United States Public Health Service DENTAL NEWSLETTER A publication of the Dental Professional Advisory CommitteeVolume 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 STORY Dushanka Kleinman, DDS, M.Sc.D.Open Letter to Surgeon General 1 RADM USPHS Assistant Surgeon GeneralREGULAR SECTIONSChief Dental Officer’s Column 1DePAC Chair’s Column 3DePAC Vice Chair’s Column 4Agency Update 9Organizational Updates 11 An Open Letter to Surgeon General Richard H. CarmonaDePAC Work Groups 13 Dear Surgeon General Carmona:FEATURES On behalf of the USPHS Dental Category I thank you for your active, creativeCOA 6 and enthusiastic support of all activities directed towards improved oral health.Clinical Perspectives 15 Those of us in the dental profession are fully engaged in oral health; for us theSenior Dental Spotlight 10 importance and value of oral health to general health and well-being is secondJunior Dental Spotlight 12 nature. It is our area of expertise and our ethical responsibility. However, ourSpecial Articles 17 efforts are amplified a thousand times over by the personal involvement and commitment of the Surgeon General of the US Public Health Service to theAssociate Recruiting Program 19 nation’s oral health. When you step up to the podium and highlight the criticalUpcoming Events 23 role of oral health, there is a fresh and revitalized visibility and importance givenEditor CAPT Stephen P. Torna to oral health and to dentistry’s role in overall health promotion and diseaseEditor CAPT Suzanne Saville 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 toThe USPHS Dental Newsletter is published 3-4 be part of your public health priority areas: prevention, preparedness, healthtimes annually, and is distributed electronically literacy and health disparities. Let me reflect on just a few:through the USPHS Dental Bulletin Board,agency distribution lists, and the USPHS Dental Prevention: We are proud that your participation in the release of A NationalDirectory. 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-The next issue of the newsletter will be private partnership under the leadership of the Office of the Surgeon General.published in September 2005. The deadline forsubmitting articles is August 13, 2005. Preparedness: Your support for and keynote at the first national conference on Dentistry’s Role in Bioterrorism and Other Catastrophic Events, held inIf you have suggestions or comments about the Washington DC set the stage for a myriad follow-up activities by professionalnewsletter, or would like to submit an article, organizations and the USPHS. We also appreciate your strong support ofplease contact the co-editors CAPT Steve Torna expanding the services that can be provided by dentists during national disasters.Steve.email@example.com or CAPT Suzanne Savillessaville@d11.uscg.mil 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
Page 2 USPHS Dental Newsletter June 2005 By CAPT Gary Pannabecker, DDSOne 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 betweenthe CPO’s and PAC’s. Also, the Chief Dental Officer, RADM Dushanka Kleinman, charged each PAC, including DePAC, to improveits effectiveness in communication of pertinent issues to and from dental officers. DePAC has formed an adhoc workgroup comprisedof CDR Tim Ricks, CDR Jim Webb, CDR Arlan Andrews, and CDR Steve Torna to address this communication issue. DentalOfficers 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 toprovide valuable input. CAPT Dean Coppola, Senior Policy Analyst in OCCFM, and CAPT Lee Shackelford, Director of Division ofCC Training and Career Development in OCCO, have asked for suggested cross training opportunities of interest to dental officersthat 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 (firstname.lastname@example.org ) to forward for consideration.CAPT Larry Furman, Director of OCCFM, has engaged in frank discussions with DePAC and other PACs regarding what has becomeknown as the “3&Freeze” promotion policy, which indicates that an officer who has been passed over three consecutive times forpromotion to a given grade (O-4, O-5, O-6) will remain at the officers current grade. DePAC has provided in depth analysis of thepotential negative impact on retention within the Dental Category of “3&Freeze” for CAPT Furman and OCCFM’s consideration andreview. CAPT Furman has also updated DePAC on the current status of the proposed 6th promotion precept which is intended torecognize duty in isolated hardship, hazardous duty, and hard to fill assignments. He reported a workgroup has been formed to furtherdevelop 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, CAPTLawrence Furman, CAPT Lee Shackelford, CAPT Dean Coppola, CAPT Chris Halliday, CAPT Deborah Noyes, CAPT NickMakrides, and CAPT Stan Bastacky during the Town Meeting 1545-1700 on Dental Category Day, Tuesday, June 7, 2005 at the COAmeeting in Philadelphia. Please plan to attend. For those unable to attend, DePAC will provide a transcript of the meeting on thedental 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."
Page 3 USPHS Dental Newsletter June 2005 By CDR Tim Ricks, DMD, MPH“An avalanche begins with a snowflake” – Joseph D. ComptonYour 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 DePACmembers, 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 onesource of career development information, from getting started in your USPHS career to promotions. This manual will compileinformation from many different sources, including OCCO, OCCFM, previous Dental Category orientation manuals, and will alsoinclude career development materials for Civil Service dentists. We expect that this manual will be released electronically to all ofyou 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 vacanciesor understanding and fitting into the Transformation of the Corps, we also continue to understand the importance of bringing inadditional partners to help us to meet your needs. We have developed, over the course of several years, significant workingrelationships with organized dentistry, including the ADA, AGD, AAPHD, APHA, NDA, HDA, AAWD, and others, and we lookforward 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 suchas 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 yourfeedback 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 throughall of our collective ideas and work, we can create an avalanche of enthusiasm, knowledge, and participation within the DentalCategory. 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 newslettersContinued from page 1:
Page 4 USPHS Dental Newsletter June 2005based movement, one that includes oral health literacy. Now you have asked for a Call to Action on health literacy and we arepleased 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 dentaland related patient advocate groups. You have informed multiple audiences and the media with important actions that can be taken toensure optimum health. Your Healthy Dozen series as part of “The Year of the Healthy Child” initiative has incorporated messagesfor oral health.You provide a role model for us. You continually address new challenges, and open new vistas and roles. As you address globalhealth, 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 JEFFCOATDr. Jeffcoat is Professor of Periodontics and Dean of the School of Dentistry. While at Alabama, she was also aUniversity of Pennsylvania School of Dental Medicine. A professor of biomedical engineering, held the James Rosenmember of the National Institutes of Health-NIDCR Advisory Endowed Chair of Dental Research and served as interim chairCommittee for Research on Womens Health, she has also for the Department of Oral Biology. A graduate of the Harvardserved on the editorial boards of a variety of professional School of Dental Medicine, she also taught Periodontologyresearch journals for more than 20 years. Prior to joining Penn there for 10 years. Dr. Jeffcoat is President of the Academy ofDental Medicine in July 2003 as Dean, Dr. Jeffcoat served as Osseointegration and a past president of both the AmericanAssistant Dean of Research and Professor and Chair of the Association for Dental Research and the InternationalDepartment of Periodontics at the University of Alabama Association for Dental Research. 2005 JACK D. ROBERTSON DENTAL AWARDCAPT Chris Halliday received a DDS degree from the served in that capacity from 1998 to 1999. While there heMarquette University School of Dentistry in 1987. He entered managed 59 dental public health and dentistry grant programsthe Commissioned Corps in January 1988 and was assigned to with a budget totaling $4.5 million and was instrumental inthe North Slope Borough Community Hospital in Barrow, creating a Pediatric Residency Program Grants program. InAlaska. In 1990, he became Chief of the Service Unit Dental the fall of 1999, Dr. Halliday assumed the position of IHSProgram at that hospital. From January 1991 to November Assistant Headquarters Dental Consultant and deputy1992 he served as chief of the basic dental satellite of the PHS Director, Program Policy and Development. Within a year heIndian Health Center in Bloomfield, New Mexico. He served was selected to become the acting Director, IHS Division ofas the Area/Regional Dental Disease Prevention Officer and Oral Health (DOH). He continues in this O-7 billetActing Area Medical and Dental Recruitment Officer of the administering the $101 million IHS Oral Health budget. WithNavajo Area Indian Health Service Dental Program in reassignment of 2 key staff, Dr. Halliday effectively utilizesWindow Rock, Arizona from November 1992 through 1998. the remaining DOH dentists and creatively employs field andHe then moved to the Health Resources and Services Area staff to allocate workloads and innovatively manage theAdministration in Rockville, Maryland as a Senior Program IHS Dental Program. The IHS Dental Program is currentlyManagement Officer in the Bureau of Health Professions and experiencing difficulties recruiting adequate numbers of
