, Boggess found that women with moderate to severe periodontitis during pregnancy have an increased risk of developing preeclampsia compared to those with gingival health. Of those mothers periodontally healthy or with mild periodontitis the rate of preeclampsia was 5%, and in those with moderate to severe periodontitis the rate was 16%. Progression of periodontitis during pregnancy was also associated with preeclampsia, with an odds ratio of 2.1.

Does treating periodontal infection in expectant mothers decrease the rate of adverse pregnancy outcomes? Preliminary evidence says yes. In a small intervention study in New York City, 74 expectant mothers received periodontal treatment and 90 received no treatment until after delivery. Nonsurgical periodontal therapy during pregnancy reduced the rate of PTLBW infants from 18.9% to 13.5%. In a larger population (n=351), the controls that received no periodontal therapy had a 10.11% incidence of PTLBW infants. If non-surgical periodontal therapy was provided before 28 weeks gestation, the incidence dropped to 1.84%. Dr. Jeffcoat’s pilot study also found that periodontal therapy, particularly scaling and root planing (SRP) at 21-25 weeks gestation, reduced the rate of spontaneous PTB at less than 35 weeks. The rate in those that received no SRP was 6.3% and in those receiving SRP it dropped to 0.8%.

PTLBW is related to 60% of infant deaths, and treatment in hospitals for associated respiratory distress, jaundice, malnutrition, anemia, and cerebral palsy costs over $5 billion annually. If poor periodontal health can lead to adverse pregnancy outcomes, dental treatment should be provided to decrease the risk for these potentially life threatening conditions. I recently had an obstetrician tell a pregnant patient not to have any dental care while pregnant. Upon consulting with him he stated that he tells all of his pregnant patients this because one patient late in her pregnancy had a spontaneous abortion after a deep cleaning and extraction. A massive bacteremia, prostaglandins, and other inflammatory mediators entering the bloodstream may have been responsible, but stopping dental care during all stages of pregnancy, as pointed out, can also put the mother and fetus at risk. In regards to treatment, The American Academy of Periodontology thinks that:

Preventive oral care services should be provided as early in the pregnancy as possible.

Expectant mothers should be counseled in the importance of oral health and oral hygiene.

If a dental exam indicates a need for periodontal therapy such as SRP with local anesthesia, these procedures should be scheduled early in the second trimester.

If a potential source of sepsis such as acute infection or abscess is present, prompt treatment is warranted, irrespective of the stage of pregnancy.

There has been some recent controversy regarding dental radiographs. Hujoel found that women with dental radiographs during pregnancy were more likely to have a term LBW infant compared with women with no dental radiography. Of interest, there was no link between radiographs and PTB or very LBW, and all women with term LBW infants had radiographs in the first trimester. The American Dental Association’s News Release in 2004 took the position that:In pregnant women, postpone elective dental radiographs until after delivery.Radiographs may be required during pregnancy to help dentists diagnose and treat oral disease. Pregnant women should continue to see a dentist regularly for oral exams and professional teeth cleanings. In addition to abdominal shielding, dentists should use thyroid collars on all patients, including pregnant women.

Health care providers do not universally know the fact that adverse pregnancy outcomes may be associated with periodontitis. To better educate their medical colleagues it is important that dental care providers share this information. To assist with this process, this paper has been incorporated into an existing PowerPoint presentation on the relationship between oral health and systemic diseases, also including diabetes, cardiovascular disease, infective endocarditis, and pulmonary disease. For convenience, this presentation has been posted on the IHS Dental Homepage at Home.dentist.ihs.gov under the title “Association of Oral Disease to Systemic Disorders.” This very large, technical presentation provides background information, and should be edited to fit your audience. In addition, Dr. Byron Jasper and the IHS Division of Oral Health, in collaboration with the IHS Maternal and Child Health and Health Educator Consultants, has published a poster for placement on walls in medical exam rooms/waiting rooms to prompt medical providers to quickly screen patients for oral disease and make appropriate referrals. The responsibility of dental providers is to target dental care to pregnant women, just as diabetics with oral disease are targeted. Pregnancy can aggravate gingivitis and periodontitis, and periodontitis increases risk for adverse pregnancy outcomes. It is sound public health policy to establish oral health in expectant mothers, potentially improving their overall health as well as their infants.

