Improving Soldier Readiness: Dental Sleep Medicine in the Army

by CPT Michael S. Pagano, DDS

The United States Army has recognized the unique issues sleep breathing disorders (SBD) bring to the battlefield. Since 2012, approximately 14,000 soldiers have been diagnosed with obstructive sleep apnea each year. In order to maintain a force ready to deploy, the Army Dental Corps has developed an initiative to train Army Dentists to treat Sleep Breathing Disorders.
Lieutenant Colonel (LTC) Phillip Neal took on the challenge to develop a course with the goal of educating Army Dentists in Dental Sleep Medicine. The reasons for needing internal training revolve around the two main missions of the Army Dental Corps: Readiness and Ready for Mission.
Readiness refers to each individual soldiers ability to deploy and “Fight Tonight.” It is a top priority of the Army and the main reason the Army Dental Corps exists. Soldiers with either untreated symptomatic mild or moderate to severe obstructive sleep apnea are considered non deployable. Soldiers treated with a Positive Airway Pressure type device are restricted to deploy only in developed areas with reliable electricity and access to additional supplies such as masks and tubing. Soldiers treated with an oral appliance can be deployed anywhere in the world. Treatment of sleep breathing disorders is one of the only medical procedures that directly correlates with improved soldier cognition and performance on the battlefield.

Figure 1: Sleeping conditions experienced by soldiers are often less than ideal
Ready for Mission refers to the individual Army Dentists ability to deploy and maintain the oral health of soldiers with limited resources and equipment. The army trains its dentists to be proficient in every aspect of dentistry to prepare for these conditions. Army Dentists need to be aware of the different types of oral appliances used in the treatment of SBD. They need to be able to resolve any possible side effects of the treatment and be able to repair devices that have defects from use while in a deployed environment.
Led by LTC Neal, the Army developed a 40-hour continuing education course to train Army Dental Providers in Dental Sleep Medicine. Prior to attending the weeklong course, each provider completed approximately 12 hours of online CE in DSM. The weeklong course included classroom and hands on learning from industry leading instructors. To date over 100 Army Dental Professionals have been trained and more courses are planned for 2018.

Each Dental Officer that attended the training returned to their respective installation to establish or enhance the local Dental Sleep Medicine Program. It is estimated in 2017 Army Dentists were able to recapture over 1.7 million dollars in care and increase the medical readiness of the force. The Army plans on taking advantage of its Dental Residency Programs and become the leader in published literature in the field of Dental Sleep Medicine.
The Army DSM education course focuses on a multidisciplinary approach to healthcare. The Army is in a unique position for enhanced coordination of care between dental and medical providers. The training programs and treatment delivery systems being developed in the Army Dental Corps is a model that should be replicated to train all dentists in DSM.

CPT Michael S. Pagano graduated from the University of Iowa College of Dentistry as an Army Health Professions Scholarship Program recipient. CPT Pagano completed the Army’s Dental Sleep Medicine Short Course at Joint Base San Antonio, TX. After attending the American Academy of Dental Sleep Medicine Conference in Boston he helped teach the Army’s next Dental Sleep Medicine Short Courses at Fort Gordon, GA, Fort Hood, TX, and Fort Bliss, TX. CPT Pagano presented at the Greater New York Dental Meeting Sleep Apnea Symposium and looks to continue to be a leader in DSM education.

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