Page 23 - SPEMD_67-1

rev port estomatol med dent cir maxilofac . 2026;67(1):11-20 17

29
to motivate military personnel to adopt healthier oral health tuguese population (26.3%). Other studies of the Portuguese
32
12
behaviors. Army and Navy reported higher rates of daily flossing, at
Regarding less positive oral health-related attitudes and 18% and 42.8%, respectively. These findings indicate that sub-
beliefs, a large percentage of the military sample (53.9%) be- optimal flossing remains a significant challenge across di-
lieved that it was impossible to prevent gum disease through verse civil and military adult populations. On the other hand,
toothbrushing alone (item 14). Also noteworthy is the lack of data on sugary food consumption are quite limited and in-
awareness among this population of the presence of bacteri- frequent compared to other military populations, such as the
34
al plaque on their teeth (item 4). Similar limited awareness US Air Force, the Iranian Armed Forces, and the Serbian
33
of dental plaque has been reported among Paraguayan re- military. 35
cruits, with nearly half failing to recognize plaque accumu- A positive and statistically significant relationship was ob-
25
lation. These less-rated items could also be included in oral served between the frequency of brushing and flossing and
health appointments to improve behaviors and attitudes. For HUDBI scores. This positive relationship was also identified in
example, the oral health professional should guide all their other populations, 17-20 emphasizing the importance of oral
patients on how to brush their teeth, using plaque dye to health self-care and its promotion by oral health professionals.
visually demonstrate areas where brushing is ineffective. Most participants (91.7%) received information from a
They should also explain and demonstrate how to brush health professional on how to care for their teeth and gums
carefully and check whether the teeth have been brushed during dental appointments. Among Paraguayan recruits, a
properly. It is important to clarify that brushing takes only large majority (87%) stated that they had been professional-
25
about 2 minutes and is a key step in maintaining healthy ly instructed on toothbrushing techniques. The result of
teeth and gums. this study is notably higher than that of other military pop-
34
The most favorable oral health-related behaviors and atti- ulations, such as the Iranian Air Force (27.8%). These find-
tudes were observed among military personnel aged 50 years ings may be attributed to the well-established preventive
or older, holding officer ranks, and possessing higher levels of oral health policy in the Portuguese Air Force, as well as the
education. Evidence from civilian populations suggests a cor- easy access to nutrition appointments at the Armed Forces
relation between advanced education and higher health liter- Hospital.
acy. 27,28 Given that officer rank is typically contingent on high- However, despite the mandatory annual appointment in
er academic qualifications, these findings suggest that oral the Portuguese Air Force, the high self-reported prevalence of
health professionals should target interventions for military dental caries underscores the need to strengthen preventive
members with lower educational attainment and lower ranks measures during this visit to improve military personnel’s oral
to reduce oral health disparities within the population. health. Soldiers with poor oral health may be unavailable for
Most participants reported that “cleaning” and preventive duty until they complete their dental treatment, affecting their
visits were the reasons for their most recent dental visit. Per- readiness.
centages were slightly higher than those found in the gener- There was a statistically significant association between
29
al Portuguese population (58.6% versus 56%, respectively). HUDBI scores and gingival bleeding and canker sores. The
Access to oral health care within the military environment is military personnel who reported these oral problems had
facilitated by the requirement for mandatory annual dental lower mean HUDBI scores. Poor oral hygiene, dental prob-
appointments for all active military personnel and by the em- lems, or an unbalanced diet are considered risk factors for
phasis on dental fitness necessary for participation in mis- canker sores. In turn, gingival bleeding can be caused by
36
sions, often scheduled at short notice. During these appoint- bacterial plaque and by hormonal, nutritional, and medica-
ments, in addition to assessing oral health status and tion-related factors. To address these oral health problems,
37
treatment needs, education and motivation on oral health effective plaque control through proper oral hygiene self-care
self-care are also provided. In contrast, the Paraguayan re- is essential.
cruits reported difficulties accessing dental services due to It was also found that higher HUDBI scores were associat-
conflicts between appointment schedules and intensive train- ed with a higher prevalence of dental trauma. This is an acci-
ing routines, which may compromise both preventive care dental oral health problem and is not dependent on specific
and oral hygiene guidance. Within the Portuguese Air Force, oral health behaviors adopted, so the observed association is
25
however, structured preventive policies and systematic dental likely due to a confounding factor. Nevertheless, during mili-
follow-ups appear to support greater adherence to recom- tary service and participation in military physical training,
mended oral health behaviors. Differences in institutional individuals are more likely to experience dental trauma than
context and access to preventive care may therefore partly in civilian life, which emphasizes the importance of promot-
38
explain the more favorable behavioral profiles observed in ing mouthguard use during risky activities.
this study population. This study has a few limitations to consider. Being a
In the present study, 81.9% of the military brushed their cross-sectional study, causal relationships cannot be ascer-
teeth at least twice a day, higher than the Portuguese Air tained. Since the sample used in this study is non-probabi-
Force cadets (63.3%), 11 the Dutch army (69%), 30 the Croatian listic and accounts for only 11.2% of the target population,
army (60%), and the general Portuguese population (74.4%). caution is required when extrapolating the results. Despite
31
29
Conversely, only 12.8% of participants flossed daily, a figure this, according to data from the Portuguese Air Force Data
similar to that of the Dutch army (13%), but less frequent Department, the distributions of military category, level of
30
25
than that of Paraguayan recruits (22%) and the general Por- education, and gender in this study correspond to those in