References provided upon request Todd Smith, DDS, MSD

Page 17 USPHS Dental Newsletter June 2005

NIH HEALTH FAIR

By CDR Renée Joskow, DDS, MPH, FAGDThe DePAC OFRD workgroup chair, CDR Renée Joskow organized a team of 7 dentists (6 Commissioned Officers, 1 Civil Service) to provide oral and pharyngeal cancer screenings at the NIH “Share the Health” healthfair, on May 15, 2005 in Montgomery County, Maryland. This collaborative effort between the Office of the Surgeon General and the National Institute of Dental and Craniofacial Research was a huge success in increasing awareness about head and neck cancer and offering cancer screenings to the approximately 35,000 people who were present. During a 4-hour period, we screened 92 individuals, who were 7 - 80 years of age (mean = 44). Participants self reported

race/ethnicity included Asian/Pacific Islander, Black/African American, Hispanic/Latino, Mexican American, Native American/Alaskan Native, White/Caucasian. In addition, information was collected regarding risk factors such as alcohol and tobacco use. The dentists who participated in this event were:

CAPT Bill Atwood, CAPT Dean Coppola, Dr. Demetrio Domingo (NIDCR Clinical Research Fellow), CAPT Andrea Feight, CAPT Chris Halliday, CDR Renée Joskow, CAPT Deborah Noyes.

41ST ANNUALFORENSIC DENTAL IDENTIFICATION AND EMERGING TECHNOLOGIES

By CAPT Steve Torna

Boasting 140 participants representing the USA, Canada, Belgium, Singapore, Saudi Arabia, The Netherlands, The United Kingdom, and Argentina, the 41st Annual Forensic Dental Identification training offered by The Armed Forces Institute of Pathology (AFIP) was completed March 25, 2005. Members of the USN, USPHS, USAF, USA as well as private dentists, physicians, and pathologists attended. The training took place in Bethesda from March 21 through March 25 at the Hyatt Regency Hotel.

Speakers included experts from the FBI, US Army, USN, and The National Museum of Health and Medicine. Forensic pathologists, forensic anthropologists, criminologists, profilers, and experts in DNA analysis participated as lecturers. Lab and workshop training included skeletal anthropology, bite mark analysis, radiographic age assessment, dental digital radiology, photographic capture and

computer database. The course culminated with a mock mass casualty identification exercise.

This training is considered the Gold Standard introductory course to forensic odontology and I consider it most challenging and fascinating. “The primary focus of the course is to expose the experienced forensic scientist, and to introduce the novice, to state of the art techniques for forensic endeavors with an emphasis on mass disaster and dental identification.”

The 42nd Annual Forensic Dental Identification and Emerging Technologies Course will be held Next March 2006. Information can be obtained by contacting The Department of Medical Education, Armed Forces Institute of Pathology, Washington DC, (800) 577-3749, email: came@afip.osd.mil

GLOBAL AIDS PROGRAM ASSIGNMENT IN TRINIDADBy CAPT Carolyn Tylenda

CAPT Carolyn Tylenda, Agency for Toxic Substances and Disease Registry, recently completed a 90-day temporary duty assignment in Port of Spain, Trinidad, where she served as the Acting Operations Officer in the Centers for Disease Control

and Prevention (CDC) Caribbean Regional Global AIDS Program (GAP) office. With the exception of sub-Saharan Africa, the Caribbean has the highest HIV prevalence rate of any region of the world, with an estimated 2% of the region's

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population infected with HIV. The CDC Caribbean Regional GAP office, founded in 2002, works closely with the Caribbean Regional Epidemiology Center (CAREC), which has 21 member countries. CDC personnel assist CAREC in planning, developing, and supporting activities to prevent HIV infection, develop capacity and infrastructure within the region, and improve the care and treatment of HIV infected individuals.

CAPT Tylenda’s assignment focused on establishing procedures and systems to enable the GAP office to function efficiently and effectively internally and with its partner organizations. “I particularly appreciated the opportunity to work closely with U.S. embassy personnel. This was a unique opportunity to learn firsthand how an embassy operates - the various sections and their responsibilities, the issues that arise and how they are managed, and the duties of an Ambassador. I enjoyed representing the CDC office at the embassy country team meetings and senior staff meetings.”

“The best word that I can use to describe my experience is “empowering”. I returned with a renewed sense of purpose, a recognition that one individual can have significant impact, and the realization that I have many valuable skills that were developed over time as a commissioned officer that enabled me to make a lasting contribution to the program”.

The assignment was completed under the auspices of the International Experience and Technical Assistance Program (IETA), a program coordinated by CDC. The IETA program was established in 1997 to increase the number of Public Health Service (PHS) staff with international training and experience, and accepts 25 participants each year from CDC and other PHS agencies. The program combines classroom work with an international work assignment. For information on the IETA program go to http://www.cdc.gov/nchstp/od/faso/ieta, and for GAP, http://www.cdc.gov/nchstp/od/gap/default.htm.

