DENTAL CLASS 4 (ORAL HEALTH)
B-5. Dental Class 4 includes patients who require periodic dental examinations or patients with unknown dental classifications. Dental Class 4 patients normally are not considered to be worldwide deployable.
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Appendix C
Dental Equipment Sets
FIELD DENTAL SETS
C-1. Field dental sets provide the equipment necessary for Dental Corps personnel to deliver and provide forward dental service support in austere environments. The equipment is designed to be portable for easy transport and set up. The equipment is robust and requires very little electrical power to operate.
C-2. Each general and comprehensive dental officer in a field clinical position has the following DES
assigned.
z
Dental instrument and supply set, emergency care.
z
Dental equipment set, comprehensive dentistry.
z
Dental equipment set, dental support.
z
Dental equipment set, emergency denture repair.
z
Dental equipment set, dental x-ray, field.
C-3. The descriptions provided below are intended only to provide a brief description of the set and its intended purpose. For a list of the equipment contained in each of these sets go to the following Web site:
http://www.usamma.army.mil/medical_equipment_handbooks.cfm or contact the following: z
United States Army Medical Materiel Agency, Customer Relations Management Office:
Telephone: Defense Switched Network 343-4301/4316 or commercial (301) 619-4301/4316.
The e-mail address is: USAMMACRM@amedd.army.mil.
z
United States Army Medical Materiel Agency, Emergency Operations Center: Telephone: Defense Switched Network 343-4408 or commercial (301) 619-4408. The e-mail address is:
DENTAL INSTRUMENT AND SUPPLY SET, EMERGENCY CARE
C-4. The dental instrument and supply set is a small dental emergency kit that is contained in a hand carried medical aid bag. It contains the instruments and materials required for simple extractions and expedient temporary restorations. Essential in this kit is the battery-operated hand piece, which allows the dental officer to open an infected tooth, prepare a cavity for temporary restoration, or section a tooth for extraction. The dental instrument and supply set, emergency care, is intended for use when the situation does not permit the setup of the dental officer’s standard equipment.
DENTAL EQUIPMENT SET, COMPREHENSIVE DENTISTRY
C-5. The DES, comprehensive dentistry is considered the primary dental equipment set for providing operational care. The field dental equipment contained in the DES is compact, rugged, and requires a limited power demand. This set provides the dental armamentarium used in the procedures to diagnosis and treat—
z
Caries.
z
Defective restorations.
z
Occlusal trauma.
z
Tooth luxation/evulsion.
z
Gingivitis and early/moderate periodontitis.
z
Periodontal abscess.
z
Oral lesions that are traumatic or inflammatory.
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Appendix C
z
Routine endodontics.
z
Postmortem examination.
C-6. Major items of equipment include one each, portable, field-type: dental chair and stool unit; dental operating and treatment unit; dental light set; and compressor.
DENTAL EQUIPMENT SET, DENTAL SUPPORT
C-7. The DES, dental support, is found in both the area support squad of medical companies, medical companies (dental service), and the dental companies (area support). It contains items which can be shared in a clinical environment and is issued to each forward treatment team. It provides necessary support items that include a curing light, composite resin, electric pulp tester, sterilizer, sink, and laboratory table.
DENTAL EQUIPMENT SET, EMERGENCY DENTURE REPAIR
C-8. The DES, emergency denture repair, provides basic materials for expedient denture repairs.
DENTAL EQUIPMENT SET, DENTAL X-RAY, FIELD
C-9. The DES, dental x-ray, field, provides a standard dental x-ray capability for the dental team.
DENTAL EQUIPMENT SET, MAINTAINING CARE
C-10. The DES, maintaining care, is only found in a medical company (dental services) or a dental company (area support). It contains a portable, light-weight fiber optic curing light system; ultrasonic endodontic equipment; and refrigerators critical to the comprehensive dental set.
SPECIALTY DENTAL SETS
C-11. General and comprehensive dental officers and dental specialists assigned to field clinical positions may have the following DES and specialty dental sets at their disposal.
z
Dental equipment set, prosthodontic.
z
Dental equipment sets, endodontic and periodontic.
z
Oral and maxillofacial surgery set.
z
Dental hygiene, field, DES.
DENTAL EQUIPMENT SET, PROSTHODONTIC
C-12. This set provides clinical and laboratory items necessary to support fixed and removable prosthodontic procedures. The prosthodontic DES must be used in conjunction with the DES, dental support.