Page 5 USPHS Dental Newsletter June 2005dentists. CAPT Halliday recognized quickly that loan at numerous meetings, regularly presents at the ADA Councilrepayment was the best recruitment tool available to IHS to of Governmental Affairs, serves as the dental categoryattract dentists to the IHS. He has developed several representative to the District of Columbia Commissionedinnovative methods to maximize the resources for this Officers Association, and has been an active member ofprogram, resulting in 150 contracts being awarded to dentists DePAC. He was personally deployed for two weeks to Worldand dental hygienists during FY04. CAPT Halliday worked Trade Center site as part of DMORT Region III; New Yorkwith the PHS Chief Dental Officer and the Immediate Office City’s Chief Medical Examiner was so impressed with hisof the Secretary as HHS attempted to address the concerns of work that officials requested to retain him past his scheduledthe American Dental Association regarding the Alaska Dental tour.Therapist Program. In this role CAPT Halliday has met withthe ADA repeatedly, accompanying both the IHS Director and CAPT Halliday has consistently performed at an outstandingthe Chief Dental Officer. He also accompanied the ADA level as indicated by superior Commissioned OfficerTask Force to Alaska to examine access to care issues in rural Effectiveness Reports, numerous PHS and outside awards, andAlaska villages. academic success. His distinctive accomplishments reflect great credit upon himself, the dental profession, and theCAPT Halliday completed a Master of Public Health degree Commissioned Corps of the United States Public Healthfrom the University of North Carolina, Chapel Hill, in Service. In recognition of CAPT Chris Halliday’s dedication,December 2002, and currently is working on his dental public service and commitment to the advancement of oral health, hehealth residency. He has represented the Chief Dental Officer is awarded the 2005 Jack D. Robertson award. 2005 SENIOR CLINICIAN DENTAL AWARDCAPT David Crain received his DDS degree from the aggressively continued to pursue the highest levels of clinicalUniversity of California at San Francisco in 1986. He entered excellence.the Commissioned Corps in August 1986 as a staff dentalofficer at the Indian Health Service Hospital in Harlem, CAPT Crain facilitates the educational experience of theMontana. From there he transferred to the Fort Berthold IHS Phoenix Indian Medical Center’s (PIMC) dental residents –Service Unit in New Town, North Dakota where he stayed both GP and Pediatric – in clinical and didactic areas. He hasfrom July 1989 to July 1992. CAPT Crain then went to the presented lectures nationally, at the COA and annual IHSIndian Medical Center in Phoenix, Arizona where he meetings, to his fellow PHS dental officers. Additionally, hecompleted an Advanced General Practice Residency from July provides CDE for the PIMC dentists, dental assistants, dental1992 to July 1994. He subsequently served as a staff dental hygienists, and medical staff. He has authored numerousofficer at the Center from July 1994 to October 1996, when he articles about a broad range of dental and medical subjects.became a staff dental clinical specialist. In October 1997 CAPT Crain is an Adjunct Professor at the University of IowaCAPT Crain became the Director of the IHS Advanced School of Dentistry, and is working with the new ArizonaGeneral Practice Residency Program at Phoenix and has School of Dentistry and Oral Health.remained so to the present. In addition to his clinical duties at PIMC, CAPT Crain has, onCAPT Crain has impressive clinical accomplishments. CAPT numerous occasions, assumed the role of Acting Chief DentalCrain has achieved both Fellowship (2000) and Mastership Officer at PIMC; participated on local and national(2004) in the Academy of General Dentistry. With attainment committees; and provided outstanding leadership Corps-wide,of his Masters, CAPT Crain joins less than 2,000 North most notably as General Co-Chair for the 2003 COA AnnualAmerican dentists who have achieved this high honor. Conference. CAPT Crain also has fulfilled the OFRD (CCRF)Furthermore, CAPT Crain has distinguished himself by readiness requirements and has deployed to CAMP Pendletonattaining Diplomate status, Federal Services Board of General for several weeks.Dentistry in 1996, and in 2004 he received Board Certificationin the American Board of General Dentistry. He is the only CAPT Crain’s performance, creativity, initiative, andPHS dental officer to have done so. The latter is among the leadership testify to his dedication and superior service to themost rigorous of challenges for a general dentist, requiring an profession of dentistry and the United States Public Healthintense comprehensive examination, documented Continuing Service. CAPT David Crain is awarded the 2005 SeniorEducation in all dental disciplines, and an oral defense of Clinician Dental Award to in recognition of outstandingmultiple case presentations. Clearly, CAPT Crain has achievements in clinical dentistry. 2005 ERNEST EUGENE BUELL AWARD
Page 6 USPHS Dental Newsletter June 2005LCDR Lynn Van Pelt graduated from the University of been the recipient of four unit commendations, one PHSMississippi School of Dentistry in 1996. She completed an citation, and two Achievement Medals as well as numerousAdvanced Education of General Dentistry (AEGD) residency other federal and non-federal awards. She has been veryin 1997 at the University of Mississippi, and entered the active in the American Dental Association, Academy ofCommissioned Corps in August 1997. Her first assignment General Dentistry, Alaska State Dental Society, Association ofwas at the Yukon-Kuskokwim Health Center in Bethel, Military Surgeons of the U.S., American Society of DentistryAlaska. From July 2001 to June 2003 she completed an for Children and the American Student Dental Association.Advanced General Practice Residency (AGPR) at the W.W.Hastings Indian Hospital in Tahlequah, Oklahoma. In July The USPHS dental category needs junior officers to assume2003 she assumed her present assignment as Deputy Chief of leadership roles. LCDR Van Pelt is a role model for all juniorDentistry at the Haskell Indian Health Center in Lawrence, officers in the dental category. She is committed to theKansas. Commissioned Corps and US Public Health Service, to furthering her professional education, and to sharing herSince entering the Commissioned Corps, she has served as one knowledge with others. She has performed in a sustained,of three editors of the Indian Health Service Dental Explorer; consistent, and professional manner that represents the veryfunctioned as the co-Administrator of the USPHS Dental best among junior USPHS dental officers. LCDR Lynn VanListerv and Dental Bulletin Board; helped moderate the 2003 Pelt is awarded the 2005 Ernest Eugene Buell Dental AwardCOA Conference Dental Day; and made numerous for her significant contributions in oral health service by apresentations at local, regional and national meetings. In her Junior Dental Officer.seven years as a Commissioned Officer, LCDR Van Pelt has SPECIAL AWARD TO RADM JOHN BABB AT 2005 PUBLIC HEALTH PROFESSIONAL MEETINGThe dental category is very pleased to recognize and make a Branch, Federal Bureau of Prisons in 1997 and Chief of thatspecial presentation to RADM John Babb, Director of Force Branch in 1999. He was appointed to his current position inReadiness and Deployment, Office of the Surgeon General. 