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News | June 14, 2021

Dental Literacy - Something to Smile about at Naval Hospital Bremerton

By Douglas H Stutz, NHB/NMRTC Bremerton public affairs officer – If you’re not true to your teeth, your teeth will be false to you. 
That old dental proverb is nothing to smirk about.
With October designated as Health Literacy Month for the Military Health System, the Navy Dental Corps at Naval Hospital Bremerton (NHB) reminds every one of the need to know as much as possible about their own oral health care.
For Capt. Mary Elizabeth Neill, board certified staff periodontist assigned to Branch Health Clinic Bangor, her belief in sharing knowledge is centered on empowering her patients to make healthy choices to increase their overall well-being.

“Knowledge is power. Most dental disease is preventable. Untreated dental disease can be physically debilitating and emotionally scarring,” said Neill, noting that public health statistics in her specialty area of periodontics are staggering.
Half of American adults - 64.7 million adults 30 years and older - suffer from gum disease with 47 percent of them having periodontitis which may involve tooth loss. 
“While I am focused on caring for the individual, we as a nation have a chronic dental disease crisis which may be influencing other major inflammatory diseases. Health literacy is a powerful tool. I truly believe in the power of information, but that information must resonate with the patient and compel action.  I spend a good portion of my dental evaluations in conversation with my patients so I can understand what is important to them and where they are in terms of self-care. We can instill healthy habits that focus on prevention which directly contributes to the fitness and readiness of our force,” stated Neill. 
Neill attests that by educating patients, they in turn become empowered using strategies which they can implement and control.
“We essentially become partners in a therapeutic approach to their disease and the goal of gaining stability and maintaining health,” Neill said.
 A typical teachable moment during an examination for Neill might focus on such topics as: the connection between diet/nutrition and dental health; the role of tobacco and nicotine products, stress, suboptimal oral hygiene - no flossing - and other factors that contribute to more aggressive dental disease; or the oral-systemic connection between bacteria and inflammation in the mouth as risk factors in heart/pulmonary disease, diabetes, rheumatoid arthritis, and adverse pregnancy outcomes.
According to Lt. Cmdr. Justin Watson, preventive dentistry expert, sharing preventive insight with patients helps reinforce the importance to reduce any risk of oral disease.
“It is very important to share basic dental health info to our patients and be able to answer their questions surrounding patients’ oral health. Preventative insights on patients’ oral health are often tailored specifically for that patient based upon the finding of the yearly exam,” explained Watson. “For example, if the patient is at high risk for cavities due to a sugary diet and poor brushing technique, the dentist will typically share the disease process that led to the new cavities found at the dental exam. Then a preventive treatment plan is presented to the patient which typically involves oral hygiene instructions and nutritional counseling.”
Neill echoes the need on increasing health literacy on prevention techniques with patients.
“In my clinical practice I use a method called Motivational Interviewing to reach patients on the topic of prevention. The goal is to increase motivation to improve patient’s oral hygiene behaviors as well as providing a framework for delivering diet, tobacco cessation, stress reduction, and alcohol advice. This tool is very collaborative and patient-centered which builds on trust and establishes a strong patient-dental professional relationship, which has been shown to improve patient outcomes. It really is not enough to just tell the patient they need to brush and floss more,” Neill said.

Dental health and wellness is not just centered on the prevention of cavities and explaining the need to brush and floss regularly. The Navy’s dental readiness classifications are an integral gauge of every command’s operational readiness.
“I always share dental readiness classification with the patient,” stated Watson. “Class I, they are good to go with no dental treatment expected in a year. Class II, they may just need minor or elective treatment such as a dental cleaning or a small filling. Class III, a cavity - active dental disease is found and the decayed part of the tooth must be removed and filled or it could get much worse within a year. Class IV, the patient hasn’t had a dental exam within the year.” 
“Most patients think they have no treatment needs if they are not on the dental ‘hit list’ for dental class 3 or 4,” added Neill. “Some do not understand the value of annual examinations and dental cleanings for maintenance of health. Class 2 may mean that they are good to go for deployment, training, or sea duty, but they still have treatment needs.” 
Navy dentistry’s validated and reliable classification system is basically set up to screen large populations and predict dental emergencies that might occur in the next 12 months. 
“We focus on treating these patients and mitigating risk to mission. This is extremely important to us as an expeditionary force where there may not be any dental assets forward. Navy dentists have always been keenly focused on operational readiness. It is our main thing. We are very good at it,” Neill remarked.  

Neill, Watson, and the rest of the dental team - located at NHB and Branch Health Clinics Bangor and Everett- ensure continual support for the Navy surgeon general priority of producing force medical readiness and medical force readiness, one smile at a time.

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