USPHS DENTAL DEPLOYMENTCAMP LEJEUNE

By CAPT Steve Torna

The United States Navy (USN) provides medical and dental care for the Marine Corps. The USN Second Dental Battalion provides dental care for the Second Marine Expeditionary Force (II MEF). The II MEF consists of 47,000 Marines Stationed at Camp Lejeune, and Marine Corps Air Station New River. A total of ten Second Dental Battalion Clinics strive to meet the dental needs of the II MEF. The five main clinics include Osborne, Mainside, French Creek, New River, and Cherry Point.

Located in North Carolina, the Marine base is approximately 246 square miles in size and home to more than 150,000 people. The base has 14 miles of Atlantic Ocean beach and miles and miles of freshwater beaches. Camp Lejeune annually generates 2 billion dollars in commerce.

Our Mission at Camp Lejeune was to assist the Second Dental Battalion in reaching 100% readiness among the Marines being re-deployed to Iraq. Readiness means that each Marine is free of dental conditions that may lead to the need for emergency treatment within a six-month period of time. Partially erupted third molars that have pericoronitis potential and severe caries are among the problems that require treatment prior to deployment. The USN dental system for

tracking patient needs, places each Marine in one of four categories. Category three patients were our primary concern as these Marines had conditions that may lead to problems while on deployment. Our goal was to provide the treatment necessary to convert these patients to category two and thus eliminate any conditions that may require emergent field care.

I consider my deployment to Camp Lejeune and my previous deployment to Camp Pendleton a privilege. It was an honor to participate in this effort and I feel a true sense of accomplishment in having assisted OFRD, the Marines, the Navy Dental Corps, and my country. I would encourage every officer to volunteer for these deployments as the rewards may prove to be deeply moving and personal.

The following officers were deployed to Camp Lejeune during the period Nov 2004 to March 2005. CAPT Walton Van Hoose, LCDR Stella Wisner, LCDR Charles Houk, LT Stephen Wiist, CAPT James Norman, LCDR Kathryn Bagg, LT John Linhart, CDR Edward Arnold, CDR Stephen Torna, CDR Rick Vaccarello, LT Laura Fuentes, LCDR Kevin Zimmerman, CDR Aaron Means, CDR Arlan Andrews, CDR Robert Good, LCDR Godfrey Onugha, CAPT Timothy Lozon and CDR Cielo Doherty.

PHS Officer Responds to Friends in NeedLCDR Phillip D. Woods

As the USPHS increases its participation in emergency and disaster relief efforts around the globe, there are also small

instances of individual PHS officers doing their part to aid those in need right here at home.

Page 19 USPHS Dental Newsletter June 2005

When CDR Jeff Gaskin awoke on December 26, 2004 he thought his would be just another ordinary day, except for the fact that he was to pick up two friends visiting him for the Christmas holidays. A few hours later he would realize that this would be anything but just another ordinary day. The day would bring a disaster of unimaginable proportions, affecting 13 countries, resulting in the death or disappearance of more than 300,000 persons. This tragedy would reverberate around the world, as well as touch him intimately at his home in the small town of Clifton, Arizona.

The two guests visiting CDR Gaskin were a Sri Lankan couple named Stanley and Padmani - two of many Sri Lankan friends Gaskin has known for several decades. CDR Gaskin has a special place in his heart for Sri Lanka and its citizens. In 1973 he was an exchange student there while a college student at Hampton University. While living in Sri Lanka he developed several close friendships, which have blossomed over the years. He’s participated in the weddings of close friends there, and since 2000 he has led several dental missions to Sri Lanka, accompanied by other PHS dental officers. Currently CDR Gaskin serves as the Regional Dental Consultant for the BOP Western Region.

By the time Jeff arrived at the airport to greet his visitors on December 26, reports of an Indian Ocean earthquake, and a resultant tsunami had begun to trickle back to the West. His guests were already aware of the disaster when as they met him at the airport, anxiously checking immediately on their cell phones, receiving frequent updates from friends back home. Originally from the capital city of Colombo, they had planned to visit Sri Lanka over the holidays before changing their plans at the last minute to visit CDR Gaskin. In fact, they had spent last Christmas holiday in Sri Lanka in 2003. So as the calls continued to come in, and as the reports continued to relay the increase in the severity of the devastation, they waited and prayed.