2000.RADM Babb received a Bachelor of Science degree inPharmacy from the University of Tennessee Center for the The dental category wants to recognize RADM John Babb forHealth Sciences and subsequently obtained a Masters Degree his major contributions to help meet national priorities and thein Public Administration with Health Services Emphasis from health and safety needs of people both within and outside theMemphis State University. He entered the Commissioned United States, and in his realizing the important role thatCorps in November 1989, serving as Chief of the Pharmacy USPHS dentists play in these efforts. Therefore we areServices at the Federal Correction Institution in Memphis, presenting a special award to RADM John Babb in deepestTennessee. In 1993 he assumed responsibility as Director, appreciation of your leadership and unwavering support of thePharmacy Services, Federal Bureau of Prisons in Washington, dental category and the deployment of USPHS dentists toD.C. He became Deputy Chief of the Health Programs meet the needs of the American and international populations. USPHS PROFESSIONAL CONFERENCE DENTAL CATEGORY DAY 2005 BY CAPT Dave LaBadieCongratulations to the Category Day Committee and its him in appreciation of his strong historical support for thechairman, CDR Dan Hickey, for an outstanding program in dental category. Dr. Jeffcoat delivered the Surgeon GeneralPhiladelphia. Monday, June 8, saw six excellent Dental David Satcher Keynote Lecture on periodontal disease as aScientific papers presented. Tuesday started early with a risk factor in prematurity. The dental category then wasbreakfast hosted by RADM Dushanka Kleinman for the honored by a visit from Surgeon General Richard Carmona,distinguished speakers presenting later that day. Those who delivered some brief remarks. The morning session,attending included Dr. Richard Haught, ADA President; Dr. assembled by CAPT Monina Klevens, was followed by aBernard McDermott, ADA 4th District Trustee; Dr. Dianne working luncheon during which Drs. Haught and McDermottRekow, NYU College of Dentistry; and Dr. Marjorie Jeffcoat, made presentations. It was also during the luncheon that thisDean of the University of Pennsylvania School of Dental year’s recipients of the Jack D. Robertson, E. Eugene Buell,Medicine. The Category day program was opened by CDR and Senior Clinician Awards were recognized.Hickey and began with an address by RADM Kleinman. Congratulations to CAPT Chris Halliday, LCDR Lynn VanCAPT. Ron Bajuscak then moderated a Force Readiness Panel Pelt, and CAPT David Crain, respectively. On behalf ofconsisting of CAPT Dean Coppola, CDR Renee Joskow, DePAC, Chair CAPT Gary Pannabecker announced that aLCDR Cristian Morazan, and Dr. Rekow. RADM John Babb contribution to the AAPHD Foundation was made in the namewas in attendance and was surprised by a plaque awarded to of RADM Dushanka Kleinman to honor her as CDO. The
Page 7 USPHS Dental Newsletter June 2005afternoon session, assembled by LCDR Van Pelt, was opened CAPT Stan Bastacky (NHSC) addressed issues and questions.by Vice Chair CAPT Dave LaBadie, beginning with a A summary of the Town Hall discussion immediately followspresentation by CAPT Kevin Hardwick on global health this article. RADM Kleinman closed the session with thanksissues. Following that presentation, CDR Tim Ricks and to all involved and attending.CAPT Ray Lala moderated a panel about the SurgeonGeneral’s National Call to Action to Promote Oral Health. The category day program ended with a dinner cruise socialPanel members included Dr. Alice Horowitz, CAPT Mark on the good ship Spirit of Philadelphia.Nehring, CAPT Tim Lozon, CAPT Isabel Garcia, CAPT ScottPresson, CAPT Gail Cherry-Peppers, and LCDR Phillip Dental Category Planning Committee: CDR D. HickeyWoods. The afternoon program ended with a Dental Town (Chair); CAPT D. LaBadie (Vice Chair); LT J. Bleuel; CDR J.Hall Meeting. A distinguished panel that consisted of RADM Colton; CDR B. Dye; CAPT M. Klevens; CDR R. Lloyd;Kleinman, CAPT Denise Canton (OCCO), CAPT Lee CAPT R. Mayberry; LCDR C. Morazan; CAPT D. Noyes;Shackelford (OCCO), CAPT Larry Furman (OCCFM), CAPT CDR T. Ricks; LCDR M. Robinson; CDR L. Van Pelt; LCDRDean Coppola (OCCFM), CAPT Chris Halliday (IHS), CAPT B. Bucur.Nick Makrides (BOP), CAPT Deborah Noyes (USCG) and TOWN HALL MEETING 7 JUNE 2005 COA ANNUAL CONFERENCE1. Have the Agency directors met with the DHHS Secretary, an EIS Officer could start with a detail to the Indian HealthMichael Leavitt? Service and then assignment with the CDC, such that field experience is incorporated into research, etc.Secretary Leavitt has met with both Surgeon GeneralCarmona and Acting Assistant Secretary for Health (ASH) 5. How is the Office of Commissioned Corps OperationsBeato. It was reported that the discussions included addressing the issue of educating non-CommissionedTransformation of the Corps. It is not clear when a final Corps supervisors on hiring, rating and promotingdecision about the Transformation will be announced. It was Commissioned Officers?indicated that the Secretary has a 500-Day Plan for theDepartment. The Plan states that the Corps will be re- OCCO has provided information to managers of the Agencies/aligned, and describes how the Corps will be seen both inside Operating Divisions (OPDIVs) explaining the Commissionedand outside the Department. It was also announced that Corps personnel management system, and has providedRADM Higgins, US Coast Guard, has met with the Surgeon education material on how to rate annually CommissionedGeneral and the ASH to discuss Readiness as it relates to the Officers through the Commissioned Officers EffectivenessUSCG and the Department of Homeland Security. Report (COER). It was noted by OCCO that with the implementation of the Electronic COER they would be able to2. Have the levels (percent total) of the Temporary Grade get better feedback on the Raters in a timelier manner. Therepromotions been decided? is a Civilian Supervisor’s Guide that is available on line; in addition, the Commissioned Officers Training AcademyThe levels were set, and announced on 8 June 05. The T- (COTA) will also be offering an agency specific supervisor’sGrade results will be released 1 Jul 05. course. The USCG has a PHS Orientation Guide available to the Line Officers within the Coast Guard. In addition, the3. Does the Secretary’s 500-Day Plan include Oral Health? Bureau of Prisons Central Office developed a web-based program for their supervisors (SENTRA). It was announcedIt does not currently include Oral Health. However, the that there does not appear to be any difference in promotionSecretary apparently revisits the 500-Day Plan every six to rates among officers who have either a Commissioned Officerseven months. or a Civilian as their supervisor. OCCO has also been looking at the categories and agencies/OPDIVs4. How can/should we recruit in times of budget cuts? independently, being mindful of the workforce as there has been a decrease in Commissioned Officers in key categories,Recruitment is still strongly encouraged to strengthen the pool and as the agencies have changed. There is also a concernof applicants for the time when hiring freezes currently that the Regular Corps of the Commissioned Corps is quicklyexperienced by some agencies are lifted. Also, there are reaching the ceiling of 2800 officers. Congress dictates thecertain categories (i.e. dental) that still have many vacancies ceiling for PHS Regular Corps Officers.and in which targeted recruitment is continuing. It was also 6. Why does the PHS have temporary and permanent grades,announced by the Office of Commissioned Corps Force while the DoD only has the permanent grade?Management (OCCFM) that there is currently a ‘RecruitmentPolicy’ or a ‘Public Relations Plan’ that is being developedby a contractor, with specific strategies in mind. For example
Page 8 USPHS Dental Newsletter June 2005The Department of Defense calculates Training and OCCFM is looking at agencies as to how they have usedEducation differently than the PHS does. It does not give Corps officers and how many they need in the near future, i.e.credit for undergraduate training. due to retirement of officers. It was stated that if agencies force manage their personnel then OCCFM would provide7. When will the “Three and Freeze” go into effect? information on hiring and billet structure. It was announced that the current personnel structure of the Public HealthThe policy that enacted "Three and Freeze" became effective Service resembles an hourglass. With the lower Generalin 2003, yet the effects (being "frozen") could be felt as early Service (GS) levels (5-7) making up the base, GS 9-11 andas the PY 06 results. 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. It8. Why doesn’t the current PHS billet system have career was also reported that the Commissioned Corps makes up tracks based on clinical, research and administration? 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 MayberryInstruments were tuned, voices warmed up, and nerves settled would like to join the Ensemble or Choir. The dentists amongas the PHS Ensemble and Choir prepared for their stellar the band members were CAPT William Stenberg (clarinet),performance on Monday evening, followed by a well-deserved CAPT Suzanne Saville (Trumpet), and CAPT Randallstanding ovation. Mayberry (Sop Saxophone). CAPT Mayberry also contributed to the performance by transposing the chorus of the USPHSSurgeon General Carmona (SG) entered and was seated front March into a key that the choral group could comfortably singand center for the PHS Music Ensemble Performance at this along with and arranging two of the pieces performed.years COA Conference held in Philadelphia, the largestgathering of Ensemble members since the Ensemble’s RADM Moritsugu directed the Band and Choral group ininception just 4 years ago. performing God Bless America and the PHS March to end the concert. The SG then mingled with the Ensemble asThe instrumental section of the Ensemble included three photographs were taken.dentists at this years performance. The SG strongly supportsthe Music Ensemble and we would like to see a larger Dental To obtain information about joining the Ensemble, ContactCorps presence in the Ensemble. See the contact information CAPT John Bartko at: JJBartko@Starpower.net.at the end of this article if you play an instrument or sing and DISTINGUISHED SERVICE AWARD At 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.