DENTAL EQUIPMENT SETS, ENDODONTIC AND PERIODONTIC
C-13. These sets have recently been added to support the new endodontist and periodontist positions in the dental company (area support) now replacing the older, smaller dental companies. These sets are also used in conjunction with the DES, dental support.
ORAL AND MAXILLOFACIAL SURGERY SET
C-14. This set is also a new addition intended to support the oral and maxillofacial surgeon in the combat support hospital. This set contains modern bone drill and plating systems.
DENTAL HYGIENE, FIELD, DENTAL EQUIPMENT SET
C-15. This set includes those instruments and materials necessary for providing preventive dentistry services by the preventive dentistry specialist/sergeant.
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Appendix D
Quality Assurance Plans
QUALITY ASSURANCE PLANS
D-1. Quality assurance plans provide a system of checks and balances that enable dental commanders and their staffs to objectively assess the quality of care being provided and the efficiency of the dental units.
The objectives of the plan are to—
z
Provide dental care consistent with the capabilities of the DTF and staff qualifications.
z
Reduce risk-creating incidents for the patients treated.
z
Improve provider-patient communication and patient satisfaction.
z
Evaluate practitioner performance.
QUALITY ASSURANCE IN THE THEATER
D-2. The dental unit commander is responsible for the management of the unit’s quality assurance plan.
Policy and guidance on quality assurance matters comes through the technical/staff dental surgeon channels. As with other matters for which policy is stated in references directed at peacetime care and organizations, quality assurance policy in AR 40-68 must be modified to fit the tactical situation. In any case, the spirit of quality assurance must be addressed. The Soldier in the theater should have access to the highest possible quality of dental care, consistent with the tactical scenario, as he would receive in a garrison dental facility. Establishment of a sound quality assurance plan by dental commanders and staff dental surgeons at all levels helps to ensure the individual Soldier’s accessibility.
PATIENT CARE EVALUATION
D-3. Patient care evaluations provide a tool to evaluate the quality and appropriateness of dental care being provided. These evaluations also provide a means to ensure that dental treatment records are established and maintained in accordance with regulatory guidance and established policies. Periodic audits also aid dental commanders and their staff in evaluating distribution of care and compliance with theater treatment policies regarding the type of care to be provided. Dental radiology, infection control, and barrier protection are areas of special command interest in field environments.
UTILIZATION MANAGEMENT
D-4. Access to and the effective utilization of dental services in theater is METT-TC driven. The goal of utilization management is to provide the highest quality dental care possible in the most efficient manner.
D-5. Utilization management is part of performance improvement data collected for the purpose of organizational improvement. For more information on this subject, see AR 40-68. Specific areas of interest include but are not limited to:
z
Time management in patient care.
z
Patient waiting time.
z
Number of patients treated per unit of practitioner’s time.
z
Equipment and facility management.
z
Logistics management.
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Appendix D
D-6. Emergency and preventive care should be provided as close to supported troop populations as possible. The result is faster return to duty of Soldiers and fewer dental emergency evacuations.
Preventive and operational dental care are provided at the convenience (location and time) of supported units.
RISK MANAGEMENT
D-7. The risk management program is concerned with the prevention of accident and injuries. For dental support in the theater, it encompasses the reduction of risk to patients, visitors, and unit personnel. For more information concerning risk management, see FM 5-19.
DENTAL RADIOLOGY
D-8. Quality assurance measures regarding dental radiology procedures include training personnel who operate dental x-ray equipment to recognize the risks associated with the use of this equipment. This training should include risk management and risk avoidance techniques which must be implemented. The following represent some of the techniques:
z
X-ray equipment is set up and operated in accordance with the manufacturer’s operational guidelines.
z
Patient shielding and protection measures are implemented.
z
Techniques of substituting distance for protective shielding during x-ray operations are used.
z
Exclusion areas are clear of all personnel prior to putting x-ray equipment into operation.
z
Dental personnel operating x-ray equipment are issued dosimeters and the dosimeters are handled and processed correctly.
z
All x-ray information is entered in the patient’s records.
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Appendix E
Sample Clinical Standing Operating Procedure
E-1. The CSOP addresses only those issues relating to clinical policies, procedures, and operations.
Procedures selected for inclusion in the CSOP are those which meet the unit’s clinical mission. Paragraphs E-2 through E-7 of this appendix provide an outline and format.
PUBLICATION FORMAT
E-2. The most often used format for the CSOP is a loose-leaf binder arrangement. Clinical policies and procedures are subject to frequent change and a loose-leaf arrangement can be easily updated. It is also relatively inexpensive and easily produced in multiple copies at the unit level.
