FM 4-02.19
July 2009
DENTAL SERVICE SUPPORT OPERATIONS
DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.
Headquarters, Department of the Army
This publication is available at
Army Knowledge Online (www.us.army.mil) and
General Dennis J. Reimer Training and Doctrine
Digital Library at (www.train.army.mil).
*FM 4-02.19
Field Manual
Headquarters
No. 4-02.19
Department of the Army
Washington, DC, 31 July 2009
Dental Service Support Operations
Contents
Page
PREFACE
.............................................................................................................iv Chapter 1
OVERVIEW OF DENTAL SERVICE SUPPORT ............................................... 1-1
Section I — Importance of Army Dentistry .................................................... 1-1
Mission ............................................................................................................... 1-1
Soldier................................................................................................................. 1-1
Section II — Army Dental Readiness .............................................................. 1-2
Dental Readiness ............................................................................................... 1-2
Oral Health Threats ............................................................................................ 1-5
Section III — Categories of Dental Care ......................................................... 1-5
Preventive Dentistry ........................................................................................... 1-5
Operational Dental Care ..................................................................................... 1-6
Comprehensive Dental Care .............................................................................. 1-6
Section IV — Additional Wartime Roles ......................................................... 1-7
Mass Casualty Scenarios ................................................................................... 1-7
Veterinary Dental Support .................................................................................. 1-7
Section V — Eligibility Determination for Dental Care ................................. 1-7
Section VI — Detainee Dental Operations ..................................................... 1-8
Concerns and Issues .......................................................................................... 1-8
Examinations ...................................................................................................... 1-9
Treatment Screening Procedures ...................................................................... 1-9
Chapter 2
ORGANIZATION AND EMPLOYMENT OF DENTAL UNITS ........................... 2-1
Section I — Concept of Operations ................................................................ 2-1
Modularity ........................................................................................................... 2-1
Proximity ............................................................................................................. 2-1
Section II — Dental Staff Positions and Responsibilities ............................ 2-2
Dental Staff Officer and Noncommissioned Officer Positions ............................ 2-2
Section III — Unit-Level Dental Support ......................................................... 2-4
Area Support Squads ......................................................................................... 2-4
Distribution Restriction: Approved for public release; distribution is unlimited.
*This publication supersedes FM 4-02.19 dated 1 March 2001.
i
Contents
Section IV — Combat Support Hospital Dental Support ..............................2-4
Dental Services Section and Operating Room/Central Materiel Services
Section ................................................................................................................2-4
Section V — Area Dental Support ...................................................................2-5
Mission ................................................................................................................2-5
Medical Company (Dental Services) ..................................................................2-5
Dental Company (Area Support) ........................................................................2-8
Chapter 3
DENTAL UNIT OPERATIONS ...........................................................................3-1
SECTION I — Establishing the Dental Treatment Facility ............................3-1
Site Selection Considerations .............................................................................3-1
Sheltering the Dental Treatment Facility .............................................................3-1
SECTION II — Administrative Tools and Requirements ...............................3-2
Dental Records ...................................................................................................3-2
Dental Reports ....................................................................................................3-3
SECTION III — Clinical Operations..................................................................3-6
Patient Safety ......................................................................................................3-6
Waste Management ............................................................................................3-7
Radiology Operations .........................................................................................3-7
Field Dentistry .....................................................................................................3-7
Medical Evacuation of Dental Patients ...............................................................3-8
Standing Operating Procedure ...........................................................................3-8
Dental Support Planning ...................................................................................3-10
SECTION IV — Chemical, Biological, Radiological, and Nuclear
Operations .......................................................................................................3-10
Fundamentals ...................................................................................................3-10
Principles of Avoidance.....................................................................................3-11
Decontamination ...............................................................................................3-11
Appendix A GENERATING FORCE OPERATIONS ............................................................ A-1
Appendix B DEPARTMENT OF DEFENSE ORAL HEALTH AND READINESS
CLASSIFICATION SYSTEM ............................................................................. B-1
Appendix C DENTAL EQUIPMENT SETS............................................................................ C-1
Appendix D QUALITY ASSURANCE PLANS ...................................................................... D-1
Appendix E
SAMPLE CLINICAL STANDING OPERATING PROCEDURE ....................... E-1
GLOSSARY
.......................................................................................... Glossary-1
REFERENCES
.................................................................................. References-1
INDEX
.........................................................................................................