Page 9 USPHS Dental Newsletter June 2005 1FEDERAL BUREAU OF PRISONS UPDATE By CAPT Nicholas S. Makrides2005 will bring many new changes to the Bureau of Prisons(BOP) Dental Program. The most significant of which is the Those dentists needing further clarification regarding currentnew Dental Program Statement. For those BOP dentists and proposed changes should call their respective Regionalreading this for the first time your eyes are not deceiving you. Dentists. E-mail updates will be sent to the field as theyThe BOP Dental Program Statement (policy) has finally been become available.approved and released. The DePAC OFRD workgroup chair, CDR Renée JoskowBOP dentists can now access the new policy via the intranet organized a team of 7 dentists (6 Commissioned Officers, 1on Sallyport. Dentists needing assistance in accessing the Civil Service) to provide oral and pharyngeal cancerpolicy should contact their respective Regional Dentists. All screenings at the NIH “Share the Health” healthfair, on MayBureau dentists are expected to make modifications to their 15, 2005 in Montgomery County, Maryland. Thisexisting local policies to reflect the new Program Statement. collaborative effort between the Office of the Surgeon General and the National Institute of Dental and Craniofacial ResearchPerhaps the most anticipated and discussed change for 2005 is was a huge success in increasing awareness about head andthe new staffing guidelines for the Health Services Division. neck cancer and offering cancer screenings to theMany dentists have expressed concern regarding the proposed approximately 35,000 people who were present. During a 4-dentist to inmate ratios. These concerns have been heard and hour period, we screened 92 individuals, who were 7 - 80appropriate changes are being made to correct the ratios. years of age (mean = 44). Participants self reported race/ethnicity included Asian/Pacific Islander, Black/AfricanWhile change is often difficult, this next proposed change American, Hispanic/Latino, Mexican American, Nativeshould be well received by most BOP dentists. Recent American/Alaskan Native, White/Caucasian. In addition,meetings between the Health Services Division (HSD) and the information was collected regarding risk factors such asProgram Review Division (PRD) has resulted in a streamlined alcohol and tobacco use. The dentists who participated in thisProgram Review process. For those dentists not assigned to event were:the BOP, Program Review is an agency audit that examinesthe compliance laws, rules, regulations, and policy. BOP CAPT Bill Atwood, CAPT Dean Coppola, Dr. Demetriodental managers can expect an abbreviated Program Review. Domingo (NIDCR Clinical Research Fellow), CAPT AndreaOnly policy compliance (ACA) will be reviewed by the Feight, CAPT Chris Halliday, CDR Renée Joskow, CAPTProgram Review team. Issues relating to clinical care will be Deborah Noyes.addressed by the Peer Review process. CDC By CAPT. R. Monina Klevens“ADA and CDC Celebrate 60th Anniversary of Community the impact of community water fluoridation for improving oralWater Fluoridation” health and overall health.Community water fluoridation, cited as one of 10 great publichealth achievements of the 20th century by the Centers forDisease Control and Prevention (CDC), celebrates its 60thbirthday this year.To help recognize this public health milestone, the AmericanDental Association (ADA) and the Centers for DiseaseControl and Prevention (CDC), will host a National In addition, CDC developed a resource poster for waterFluoridation Symposium at the ADA headquarters in Chicago facility operators. The poster provides key information,from July 13–July 16, 2005. The symposium will recognize including optimal fluoridation level for their states, how to monitor fluoridation levels at the plant to ensure optimal
Page 10 USPHS Dental Newsletter June 2005levels, operational and maintenance guidance, and benefits to Dental officers interested in learning more about thethe community. The poster has been endorsed by key partners symposium can visitin expanding community water fluoridation including the http://www.ada.org/prof/events/featured/fluoridation/index.aspAmerican Water Works Association, the National Rural Water The site has information about registration and the meetingAssociation, and the Association of State and Territorial agenda. Additional information about this and other oralDental Directors. 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, RDHThe 2005 National Oral Health Conference was held in conference planning company contracted for the conference,Pittsburgh, Pennsylvania on May 2 through May 4, 2005. The planning and implementation required the work and input of aconference, which is sponsored by the Association of State twenty-member program committee. The success of the preand Territorial Dental Directors (ASTDD), the American conference and conference sessions themselves relied on theAssociation of Public Health Dentistry (AAPHD), the Centers work of session planners, moderators, co-moderators, andfor Disease Control and Prevention (CDC) and the Health presenters. Members of AAPHD and ASTDD volunteered toResources and Services Administration (HRSA), attracted serve as coordinators for the fluoridation, AAPHD, ASTDD,approximately 650 participants. and student awards as well as for coordination of the round table luncheon and the contributed papers/poster sessions.The conference was preceded by three days of pre conference Finally, members of ASTDD and AAPHD acted asactivities. These included meetings of ASTDD, AAPHD, the photographers and created the opening session photo montage.American Association of Community Dental Programs(AACDP), and the newly established Medicaid/SCHIP Dental Each year everyone involved in the planning andProgram Representatives Association (MSDPR). In addition, implementation of the conference works hard to build on thepre conference activities included full day Medicaid and success of previous meetings and this year was no exception.AACDP Symposiums, a Dental Public Health Residency Based on evaluations from previous conferences, more timeworkshop, a Military Session and the administration of the was set aside between sessions. A new feature this year wasAmerican Board of Dental Public Health board examination. the submission of round table luncheon presentationThe conference itself featured four plenary sessions and 18 applications on-line. In response to suggestions received afterconcurrent sessions. The round table luncheon had 40 round previous conferences, a General Poster Session was heldtables and 77 abstracts were presented during the poster during which no other competing events were scheduled. Thissession. resulted in a large number of attendees taking time to view and visit with the poster presenters.While the focus of the conference is educational, it was not allwork and no play. Evening receptions were hosted by Stone Of course, the NOHC is successful in large part because of thePharmaceuticals, Aseptico, the American Dental Hygienists’ sponsorship of many partners. The CDC and the HRSAAssociation and the Children’s Dental Health Project and Oral provided significant financial and planning support. OtherHealth America coordinated the fun run. The AAPHD corporate partners who made significant contributions to theFoundation held a reception at the Carnegie Museum and one conference included Aseptico, OMNII Oral Pharmaceuticals,night was set aside for a buffet dinner, dancing and games. Software of Excellence, Stone Pharmaceuticals and the Xylitol Information Center. Additional sponsorship was provided byNumerous individuals were involved in the planning and the numerous exhibitors.implementation of the conference. In addition to MRSI, the 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: email@example.com, or go to the website: http://www.aaphd.org/
Page 11 USPHS Dental Newsletter June 2005 By CAPT Jeanine Tucker In 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 toapplications.