ORGANIZATION
E-3. Annexes with supporting appendixes and tabs are easy to change and update; therefore, maximum use of annexes in a CSOP is advisable. The CSOP should be organized as follows:
z
Directive.
z
Table of contents.
z
Record of changes and corrections.
z
Annexes, appendixes, and tabs.
DIRECTIVE
E-4. The commander’s directive should be the first page of the CSOP. This directive is a letter order signed by the commander that directs implementation of the CSOP. The directive should be on unit letterhead and in memorandum format.
RECORD OF CHANGES AND CORRECTIONS
E-5. Since information in the CSOP is subject to frequent change, include a page in the front of the binder to record changes and corrections. This allows the user and the DTF officer in charge to easily audit that particular copy of the CSOP. A single page formatted as shown in Figure E-1 will serve this purpose.
RECORD OF CHANGES AND CORRECTIONS
Dental treatment facilities designation or unit designation CSOP
NUMBER
DESCRIPTION
AUTHORITY
DATE
ENTERED
BY
_________
______________
____________
_____
_____________
_________
______________
____________
_____
_____________
_________
______________
____________
_____
_____________
_________
______________
____________
_____
_____________
Figure E-1. Format for changes and corrections
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Appendix E
ANNEXES
E-6. Information in the CSOP is incorporated into annexes dealing with general areas. Annexes are supported by appendixes and tabs that deal with more specific issues. Information in annexes and supporting appendixes and tabs should not be redundant, nor voluminous. However, there should be sufficient detail to ensure proper performance of the task addressed or compliance with the policy prescribed. As with the TSOP, annexes to the CSOP are directive and address who, what, where, when, and how. Annexes are attached in alphabetical order after the body of the table of contents, with appendixes (numerical) and tabs (alphabetical) following their supported annexes. Annexes are generally formatted in the same manner prescribed for the TSOP (see paragraph E-7); however, as a matter of expediency and economy, some material may be incorporated as an appendix or tab in its original form simply by adding a tab or appendix designator. Some examples of this method are manufacturer’s instruction manuals, military technical manuals, or written policy directives from higher headquarters.
CONTENT
E-7. The information contained in annexes is variable and will depend on the type of unit and, of course, guidance and policy from the unit commander and his higher headquarters. The following is an outline of annexes, appendixes, and tabs recommended for inclusion in a generic CSOP.
E-8. Annex A—Organization. A general statement of the mission and organization of the unit.
z
Appendix 1—Dental treatment facility layout. Line diagram of the suggested DTF layout.
Tab A—Vehicle load plans. Load plans for the DTF personnel and equipment.
z
Appendix 2—Personnel. Organization of personnel assigned to the DTF and delineation of duties.
Tab A—Duty description. Detailed description of individual and special duties as
necessary.
E-9. Annex B—Equipment. Listing of equipment assigned to the DTF.
z
Appendix 1—Operation and maintenance. Statement of DTF policy for equipment operation and operator maintenance.
Tab A—Individual major items. Manufacturer’s operator manual or service technical
manual, if available, for each major item of equipment, to include vehicles and generators.
z
Appendix 2—Maintenance support procedures. Prescribe procedure for obtaining maintenance support.
E-10. Annex C—Supply.
z
Appendix 1—Class VIII medical supply. Statement of procedure for ordering, receiving, storing, and issuing Class VIII medical supplies.
z
Appendix 2—Property control. Hand receipt procedure for maintaining accountability of the DTF’s TOE and common tables of allowance property.
z
Appendix 3—Precious metals control. Procedure for control of precious metals and finished fixed prosthodontic cases, if appropriate.
z
Appendix 4—Medication control measures. Procedure for prescribing, issuing, storing, and disposing of schedule substances.
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Sample Clinical Standing Operating Procedure
E-11. Annex D—Patient care operations.
z
Appendix 1—Patient treatment policy. Statement of treatment policy to include priority of care, if appropriate.
Tab A—Policy letters from higher headquarters.
Tab B—Eligibility for care matrix.
z
Appendix 2—Patient flow. Prescribe patient flow.