"It was a very sad and frustrating time for them as they continued to get conflicting reports from friends in other parts of Sri Lanka. We were also getting higher and higher death tolls by the hourly reports on the TV . . . first 10,000 dead, then 20,000 dead and more and more. And I could sense that they were also experiencing ‘survivors guilt’ as well - guilty that they had been lucky enough not to make their originally scheduled trip to Sri Lanka"

"Because Padmani and Stanley had their cell phones and because it seemed they were obtaining more accurate information via their cell phones than from the television reports, I thought I’d try to help as much as possible to take their minds off this ever-expanding tragedy. So I packed us all up and we spent the next 4 days at a local hot springs and in Paloma, Mexico which is just over the border.”

Anyone who knows CDR Gaskin knows he has a gift of thinking out of the box, and making the best of a challenging situation. This time was no exception. With the help of his Clifton neighbors, Gaskin ended his guest’s visit by hosting a special dinner. His guests happen to be great chefs creating several wonderful Sri Lankan dishes for the occasion. Everyone enjoyed the affair, and it provided great respite from the frustration of helplessly watching the worsening CNN reports. At the end of the week, the couple left for New York, grateful for the support CDR Gaskin provided them during their time of need.

Today we find ourselves more and more living as part of a global community, with fewer distinctions of who are our brother, our sister, and our neighbor. It is good to know we have exemplary dental officers like CDR Gaskin representing the USPHS whether on CCRF missions or in his everyday life, serving as a good will ambassador as he did. As he puts it, “I just did what I felt anyone would do."

By CDR James T. Owen, D.D.S.

The Dental Associate Recruiter Program is actively formulating plans and ideas to bolster recruiting efforts and to educate dental students about the Public Health Service. A continuing challenge the dental category has is maintaining our strength and viability. As officers retire or resign their commission we must recruit new officers to fill vacant billets. Dentists graduating today for various reasons are more apt to pursue a private sector career than opting for a career in the public sector. One possible reason for new graduates not electing to practice in the public sector is a lack of knowledge of the career options, job satisfaction or security offered by the public sector.

Dental students need to be informed early in their curriculum of the opportunities available in the Public Health Service so they are aware of practice choices they may have upon

graduation. The Dental Associate Recruiter Program plans to pair each dental school in the country with an associate recruiter who is to visit the school at least once per year. The dental schools will be asked to appoint a faculty staff member to act as a contact point between the school and the associate recruiter. The associate recruiter will make a presentation informing students of the unique practice opportunities, benefits and compensation available in the Public Health Service. A power point presentation is being developed to assist associate recruiters when making presentations and a guideline letter has been developed to assist the faculty contact member in their role.

The Retention/Recruitment and Assignments Workgroup of the Dental Professional Advisory Committee have also prepared a Call to Active Duty survey. This survey will query

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newly commissioned officers of their reasons for joining the Public Health Service and will assist us in enhancing our recruitment efforts. This information will also be beneficial in analyzing our current recruitment practices and determine if any changes are needed.

A recruitment booth will be in place at the annual meeting of the Academy of General Dentistry (http://www.agd.org/)

and the American Association of Women Dentists (http://www.aawd.org/) which is in Washington D.C., July 13-17, 2005. Volunteer Dental Associate Recruiters are needed for this event. To volunteer or inquire about the Dental Associate Recruiter Program you may contact me, CDR James “Tim” Owen, mailto:at jxowen@bop.gov.

Organization Meeting Meeting date

Location of meeting

Academy of General Dentistry (AGD) Annual Meeting July 13-17 WashingtonSociety of American Indian Dentists (SAID) Annual Meeting July 14-17 AlbuquerqueAmerican Association of Women Dentists (AAWD) Annual Meeting July 14-17 WashingtonNational Dental Association (NDA) Annual Meeting July 29-Aug.

3Las Vegas

American Dental Association (ADA) Annual Meeting Oct. 6-9 PhiladelphiaAssociation of Military Surgeons of the U.S. (AMSUS) Annual Meeting Oct. 30 –

Nov. 4Nashville

American Public Health Association (APHA) Annual Meeting Nov. 5-9 New OrleansHispanic Dental Association (HDA) Annual Meeting Nov. 17-19 San Antonio

DePAC SELF-NOMINATION INSTRUCTIONS

The DePAC would like to solicit self-nominations to serve for a three-year commitment.Please follow the instructions carefully. Send all documents electronically to swisner@bop.gov.

1) Fill out the self-nomination form and have your supervisor sign off (http://www.phs-dental.org/depac/self_nom.doc)

2) Send current CV3) Send cover letter with statement expressing your reasons for serving the DePAC4) Ensure that you have met all Basic Readiness Requirements (http://www.phs-

dental.org/depac/actionlist.htm)

Please send all documents to swisner@bop.gov by COB September 1st, 2005.Please use the link (http://www.phs-dental.org/depac/self_nom.doc) for the self-nomination form.

Page 21 USPHS Dental Newsletter June 2005