Page 12 USPHS Dental Newsletter June 2005 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.
Page 13 USPHS Dental Newsletter June 2005 MINORITY ISSUES UPDATE ON DePAC MINORITY AFFAIRS SUBCOMMITTEE By LCDR Philip WoodsThe DePAC Minority Affairs Subcommittee (MAS) serves as Dental Society in their efforts to increase the representation ofa voice for and represents the interests of minority USPHS Hispanic Americans in the dental profession, and in the DentalDental Category members. Last January the Minority Affairs Corps.Subcommittee held an introductory meeting to provide anopportunity for new and former subcommittee members, and Over the last four months great progress has been madethe new chair, LCDR Phillip Woods to get acquainted. Several towards meeting our 2005 objectives. Survey questions havenew members including LCDR Scott Brown, LCDR Marlon been formulated, and the survey is expected to be ready byBrown and CDR Jeff Gaskin were added to the MAS roster. July. Work has been initiated to develop a means by whichA brief questionnaire was sent to subcommittee members to minority officers might mentor and support their minoritygather information regarding their areas of interest relative to colleagues in their pursuit of successful PHS careers.potential projects for the 2005 year agenda. Following a Collaboration with Recruitment and Retention Subcommitteereview of the responses from the January questionnaire, the through participation of two MAS subcommittee members2005 MAS Strategic Plan was developed. should also prove helpful to our shared goals. Retired PHS Officer George Blue Spruce has been contacted, andSix activities which comprise our 2005 Strategic Plan include welcomes our involvement; we hope to send a MASthe following: 1) Conducting a survey of Dental Category representative to the annual American Society of Indianminority officers to see what issues may be unique to them; 2) Dentists meeting in July. Dr. Algernon Bolden, the currentMentoring of minority Dental Category PHS officers to better NDA president, has been contacted and looks forward toprepare for promotions and for increased visibility in the working with the MAS. We hope to send a representative toCorps; 3) Partnering with the Recruitment and Retention the annual meeting this summer. Finally, we have recentlySubcommittee to enhance entry of new minority Officers into initiated contact with the Hispanic Dental Society to expressthe Corps, and to ascertain why fewer minority officers may our support of their work to accomplish our shared mission.be staying with the USPHS; 4) Partnering with the AmericanSociety of Indian Dentists in their efforts to increase the Participating 2005 MAS Members include CDR Wilnettarepresentation of Native Americans in the dental profession Sweeting, Dr. Jay Anderson, CDR Gail Cherry-Peppers,and in the Dental Corps; 5) Continuing our relationship with LCDR Scott Brown, LCDR Marlon Brown, CDR Alanthe National Dental Association, working to increase the Peterson, LCDR Stephanie Burrell, CDR Tamieka Lewis-representation of African Americans in the dental profession Baker, LCDR Earlena Wilson, LCDR Marlon Brown, CDRand in the Dental Corps; and 6) Partnering with the Hispanic Jeff Gaskin and LCDR Phillip Woods, Chair. OFRD By CDR Renée Joskow, DDS, MPH, FAGDAs of May 1, 2005, 74.62% of the dental category meets Basic USNS Mercy deployments included 2 dentists (1 from CG andReadiness. From October 2004 to March 2005, the II Marine 1 IHS) who went to remote villages and set up a dental clinicExpeditionary Force (II MEF) at Camp LeJeune had reached outside a local hospital. They treated 20-30 patients per day94.6% Operational Dental Readiness (ODR) with the and provided approximately 60-100 extractions per day. Inassistance of dental officers from five Navy Dental addition, PHS pharmacists sorted donated pharmaceuticalsCommands and the U.S. Public Health Service. II MEF has from foreign governments. Also deployed were 2 physicians,already begun another round of deployments that is scheduled 3 Environmental Officers and 2 Engineers.through October 2005. OFRD will be deploying a total of 27dental officers to support the current dental needs of II MEF at OFRD continues to perform weekly updates of the roster ofCamp LeJeune. trained USPHS Forensic dentists. We currently have 55 dentists who have submitted documentation of Forensic training to OFRD.
Page 14 USPHS Dental Newsletter June 2005The Office of the Surgeon General supported an OFRD effort Commissioned Corps Officers and one NIH/NIDCR Clinicalto provide oral and pharyngeal cancer screenings at the May Center Fellow. The OFRD provided an in-service training of15, 2005 NIH “Share the Health” healthfair in Montgomery all participating dentists prior to the event.County, MD. Seven dentists participated in the effort, six CALL TO ACTION SUBCOMMITTEE By CDR Robin ScheperThis workgroup has been tasked with developing input from Also, at the Commissioned Officers Association Meeting, heldDePAC to assist in implementation of the National Call to in early June, there was a National Call To Action panelAction to Promote Oral Health. A National Call to Action to discussion. The panel addressed the five Action Steps fromPromote Oral Health, referred to as the Call to Action, reflects the Call To Action: Action 1: Change Perceptions of Oralthe work of a partnership of public and private organizations Health,that have specified a vision, goals, and a series of actions to Action 2: Overcome Barriers by Replicating Effectiveachieve the goals. Programs and Proven Efforts, Action 3: Build the Science Base and Accelerate ScienceAt the National Oral Health Conference, held May 2-4 in Transfer, Action 4: Increase Oral Health Workforce Diversity,Pittsburgh, CAPT James Lipton presented a roundtable Capacity, and Flexibility, and Action 5: Increasesession on the National Call To Action to Promote Oral Collaborations.Health. During the discussion he described the inventory ofcurrent federal programs that address particular actions For further information on the National Call to Action, pleaserecommended in the Call to Action and solicited ideas from visit the following web site: http://www.phs-dental.org/ncta/participants about how the private sector and state/local For further information on the Call To Action Subcommittee,governments can participate in helping to implement the Call please contact CDR Robin Scheper atto Action. . firstname.lastname@example.org CAREER DEVELOPMENT BY CAPT Suzanne K. Saville, DDS, MPH, FAGDThe Career Development Subcommittee is enthusiastically to Action papers, the Oral Health Coordinating Committee,undertaking the monumental task of creating a Career military customs and courtesies, moving allowances,Development Resource Guide. Previously, members of the uniforms, leave issues, retirement, BOTC/IOTC, mentoring,DePAC developed an orientation manual. The committee will curriculum vitae, and professional development. An outline isincorporate the orientation manual and other resources to being developed with a rough draft of the guide planned fordevelop the resource guide. The resource guide is proposed to completion in August 2005. The Career Developmentassist commissioned corps and civil service dentists find Subcommittee meets on an as needed basis. For moreinformation such as: the history, mission and organization of information, please contact Suzanne K. Saville, DDS, Chair.the USPHS, the Surgeon General’s Report and a National Call MENTORING WORK GROUP By CDR Robin ScheperFor 2005, the DePAC Mentoring Workgroup is working on The workgroup has also recently updated a resource page thatincluding Civil Service dentists as participants in the Program. is sent out to all new mentors and protégées, in addition toThis has proved somewhat challenging, as there is not a reorganizing/updating our database of the activecentralized database of new hires, as with Commissioned mentor/protégée pairs.Officers. The workgroup is in the process of contacting theArea Dental Directors with the Indian Health Service, as well For further information or an application, please check theas the Bureau of Prisons to obtain contact information on new PHS Dental Category Web Page at http://www.phs-dental.org/hires. depac/newfile14.html or you may contact CDR Robin Scheper at email@example.com