Index-1
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FM 4-02.19
31 July 2009
Contents
Figures
Page
Figure 2-1. Medical company (dental services) ............................................................. 2-5
Figure 2-2. Dental company (area support) ................................................................... 2-9
Figure 3-1. Sample dental activity report........................................................................ 3-4
Figure E-1. Format for changes and corrections............................................................ E-1
Tables
Page
Table 2-1. Dental personnel organic to a typical area support squad ........................... 2-4
Table 2-2. Dental personnel organic to the combat support hospital ............................ 2-5
Table 2-3. Medical company (dental services)............................................................... 2-7
Table 2-3. Medical company (dental services) (continued) ........................................... 2-8
Table 2-4. Dental company (area support) .................................................................. 2-10
Table 2-4. Dental company (area support) (continued) ............................................... 2-11
Table 2-4. Dental company (area support) (continued) ............................................... 2-12
31 July 2009
FM 4-02.19
iii
Preface
This field manual (FM) provides doctrinal guidance for the employment of dental units conducting dental service support missions. The manual is intended for use by medical and nonmedical unit commanders and their staffs.
This manual has been completely revised and sequenced in order to achieve a more concise document with an improved flow of information. The focus is to provide discussion of the dental service support mission, the organization of medical/dental units, and the conduct of dental service support operations.
The staffing and organizational structures and positions presented in this manual reflect Medical Force 2000, Medical Reengineering Initiative, and Army transformation organizations established in tables of organization and equipment (TOEs). These tables were current at the time this manual was published. The organization of these units is subject to change in order to comply with manpower requirements criteria outlined in Army Regulation (AR) 71-32. These organizations are also subject to change at the unit level in order to meet wartime requirements and changes are reflected in the units’ modified table of organization and equipment.
This publication implements or is in consonance with the following North Atlantic Treaty Organization (NATO) International Standardization Agreements (STANAGs):
NATO
TITLE
STANAG
2014
Formats for Orders and Designation of Timings, Locations and Boundaries
2068
Emergency War Surgery
2122
Medical Training in First-Aid, Basic Hygiene and Emergency Care
Orders for the Camouflage of the Red Cross and the Red Crescent on Land
2931
in Tactical Operations
This publication applies to the Active Army, the Army National Guard (ARNG)/Army National Guard of the United States (ARNGUS), and the U.S. Army Reserve (USAR) unless otherwise stated.
The proponent of this publication is the United States (U.S.) Army Medical Department Center and School (USAMEDDC&S). Send comments and recommendations in a letter format directly to the Commander, USAMEDDC&S, ATTN: MCCS-FCD-L, 1400 East Grayson Street, Fort Sam Houston, Texas 78234-5052 or at e-mail address: Medicaldoctrine@amedd.army.mil. All recommended changes should be keyed to the specific page, paragraph, and line number. A rationale should be provided for each recommended change to aid in the evaluation of that comment.
Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.
The use of the term continental United States (CONUS) includes the continental U.S., Hawaii, Alaska, and its territories and possessions.
The use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense (DOD).
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Chapter 1
Overview of Dental Service Support
SECTION I — IMPORTANCE OF ARMY DENTISTRY
MISSION
1-1. The mission of the Army Dental Care System is to provide Soldier-focused dental services in a timely and cost-effective manner that supports America’s Army.
1-2. Stability operations, a part of full spectrum operations, are recognized in Department of Defense Directive 3000.05 and FM 3-0. As a result, the expanding mission of the Dental Corps includes supporting the main tenets of stability operations. For more detailed discussions refer to FM 3-0 and FM 8-42.
SOLDIER
1-3. The Soldier as the centerpiece of the U.S. Army is the basic guarantor of mission success. As such, his health and physical fitness are vitally important. Equally important is the Soldier’s oral and dental health, which if not properly maintained can result in the Soldier becoming nondeployable and if already deployed, can render him nonmission-capable.
1-4. There are many reasons why a Soldier’s oral and dental health can break down. This is especially true while a Soldier is deployed. There are a number of causes which can contribute to a decline in a Soldier’s oral and dental health. Some of the more common causes include—
z
Stress-induced compromise of the immune system.
z
Inadequate oral and dental hygiene practices.
z
Use of tobacco products.
z
Accidental and combat-related injury to the face.
1-5. In addition to those considerations already listed, mission, enemy, terrain and weather, troops and support available, time available, civil considerations (METT-TC) may also present situations where Soldiers will not have ready access to a dental treatment facility (DTF) when routine dental care may be all that is required to correct a minor problem before it becomes more serious.
