Oral-maxillofacial injury surveillance in the Department of Defense, 1996-2005

Abstract

Introduction: Oral-maxillofacial injuries can lead to deformity and malfunction, greatly diminishing quality of life and worker productivity. Data suggest that over 10% of civilian emergency room visits are due to craniofacial injuries. The size and scope of oral-maxillofacial injuries in the military is not well understood. This study reports U.S. military rates of oral-maxillofacial injuries, causes of oral-maxillofacial hospitalizations, and recommends approaches to improving surveillance, research, and prevention.

Methods: Active duty U.S. military personnel who sought inpatient or outpatient treatment for one or more oral-maxillofacial injuries from 1996 to 2005 were identified in the Defense Medical Surveillance System using ICD-9-CM diagnosis codes associated with oral-maxillofacial injuries. ICD-9-CM diagnosis codes were divided into two categories: oral-maxillofacial wounds and oral-maxillofacial fractures.

Results: The oral-maxillofacial fracture rates for men were consistently 1.5 to 2 times higher than those for women, with 2000-2005 rates between 1.2 and 1.5/1000 person-years for men and between 0.7 and 1.0/1000 person-years for women. Wound rates for men were similar to those for women for all years examined (p<0.001), with 2000-2005 rates ranging from 11.0 to 14.6/1000 person-years for men and 12.2-14.8/1000 person-years for women. Compared to the over-40 age group, active duty personnel under age 25 had the highest rates of both oral-maxillofacial fractures and wounds (p<0.001). Among those injuries with a cause recorded, fighting (13.5%) was the leading cause of oral-maxillofacial injury hospitalizations in 2005.

Conclusions: Oral-maxillofacial injuries can and should be monitored using military medical surveillance data. Surveillance efforts would be enhanced by the addition of dental care data. There is also a need for additional quality intervention studies on the strategies to prevent oral and craniofacial injury.