Page 15 USPHS Dental Newsletter June 2005 PREGNANCY AND PERIODONTITIS Todd Smith, DDS, MSD IHS Periodontal ConsultantPregnancy can exacerbate gingivitis and accelerate attachment in controls. He also noted that as prostaglandin levelsloss. During pregnancy, increases in prostaglandin synthesis, increased, birth weight decreased. Four organisms associatedvascular permeability, gingival crevicular fluid flow, and gram with mature plaque and progressing periodontitis werenegative anaerobic bacteroides species lead to increased detected at higher levels in pre-term low birth weightgingivitis as well as aggravation of existing gingival problems. (PTLBW) mothers, as compared to normal birth weightMiyazaki found that pregnancy increased the percentage of mothers. Madianos found that in the absence of a protectivemoderately deep pockets as the pregnancy progressed. maternal antibody response to periodontal pathogens, fetalRecently, Lieff found that pregnant women at less than 26 exposure and preterm complications are likely to occur, with aweeks, with moderate to severe periodontitis were more likely pre-maturity rate approaching 67%.to have periodontitis progress (51%) in comparison to thoseinitially periodontally healthy (9%). In epidemiologic studies, Offenbacher found that if the mother had periodontitis, the risk of PTB and LBW infants wasCurrent evidence points to a 2-way relationship between significantly higher than in those mothers with noperiodontitis and complications of pregnancy including pre- periodontitis (Adjusted Odds Ratio 7.9 and 7.5 respectively).term birth (PTB), low birth weight (LBW), and preeclampsia. He estimated that 18% of all PTLBW cases may be25% of pre-term low weight babies cannot be explained by attributable to periodontal disease. In a larger study whereaccepted risk factors such as smoking, alcohol, nutrition, periodontal exams were provided at less than 28 weeksurinary tract infection, level of education and prenatal care. Is gestation and within 48 hours postpartum, a dose responseperiodontitis also an independent risk factor for these relationship was seen. The prevalence of births in thosecomplications of pregnancy? periodontally healthy at less than 28 weeks gestational age was 1.1%. In pregnant women with mild periodontitis it roseInfections adversely affect pregnancy. In the hamster model, to 3.5% and in those with moderate to severe periodontitis itinfection with the periopathogen Porphyromonas gingivalis was 11.1%. In regards to LBW deliveries of less than 1000increased prostaglandin and tumor necrosis factor alpha and grams, the rates were 0%, 6.1%, and 11.4% for those mothersappeared to be associated with decreased fetal birth weight. periodontally healthy, those with mild periodontitis, and thosePorphyromonas gingivalis could also be detected in the with moderate to severe periodontitis, respectively. It wasplacenta. Non-human species of Campylobacter are known to concluded that maternal periodontitis was an independent riskcross the placental barrier and induce abortion and preterm factor for PTB, LBW, and fetal growth restrictions.births in cattle and sheep. In humans, the chorioamnion canbe infiltrated by neutrophils and positive bacterial cultures In 2001, Jeffcoat found that low birth weight and gestationalfrom amniotic fluid and membranes have been obtained. age were closely associated with the severity of the mother’sClinically evident infections have also been found in pre-term periodontitis. Mother’s with the most severe class ofneonates. prematurity were more likely to have severe periodontitis during the second trimester (Adjusted OR 4.45 at 37 weeks,The Surgeon General’s Report on Oral Health in America 5.28 at less than 35 weeks, and 7.07 at less than 32 weeks).describes the oral cavity as a portal of entry as well as the siteof disease for microbial infections that affect general health Not all populations with periodontitis may be at risk forstatus. In his Call to Action to Promote Oral Health, the adverse pregnancy outcomes. In one contradictory casemouth was cited as a source of disease or pathologic processes control study involving a population of mainly Bengaleseaffecting other parts of the body, including the fetus. Pre term women in the United Kingdom, no association was foundlabor may be the result of the maternal immune response to between maternal periodontal disease and increased risk forperiodontal infection. A proposed biologic mechanism PTLBW infants.implicates an increased inflammatory response with cytokinesand prostaglandin synthesis that interferes with fetal growth Another complication of pregnancy is preeclampsia, which isand triggers pre-term labor. Offenbacher, found the development of swelling of the hands and feet, elevatedprostaglandin levels in the gingival crevicular fluid to be blood pressure, and protein in the urine during pregnancy. Itsignificantly higher in mothers of low birth weight infants than is a major cause of maternal and fetal morbidity, and the cause
Page 16 USPHS Dental Newsletter June 2005remains unknown. In the United States it is a complication in procedures should be scheduled early in the secondapproximately 5% of all pregnancies. As part of the Oral trimester.Conditions and Pregnancy Study, Boggess found that women • If a potential source of sepsis such as acute infectionwith moderate to severe periodontitis during pregnancy have or abscess is present, prompt treatment is warranted,an increased risk of developing preeclampsia compared to irrespective of the stage of pregnancy.those with gingival health. Of those mothers periodontallyhealthy or with mild periodontitis the rate of preeclampsia was There has been some recent controversy regarding dental5%, and in those with moderate to severe periodontitis the rate radiographs. Hujoel found that women with dentalwas 16%. Progression of periodontitis during pregnancy was radiographs during pregnancy were more likely to have a termalso associated with preeclampsia, with an odds ratio of 2.1. LBW infant compared with women with no dental radiography. Of interest, there was no link betweenDoes treating periodontal infection in expectant mothers radiographs and PTB or very LBW, and all women with termdecrease the rate of adverse pregnancy outcomes? LBW infants had radiographs in the first trimester. ThePreliminary evidence says yes. In a small intervention study American Dental Association’s News Release in 2004 tookin New York City, 74 expectant mothers received periodontal the position that:treatment and 90 received no treatment until after delivery. In pregnant women, postpone elective dental radiographs untilNonsurgical periodontal therapy during pregnancy reduced the after delivery.rate of PTLBW infants from 18.9% to 13.5%. In a larger Radiographs may be required during pregnancy to helppopulation (n=351), the controls that received no periodontal dentists diagnose and treat oral disease. Pregnant womentherapy had a 10.11% incidence of PTLBW infants. If non- should continue to see a dentist regularly for oral exams andsurgical periodontal therapy was provided before 28 weeks professional teeth cleanings. In addition to abdominalgestation, the incidence dropped to 1.84%. Dr. Jeffcoat’s pilot shielding, dentists should use thyroid collars on all patients,study also found that periodontal therapy, particularly scaling including pregnant women.and root planing (SRP) at 21-25 weeks gestation, reduced therate of spontaneous PTB at less than 35 weeks. The rate in Health care providers do not universally know the fact thatthose that received no SRP was 6.3% and in those receiving adverse pregnancy outcomes may be associated withSRP it dropped to 0.8%. periodontitis. To better educate their medical colleagues it is important that dental care providers share this information. ToPTLBW is related to 60% of infant deaths, and treatment in assist with this process, this paper has been incorporated intohospitals for associated respiratory distress, jaundice, an existing PowerPoint presentation on the relationshipmalnutrition, anemia, and cerebral palsy costs over $5 billion between oral health and systemic diseases, also includingannually. If poor periodontal health can lead to adverse diabetes, cardiovascular disease, infective endocarditis, andpregnancy outcomes, dental treatment should be provided to pulmonary disease. For convenience, this presentation hasdecrease the risk for these potentially life threatening been posted on the IHS Dental Homepage atconditions. I recently had an obstetrician tell a pregnant Home.dentist.ihs.gov under the title “Association of Oralpatient not to have any dental care while pregnant. Upon Disease to Systemic Disorders.” This very large, technicalconsulting with him he stated that he tells all of his pregnant presentation provides background information, and should bepatients this because one patient late in her pregnancy had a edited to fit your audience. In addition, Dr. Byron Jasper andspontaneous abortion after a deep cleaning and extraction. A the IHS Division of Oral Health, in collaboration with the IHSmassive bacteremia, prostaglandins, and other inflammatory Maternal and Child Health and Health Educator Consultants,mediators entering the bloodstream may have been has published a poster for placement on walls in medical examresponsible, but stopping dental care during all stages of rooms/waiting rooms to prompt medical providers to quicklypregnancy, as pointed out, can also put the mother and fetus at screen patients for oral disease and make appropriate referrals.risk. In regards to treatment, The American Academy of The responsibility of dental providers is to target dental care toPeriodontology thinks that: pregnant women, just as diabetics with oral disease are targeted. Pregnancy can aggravate gingivitis and • Preventive oral care services should be provided as periodontitis, and periodontitis increases risk for adverse early in the pregnancy as possible. pregnancy outcomes. It is sound public health policy to • Expectant mothers should be counseled in the establish oral health in expectant mothers, potentially importance of oral health and oral hygiene. improving their overall health as well as their infants. • If a dental exam indicates a need for periodontal therapy such as SRP with local anesthesia, these 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 race/ethnicity included Asian/Pacific Islander, Black/Africanorganized a team of 7 dentists (6 Commissioned Officers, 1 American, Hispanic/Latino, Mexican American, NativeCivil Service) to provide oral and pharyngeal cancer American/Alaskan Native, White/Caucasian. In addition,screenings at the NIH “Share the Health” healthfair, on May information was collected regarding risk factors such as15, 2005 in Montgomery County, Maryland. This alcohol and tobacco use. The dentists who participated in thiscollaborative effort between the Office of the Surgeon General event were:and the National Institute of Dental and Craniofacial Researchwas a huge success in increasing awareness about head and CAPT Bill Atwood, CAPT Dean Coppola, Dr. Demetrioneck cancer and offering cancer screenings to the Domingo (NIDCR Clinical Research Fellow), CAPT Andreaapproximately 35,000 people who were present. During a 4- Feight, CAPT Chris Halliday, CDR Renée Joskow, CAPThour period, we screened 92 individuals, who were 7 - 80 Deborah Noyes.years of age (mean = 44). Participants self reported 41ST ANNUAL FORENSIC DENTAL IDENTIFICATION AND EMERGING TECHNOLOGIES By CAPT Steve TornaBoasting 140 participants representing the USA, Canada, computer database. The course culminated with a mock massBelgium, Singapore, Saudi Arabia, The Netherlands, The casualty identification exercise.United Kingdom, and Argentina, the 41st Annual ForensicDental Identification training offered by The Armed Forces This training is considered the Gold Standard introductoryInstitute of Pathology (AFIP) was completed March 25, 2005. course to forensic odontology and I consider it mostMembers of the USN, USPHS, USAF, USA as well as private challenging and fascinating. “The primary focus of the coursedentists, physicians, and pathologists attended. The training is to expose the experienced forensic scientist, and totook place in Bethesda from March 21 through March 25 at introduce the novice, to state of the art techniques for forensicthe Hyatt Regency Hotel. endeavors with an emphasis on mass disaster and dental identification.” Speakers included experts from the FBI, US Army, USN, andThe National Museum of Health and Medicine. Forensicpathologists, forensic anthropologists, criminologists, The 42nd Annual Forensic Dental Identification and Emergingprofilers, and experts in DNA analysis participated as Technologies Course will be held Next March 2006.lecturers. Lab and workshop training included skeletal Information can be obtained by contacting The Department ofanthropology, bite mark analysis, radiographic age Medical Education, Armed Forces Institute of Pathology,assessment, dental digital radiology, photographic capture and Washington DC, (800) 577-3749, email: firstname.lastname@example.org GLOBAL AIDS PROGRAM ASSIGNMENT IN TRINIDAD By CAPT Carolyn TylendaCAPT Carolyn Tylenda, Agency for Toxic Substances and GAP office, founded in 2002, works closely with theDisease Registry, recently completed a 90-day temporary duty Caribbean Regional Epidemiology Center (CAREC), whichassignment in Port of Spain, Trinidad, where she served as the has 21 member countries. CDC personnel assist CAREC inActing Operations Officer in the Centers for Disease Control planning, developing, and supporting activities to prevent HIVand Prevention (CDC) Caribbean Regional Global AIDS infection, develop capacity and infrastructure within theProgram (GAP) office. With the exception of sub-Saharan region, and improve the care and treatment of HIV infectedAfrica, the Caribbean has the highest HIV prevalence rate of individuals.any region of the world, with an estimated 2% of the regionspopulation infected with HIV. The CDC Caribbean Regional
Page 18 USPHS Dental Newsletter June 2005CAPT Tylenda’s assignment focused on establishing developed over time as a commissioned officer that enabledprocedures and systems to enable the GAP office to function me to make a lasting contribution to the program”.efficiently and effectively internally and with its partnerorganizations. “I particularly appreciated the opportunity to The assignment was completed under the auspices of thework closely with U.S. embassy personnel. This was a unique International Experience and Technical Assistance Programopportunity to learn firsthand how an embassy operates - the (IETA), a program coordinated by CDC. The IETA programvarious sections and their responsibilities, the issues that arise was established in 1997 to increase the number of Publicand how they are managed, and the duties of an Ambassador. Health Service (PHS) staff with international training andI enjoyed representing the CDC office at the embassy country experience, and accepts 25 participants each year from CDCteam meetings and senior staff meetings.” and other PHS agencies. The program combines classroom work with an international work assignment. For information“The best word that I can use to describe my experience is on the IETA program go to“empowering”. I returned with a renewed sense of purpose, a http://www.cdc.gov/nchstp/od/faso/ieta, and for GAP,recognition that one individual can have significant impact, http://www.cdc.gov/nchstp/od/gap/default.htm.and the realization that I have many valuable skills that were USPHS DENTAL DEPLOYMENT CAMP LEJEUNE By CAPT Steve TornaThe United States Navy (USN) provides medical and dental tracking patient needs, places each Marine in one of fourcare for the Marine Corps. categories. Category three patients were our primary concernThe USN Second Dental Battalion provides dental care for the as these Marines had conditions that may lead to problemsSecond Marine Expeditionary Force (II MEF). The II MEF while on deployment. Our goal was to provide the treatmentconsists of 47,000 Marines Stationed at Camp Lejeune, and necessary to convert these patients to category two and thusMarine Corps Air Station New River. A total of ten Second eliminate any conditions that may require emergent field care.Dental Battalion Clinics strive to meet the dental needs of theII MEF. The five main clinics include Osborne, Mainside, I consider my deployment to Camp Lejeune and my previousFrench Creek, New River, and Cherry Point. deployment to Camp Pendleton a privilege. It was an honor to participate in this effort and I feel a true sense ofLocated in North Carolina, the Marine base is approximately accomplishment in having assisted OFRD, the Marines, the246 square miles in size and home to more than 150,000 Navy Dental Corps, and my country. I would encourage everypeople. The base has 14 miles of Atlantic Ocean beach and officer to volunteer for these deployments as the rewards maymiles and miles of freshwater beaches. Camp Lejeune prove to be deeply moving and personal.annually generates 2 billion dollars in commerce. The following officers were deployed to Camp Lejeune duringOur Mission at Camp Lejeune was to assist the Second Dental the period Nov 2004 to March 2005. CAPT Walton VanBattalion in reaching 100% readiness among the Marines Hoose, LCDR Stella Wisner, LCDR Charles Houk, LTbeing re-deployed to Iraq. Readiness means that each Marine Stephen Wiist, CAPT James Norman, LCDR Kathryn Bagg,is free of dental conditions that may lead to the need for LT John Linhart, CDR Edward Arnold, CDR Stephen Torna,emergency treatment within a six-month period of time. CDR Rick Vaccarello, LT Laura Fuentes, LCDR KevinPartially erupted third molars that have pericoronitis potential Zimmerman, CDR Aaron Means, CDR Arlan Andrews, CDRand severe caries are among the problems that require Robert Good, LCDR Godfrey Onugha, CAPT Timothy Lozontreatment prior to deployment. The USN dental system for and CDR Cielo Doherty. 1PHS Officer Responds to Friends in Need LCDR Phillip D. WoodsAs the USPHS increases its participation in emergency and him for the Christmas holidays. A few hours later he woulddisaster relief efforts around the globe, there are also small realize that this would be anything but just another ordinaryinstances of individual PHS officers doing their part to aid day. The day would bring a disaster of unimaginablethose in need right here at home. proportions, affecting 13 countries, resulting in the death or When CDR Jeff Gaskin awoke on December 26, disappearance of more than 300,000 persons. This tragedy2004 he thought his would be just another ordinary day, would reverberate around the world, as well as touch himexcept for the fact that he was to pick up two friends visiting intimately at his home in the small town of Clifton, Arizona.
