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Dental Treatment Workload and Cost of Newly Enrolled Personnel in the Canadian Forces

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Dental Treatment Workload and Cost of Newly Enrolled Personnel in the Canadian Forces Dental treatment workload and cost of newly enrolled personnel in the Canadian Forces [A study of the 2007 and 2008 recruit population] by Constantine Batsos A thesis submitted in conformity with the requirements for the degree of Master in Science in Dental Public Health Graduate Department of Dentistry University of Toronto © Copyright by Constantine Batsos (2010) Dental treatment workload and cost of newly enrolled personnel in the Canadian Forces [A study of the 2007 and 2008 recruit population] Constantine Batsos Master in Science in Dental Public Health Graduate Department of Dentistry University of Toronto 2010 Abstract Aim: To describe and analyze the demographic profile and the dental treatment needs, workload and costs of the 2007 and 2008 CF recruit population (N=10,641). Method: Treatment procedures and costs were aggregated and calculated, beginning from the date of a member’s enrolment, over a period that ranged between 13 to 36 months. Associations between treatment services and the demographic variables were tested using one-way ANOVA and chi-square tests. Independent samples T-test was used to compare means. Linear regression models were used to determine the influence of demographic variables on treatment cost. Results: Treatment needs and costs varied with recruit age, gender, rank, first language (French/English), birthplace (Canada/Foreign), tobacco use, province and census tract. The cost of treatment for the entire population was $13.9M. Mean cost per recruit was $1224 over an average period of 26 months. Outsource costs ($2.9M) were driven by referrals for restorative, endodontic and oral surgery procedures. ii Dedication To Peggy, for her unwavering patience, support and understanding, and for bringing happiness into my life. To my Father, Mother and big brother Steve for always being there. iii Acknowledgments I owe a great amount of gratitude to my supervisor, the late Dr. David Locker, who left us before this thesis was completed. David left behind a wealth of insight and thought-provoking literature that guided me through my work, as it will guide scholars for years and years. Reading his papers brings a somber smile to my face. I am fortunate to have known him. I miss our luncheons at the Met. Equally, I would like to thank Dr. Carlos Quiñonez for taking over as my supervisor in his own right. His vast knowledge in many areas and distinct approach to instruction challenged me to think about public health issues and concepts in a different light. I am grateful for his encouragement and exacting standards in writing this thesis. I wish to thank Dr. Herenia Lawrence for serving on my thesis advisory committee and providing me with advice and statistical expertise. I would also like to thank Dr. Jim Lai and Dr. Peter Cooney for taking time away from their busy schedules to serve as my internal and external examiners. Lastly, I would like to acknowledge the support I received from the CFDS: Col S.A Becker LCol J.P. Picard LCol D. Lemon LCol J.J.A. Ouellet LCol (Ret’d) G. Levesque LCol (Ret’d) E. Reid Maj R.R Groves Maj T.L. Russu iv Table of Contents Abstract……………………………………………………………………………………..ii Dedication ...................................................................................................................................... iii Acknowledgments .......................................................................................................................... iv Table of Contents ............................................................................................................................ v List of Tables ............................................................................................................................... viii List of Figures .............................................................................................................................. xiii List of Appendices ....................................................................................................................... xiv List of Abbreviations .................................................................................................................... xv Executive Summary ..................................................................................................................... xvi Recommendations ........................................................................................................................ xix Preface .......................................................................................................................................... xxi 1 Overview of the Canadian Forces Dental Services (CFDS) ...................................................... 1 1.1 CFDS structure and personnel ............................................................................................ 1 1.2 The Canadian Forces Dental Care Program (CFDCP) ....................................................... 2 1.3 Military Dental Fitness Classification ................................................................................ 3 1.4 CF Health and Dental Information Systems ....................................................................... 6 1.5 Summary ............................................................................................................................. 8 2 Literature review of Canadian young adult and military recruit dental treatment needs ........... 9 2.1 Introduction ......................................................................................................................... 9 2.2 Young adult oral health and the determinants of oral health in Canada ........................... 10 2.3 CFDS studies on recruits .................................................................................................. 15 2.4 Dental research on the recruit population of foreign militaries ........................................ 18 2.4.1 Historical trends in dental caries experience among military recruits .................. 18 2.4.2 Periodontal health of recruits ................................................................................ 20 v 2.4.3 Recruit dental treatment cost ................................................................................ 21 2.4.4 Recruit dental treatment workload ........................................................................ 22 2.4.5 Recruit dental service utilization .......................................................................... 23 2.5 Summary of expected dental treatment needs in newly enrolled CF members ................ 25 3 Dental treatment requirements of the 2007 and 2008 recruit population ................................. 26 3.1 Abstract ............................................................................................................................. 27 3.2 Introduction ....................................................................................................................... 28 3.3 Methodology ..................................................................................................................... 29 3.3.1 Study Design ......................................................................................................... 29 3.3.2 Measures ............................................................................................................... 31 3.3.3 Statistical analysis ................................................................................................. 32 3.4 Results ............................................................................................................................... 32 3.5 Discussion ......................................................................................................................... 36 3.6 Conclusion ........................................................................................................................ 45 4 Is census tract income an indicator of dental treatment needs in a young adult Canadian military population? ................................................................................................................. 47 4.1 Abstract ............................................................................................................................. 48 4.2 Introduction ....................................................................................................................... 50 4.3 Methodology ..................................................................................................................... 51 4.3.1 Study Design ......................................................................................................... 51 4.3.2 Measures ............................................................................................................... 54 4.3.3 Statistical Analysis ................................................................................................ 54 4.4 Results ............................................................................................................................... 55 4.5 Discussion ......................................................................................................................... 58 4.6 Conclusion ........................................................................................................................ 63 5 The impact of recruit dental treatment workload on Canadian Forces dental detachments .... 65 vi 5.1 Abstract ............................................................................................................................
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