1-6. Review of past U.S. military deployments suggests that the longer a deployment lasts the more likely a Soldier is to experience a dental emergency. The same review also indicates that as a deployment lengthens there are fewer opportunities and resources available to enhance, maintain, and improve a Soldier’s dental health. It is for these reasons that dental service support assets are organic to maneuver and movement units of the Army.
1-7. Although the primary focus of this publication is dental service support provided in theater, it is important to understand that the emphasis on a Soldier’s oral and dental health begins at the time that he enters the Army and continues throughout his service commitment.
IMPACT OF DENTAL EMERGENCIES ON UNIT READINESS
1-8. Historically, 20 to 25 percent of all deployed Soldiers have experienced a dental emergency during a one-year deployment. The significance of this statistic is the potential impact on a unit’s ability to execute its mission. The following examples are provided:
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Chapter 1
z
During World War II, specifically 1943, the greatest numbers of Soldier complaints were in regard to the lack of adequate dental support.
z
During the Korean War, 133,720 dental visits were recorded. These visits resulted in 493,441
dental procedures being performed.
z
During the Vietnam War, dental emergencies for deployed U.S. Navy and U.S. Marine Corps personnel averaged 200 dental emergencies per one thousand Sailors and Marines deployed per year.
z
During deployment processing for Operation Desert Shield over 150,000 Army National Guard and Reserve Component Soldiers were processed through DTFs in the CONUS. Over 40,500 of these Soldiers required panographic x-rays and 33,000 required dental treatments to be classified as deployable. The result was a mobilization system that was severely stressed and its ability to quickly process Soldiers for deployment was degraded.
z
A review of the 12th Evacuation Hospital patient treatment records during Operation Desert Shield and Operation Desert Storm indicated that approximately 14 percent of Soldiers reporting for sick call were seen for dental emergencies. Once a detailed analysis of the information was completed the percentage of dental emergencies was actually found to be higher than 14 percent.
z
Mobilization and deployment dental processing during Operation Desert Shield and Operation Desert Storm was provided to 243,829 DOD personnel between 2 August 1990 and the end of the war. Five reserve dental units and a number of individual mobilization augmentees were activated to help with the massive dental workload brought on by reserve force mobilization.
This period also saw the stateside dental capability depleted by deployment of Active Army dental personnel.
1-9. The examples in paragraph 1-8 provide us with valuable insight regarding the number of Soldiers that may require dental treatment during a lengthy deployment. They also illustrate that when dental care is not readily available and Soldiers must be evacuated for treatment of dental emergencies, those Soldiers may be separated from their units for extended periods of time.
1-10. Based on the information provided above, it is easy to conclude that good oral and dental health is a force multiplier and that ready access to dental care can contribute significantly to unit readiness and morale.
SECTION II — ARMY DENTAL READINESS
DENTAL READINESS
1-11. Dental readiness refers to a Soldier’s dental health as it relates to his worldwide deployment status.
Dental readiness is fundamental to maintaining unit readiness and reducing noncombat dental casualties during deployments. Community oral health protection emphasizes not only oral health, but also general wellness and overall fitness of our Soldiers and all authorized beneficiaries. Army Regulation 40-35
provides guidance for the development and conduct of dental readiness and community oral health protection programs for all authorized beneficiaries of the Army Dental Care System. It describes the Dental Readiness Program for Active Army Soldiers and other programs that benefit all members of the Army community.
1-12. Lessons learned from previous mobilizations indicate that—
z
Little time is available for treatment of dental emergencies during mobilization and deployment operations.
z
High levels of dental readiness and dental preparedness reduce mobilization dental processing and treatment time.
z
Three to five days is the average length of time a Soldier is lost to his unit when he must be evacuated for dental emergencies.
1-2
FM 4-02.19
31 July 2009
Overview of Dental Service Support
1-13. Due to the potential impact that dental emergencies may have on a unit’s readiness, preventive dentistry programs must be actively supported by leaders.
1-14. High levels of premobilization dental readiness significantly reduce the number of dental emergencies experienced by deployed Soldiers.
1-15. Unit commanders, leaders at every level, the Army Dental Care System, and the Soldier all share the responsibility for the dental readiness of the command.