Page 19 USPHS Dental Newsletter June 2005 The two guests visiting CDR Gaskin were a Sri that they were also experiencing ‘survivors guilt’ as well -Lankan couple named Stanley and Padmani - two of many Sri guilty that they had been lucky enough not to make theirLankan friends Gaskin has known for several decades. CDR originally scheduled trip to Sri Lanka"Gaskin has a special place in his heart for Sri Lanka and its "Because Padmani and Stanley had their cell phonescitizens. In 1973 he was an exchange student there while a and because it seemed they were obtaining more accuratecollege student at Hampton University. While living in Sri information via their cell phones than from the televisionLanka he developed several close friendships, which have reports, I thought I’d try to help as much as possible to takeblossomed over the years. He’s participated in the weddings of their minds off this ever-expanding tragedy. So I packed us allclose friends there, and since 2000 he has led several dental up and we spent the next 4 days at a local hot springs and inmissions to Sri Lanka, accompanied by other PHS dental Paloma, Mexico which is just over the border.”officers. Currently CDR Gaskin serves as the Regional Dental Anyone who knows CDR Gaskin knows he has a giftConsultant for the BOP Western Region. of thinking out of the box, and making the best of a By the time Jeff arrived at the airport to greet his challenging situation. This time was no exception. With thevisitors on December 26, reports of an Indian Ocean help of his Clifton neighbors, Gaskin ended his guest’s visit byearthquake, and a resultant tsunami had begun to trickle back hosting a special dinner. His guests happen to be great chefsto the West. His guests were already aware of the disaster creating several wonderful Sri Lankan dishes for the occasion.when as they met him at the airport, anxiously checking Everyone enjoyed the affair, and it provided great respite fromimmediately on their cell phones, receiving frequent updates the frustration of helplessly watching the worsening CNNfrom friends back home. Originally from the capital city of reports. At the end of the week, the couple left for New York,Colombo, they had planned to visit Sri Lanka over the grateful for the support CDR Gaskin provided them duringholidays before changing their plans at the last minute to visit their time of need.CDR Gaskin. In fact, they had spent last Christmas holiday in Today we find ourselves more and more living asSri Lanka in 2003. So as the calls continued to come in, and as part of a global community, with fewer distinctions of who arethe reports continued to relay the increase in the severity of the our brother, our sister, and our neighbor. It is good to know wedevastation, they waited and prayed. have exemplary dental officers like CDR Gaskin representing "It was a very sad and frustrating time for them as the USPHS whether on CCRF missions or in his everyday life,they continued to get conflicting reports from friends in other serving as a good will ambassador as he did. As he puts it, “Iparts of Sri Lanka. We were also getting higher and higher just did what I felt anyone would do."death tolls by the hourly reports on the TV . . . first 10,000dead, then 20,000 dead and more and more. And I could sense By CDR James T. Owen, D.D.S.The Dental Associate Recruiter Program is actively recruiter. The associate recruiter will make a presentationformulating plans and ideas to bolster recruiting efforts and to informing students of the unique practice opportunities,educate dental students about the Public Health Service. A benefits and compensation available in the Public Healthcontinuing challenge the dental category has is maintaining Service. A power point presentation is being developed toour strength and viability. As officers retire or resign their assist associate recruiters when making presentations and acommission we must recruit new officers to fill vacant billets. guideline letter has been developed to assist the faculty contactDentists graduating today for various reasons are more apt to member in their role.pursue a private sector career than opting for a career in thepublic sector. One possible reason for new graduates not The Retention/Recruitment and Assignments Workgroup ofelecting to practice in the public sector is a lack of knowledge the Dental Professional Advisory Committee have alsoof the career options, job satisfaction or security offered by the prepared a Call to Active Duty survey. This survey will querypublic sector. newly commissioned officers of their reasons for joining the Public Health Service and will assist us in enhancing ourDental students need to be informed early in their curriculum recruitment efforts. This information will also be beneficial inof the opportunities available in the Public Health Service so analyzing our current recruitment practices and determine ifthey are aware of practice choices they may have upon any changes are needed.graduation. The Dental Associate Recruiter Program plans topair each dental school in the country with an associate A recruitment booth will be in place at the annual meeting ofrecruiter who is to visit the school at least once per year. The the Academy of General Dentistry (http://www.agd.org/)dental schools will be asked to appoint a faculty staff member and the American Association of Women Dentiststo act as a contact point between the school and the associate (http://www.aawd.org/) which is in Washington D.C.,
Page 20 USPHS Dental Newsletter June 2005July 13-17, 2005. Volunteer Dental Associate Recruiters are Dental Associate Recruiter Program you may contact me,needed for this event. To volunteer or inquire about the CDR James “Tim” Owen, mailto:at email@example.com. DePAC SELF-NOMINATION INSTRUCTIONSThe DePAC would like to solicit self-nominations to serve for a three-year commitment.Please follow the instructions carefully. Send all documents electronically firstname.lastname@example.org. 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 CV 3) Send cover letter with statement expressing your reasons for serving the DePAC 4) Ensure that you have met all Basic Readiness Requirements (http://www.phs-dental.org/ depac/actionlist.htm)Please send all documents to email@example.com by COB September 1st, 2005.Please use the link (http://www.phs-dental.org/depac/self_nom.doc) for the self-nomination form. Organization Meeting Meeting date Location of meetingAcademy 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. 3 Las VegasAmerican Dental Association (ADA) Annual Meeting Oct. 6-9 PhiladelphiaAssociation of Military Surgeons of the U.S. (AMSUS) Annual Meeting Oct. 30 – Nov. Nashville 4American Public Health Association (APHA) Annual Meeting Nov. 5-9 New OrleansHispanic Dental Association (HDA) Annual Meeting Nov. 17-19 San Antonio