Tab A—Detainee dental operations. Provide information on security procedures.
z
Appendix 3—Patient records. Prescribe procedure for preparation and maintenance of patient records.
z
Appendix 4—Workload reporting. Prescribe procedure for workload data accountability and reporting.
z
Appendix 5—Preventive dentistry. Describe and define responsibilities for the DTF’s preventive dentistry program.
z
Appendix 6—Referrals. Prescribe procedure for referral and evacuation of patients for treatment available at other DTFs.
z
Appendix 7—Nutritional supplements. Provide guidance on providing patients undergoing lengthy treatment nutritional supplements prior to undergoing a dental procedure. (Refer to paragraph 1-59.)
E-12. Annex E—Immediate response situations.
z
Appendix 1—Mass casualty scenarios.
z
Appendix 2—Reaction to enemy action. Prescribe the DTF’s response in the event of enemy action, to include handling of patients within the DTF.
Tab A—CBRN response.
Tab B—Ground attack.
Tab C—Air attack.
z
Appendix 3—Mass casualty response. Prescribe the DTFs responsibilities in the event of mass casualties (alternate wartime role).
E-13. Annex F—Infection control. Statement of required infection control procedures.
z
Appendix 1—Personal and patient protection. Prescribe procedure for protection of health care provider and patient.
z
Appendix 2—Sterilization of instruments.
z
Appendix 3—Disposal of medical waste.
E-14. Annex G—Relocation. Procedures for emplacement and displacement of the DTF.
z
Appendix 1—Dental treatment facility setup.
z
Appendix 2—Dental treatment facility takedown.
z
Appendix 3—Provision of dental treatment during relocation. Prescribe procedure for provision of emergency dental treatment during relocation.
E-15. Annex H—Safety. Statement of safety policies and procedures.
z
Appendix 1—X-ray operations.
z
Appendix 2—Fire safety.
z
Appendix 3—Hearing conservation.
z
Appendix 4—Hazardous material handling.
E-16. Annex I—Physical security. Statement of physical security plan for the DTF.
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Glossary
ACRONYMS AND ABBREVIATIONS
AMEDD
Army Medical Department
AOC
area of concentration
AR
Army regulation
ASCC
Army Service component command
attn
attention
BCT
brigade combat team
CBRN
chemical, biological, radiological, and nuclear
CONUS
continental United States
CSOP
clinical standing operating procedure
DA
Department of the Army
DA Pam
Department of the Army pamphlet
DENCOM
Dental Command
DES
dental equipment set
DOD
Department of Defense
DTF
dental treatment facility
FM
field manual
G-9
Assistant Chief of Staff (Civil Affairs)
MEDBDE
medical brigade
MEDCOM (DS)
medical command (deployment support)
METT-TC
mission, enemy, terrain and weather, troops and support available, time
available, civil considerations
MOS
military occupational specialty
MTF
medical treatment facility
NATO
North Atlantic Treaty Organization
NCO
noncommissioned officer
SF
standard form
SOP
standing operating procedure
STANAG
Standardization Agreement
TOE
table of organization and equipment
TSOP
tactical standing operating procedure
U.S.
United States
USAMEDDC&S
United States Army Medical Department Center and School
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References
SOURCES USED
These are the sources quoted or paraphrased in this publication.
NATO STANAGS
These documents are available online at: https://nsa.nato.int (password required) 2014 ( Edition 9), Formats for Orders and Designation of Timings, Locations and Boundaries, 17
October 2000 (Latest Amendment, 14 February 2002)
2068 ( Edition 5), Emergency War Surgery, 12 September 2005
2122 ( Edition 2), Medical Training in First-Aid, Basic Hygiene and Emergency Care, 10 December 1975 (Latest Amendment, 7 January 1999)
2931 ( Edition 2), Orders for the Camouflage of the Red Cross and Red Crescent on Land in Tactical Operations, 19 January 1998 (Latest Amendment, 3 April 1998)
UNITED STATES CODE
This document is available online at: http://uscode.house.gov/download/title_10.shtml
Title 10, Armed Forces, 3 January 2007
MULTISERVICE PUBLICATIONS
These documents are available online at: http://www.usapa.army.mil/
FM 3-11.3/MCRP 3-37.2A/NTTP 3-11.25/AFTTP(I) 3-2.56, Multiservice Tactics, Techniques, and Procedures for Chemical, Biological, Radiological, and Nuclear Contamination Avoidance, 2
February 2006
FM 3-11.5/MCWP 3-37.3/NTTP 3-11.26/AFTTP(I) 3-2.60, Multiservice Tactics, Techniques, and Procedures for Chemical, Biological, Radiological, and Nuclear Decontamination, 4 April 2006
DEPARTMENT OF DEFENSE DIRECTIVE
This document is available online at: http://www.dt