1-16. The importance of dental readiness cannot be overstated. Failure to maintain high levels of dental readiness adversely impacts on the ability of units to quickly mobilize and deploy. Army dental service support-specific Generating Force operations are addressed in Appendix A.
DENTAL READINESS PROGRAM
1-17. The Dental Readiness Program provides methods developed to reduce the risk of Soldiers becoming noncombat-related dental casualties when such an event could jeopardize the success of the mission.
Dental Readiness Program methods include—
z
Annual dental examinations in order to determine the oral and dental fitness and classification of each Soldier in the command.
z
Priority examinations and treatment appointments for Soldiers who are at high risk or who have not had recent dental examinations (dental Class 3 and dental Class 4).
z
Monthly dental readiness reports to unit commanders that identify the dental risk profile of the unit.
DENTAL CLASSIFICATIONS
1-18. Every Soldier is assigned a dental classification based on the results of a thorough oral and dental examination. The classification is a dentist’s best judgment of the state of a Soldier’s oral and dental health and is used to determine the likelihood that a patient will experience a dental emergency during a deployment. Dental classification criteria are provided in Appendix B.
PROCEDURES
1-19. The dental records of every Active Army Soldier will be screened on arrival at a new permanent duty station.
z
Active Army Soldiers inprocessing at their permanent duty stations whose dental records indicate that no examination has been performed within the previous 6 months or who are dental Class 3 or dental Class 4 must have a dental examination at the local DTF prior to completing their inprocessing procedures. Every effort will be made to achieve dental Class 1 or dental Class 2 for all inprocessing Soldiers prior to reporting to their unit.
z
Soldiers whose records indicate they are in dental Class 1 or dental Class 2 will have their next annual dental examination scheduled no later than 13 months from the date of completion of their last dental examination and readiness classification.
z
Every Soldier’s record will also be screened to ensure a panographic x-ray is present and that it is of adequate quality for diagnostic/identification purposes. If no panographic x-ray is present, one will be taken and placed in the dental record. There is no time requirement on updating panographic x-rays; however, the existing images must accurately represent the current oral and dental condition of the Soldier.
1-20. Soldiers in basic training or advanced individual training are required to have a dental readiness examination. This is dependent on the absence of a dental emergency, the availability of time during the training cycle, and the ability of local DTF to schedule and examine these Soldiers. If no examination occurs at this time, they must be examined at their first permanent duty station immediately upon inprocessing.
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Chapter 1
1-21. Soldiers will have their dental readiness classification updated annually by a clinical examination.
Soldiers who fail to receive a dental examination by the last day of the 13th month from the date of their last examination or dental readiness update are automatically classified as dental Class 4 and are then placed in a nondeployable status.
1-22. Appointments for dental treatment required to achieve a satisfactory dental readiness status are scheduled according to the Soldier’s current dental classification.
z
Soldiers in dental Class 1 require no treatment.
z
Soldiers in dental Class 2 are counseled on their dental needs and every effort must be made to move that patient to dental Class 1.
z
Soldiers in dental Class 3 will have the condition causing the potential dental emergency described in the narrative portion of their dental health record so they may be reclassified to dental Class 1 or dental Class 2 as soon as the condition is corrected. Personnel in dental Class 3 will receive expedited treatment to remove them from this unsatisfactory dental classification.
The immediate goal of expedited treatment is to take care of the patients most urgent dental needs and to avoid a potential dental emergency.
1-23. Prior to a Soldier’s reassignment to an overseas location, his dental treatment records will be screened. Soldiers listed as dental Class 3 or dental Class 4 will not be cleared for overseas movement until they receive the necessary dental treatment to place them in at least dental Class 2 or unless otherwise approved in accordance with Department of the Army (DA) Pamphlet (DA Pam) 600-81. Dental screening should be completed at least 7 days prior to their actual rotation date.
1-24. Soldiers in dental Class 3 and dental Class 4 normally are not to be deployed unless the mission dictates otherwise. In these circumstances, a waiver may be granted by the installation commander with a recommendation from a dental officer in the rank of colonel or above.
ORGANIZATIONAL RESPONSIBILITIES
1-25. Commanders are responsible for the dental readiness of the Soldiers assigned to their command.
Commanders must establish and implement procedures that will ensure that their command meets dental readiness standards as required by the Dental Readiness Program. Commanders will make their personnel available for appointments and maintain surveillance over the program to ensure the following: z
The supporting unit’s dental clinic is the sole custodian of all unit personnel dental records.