Preventive Dentistry and Dental Readiness

Transcription

1 Army Regulatin Medical Services Preventive Dentistry and Dental Readiness Headquarters Department f the Army Washingtn, DC 21 July 2016 UNCLASSIFIED

2 SUMMARY f CHANGE AR Preventive Dentistry and Dental Readiness This majr revisin, dated 21 July Changes the title f the publicatin frm Dental Readiness and Cmmunity Oral Health Prtectin t Preventive Dentistry and Dental Readiness (cver). Clarifies the purpse, bjectives, and scpe f this regulatin, as well as the Dental Readiness and Oral Health Prtectin Prgrams (para 1-1). Redistributes and adds respnsibilities fr the public health dentistry cnsultant and the cmmanders f reginal medical cmmands (chap 2). Changes the name f the Cmmunity Oral Health Prtectin Reprt back t the Preventive Dentistry Reprt (para 2-1b(2)). Updates criteria fr dental readiness classificatins (para 3-16b). Updates prcedures fr dental care within the Regular Army Dental Care System and the dental examinatin requirements fr all Sldiers (para 3-17). Adds a prvisin regarding dental readiness prir t a Sldier s assignment at their first duty statin (para 3-17a(1)). Reaffirms the Health Affairs gal f having 95 percent f all active duty frces in dental class 1 and class 2 (para 3-17b). Adds a sectin n Reserve Cmpnent dental readiness and utilizatin f the Reserve Cmpnent-directed Army Selected Reserve Dental Readiness System (para 3-18). Updates the use f DD Frm 2813 (Department f Defense Active Duty/Reserve/ Guard/Civilian Frces Dental Examinatin)(para 3-18d and 3-19). Expands the sectin that utlines rganizatinal prcedures t ensure dental readiness and suggests measures t deal with Sldiers wh refuse t cmply with dental readiness standards (para 3-20). Reaffirms the Health Affairs gal f having 65 percent f all active duty and selected reserve Sldiers in dental class 1 (para 3-20b(1)). Expands the sectin n Clinical Oral Health Prmtin and Disease Preventin by updating the sectins n examinatin and risk assessment and preventive interventins (paras 4-2 and 4-3). Expands implementatin guidance fr the Cmmunity Oral Health Prmtin and Disease Preventin Prgram (para 5-2). Changes "dental fitness classificatin" t "dental readiness classificatin" (thrughut).

3 Headquarters Department f the Army Washingtn, DC 21 July 2016 *Army Regulatin Effective 21 August 2016 Medical Services Preventive Dentistry and Dental Readiness H i s t r y. T h i s p u b l i c a t i n i s a m a j r revisin. S u m m a r y. T h i s r e g u l a t i n d e f i n e s t h e Army Dental Readiness and Oral Health Prtectin Prgrams; fixes respnsibility fr administratin and implementatin f the prgrams and details prcedures fr their executin; defines the dental readiness classificatin scheme and sets frth prcedures fr assigning dental readiness classes; and fixes respnsibilities and establishes prcedures fr cmpleting and f r w a r d i n g t h e P r e v e n t i v e D e n t i s t r y Reprt. The plicies and prcedures regarding ral health and dental readiness are in accrdance with prvisins in AR 40 3, AR 40 5, DODI , HA Plicy , HA Plicy , HA Pli c y , a n d c u r r e n t p r f e s s i n a l standards. Applicability. This regulatin applies t t h e R e g u l a r A r m y, t h e A r m y N a t i n a l Guard/Army Natinal Guard f the United States, and the U.S. Army Reserve, unless therwise stated. Prpnent and exceptin authrity. The prpnent f this regulatin is The Surgen General f the United States Army. The prpnent has the authrity t apprve exceptins r waivers t this regulatin that are cnsistent with cntrlling law and regulatins. The prpnent may delegate this apprval authrity, in writing, t a divisin chief within the prpnent agency r its direct reprting unit r field perating agency, in the grade f clnel r the civilian equivalent. Activities may request a waiver t this regulat i n b y p r v i d i n g j u s t i f i c a t i n t h a t includes a full analysis f the expected benefits and must include frmal review by the activity s senir legal fficer. All waiver requests will be endrsed by the cmmander r senir leader f the reque s t i n g a c t i v i t y a n d f r w a r d e d t h r u g h t h e i r h i g h e r h e a d q u a r t e r s t t h e p l i c y prpnent. Refer t AR fr specific guidance. Army internal cntrl prcess. This regulatin cntains internal cntrl prvisins in accrdance with AR 11 2 and identifies key internal cntrls that must be evaluated (see appendix B). S u p p l e m e n t a t i n. S u p p l e m e n t a t i n f this regulatin and establishment f cmmand and lcal frms are prhibited with u t p r i r a p p r v a l f r m O f f i c e f T h e Surgen General (OTSG DC), 7700 Arl i n g t n B u l e v a r d, S u i t e , F a l l s Church, VA Suggested imprvements. Users are invited t send cmments and suggested imprvements n DA Frm 2028 (Recmm e n d e d C h a n g e s t P u b l i c a t i n s a n d Blank Frms) directly t Office f The Surgen General (OTSG DC), 7700 Arl i n g t n B u l e v a r d, S u i t e , F a l l s Church, VA Distributin. This publicatin is available in electrnic media nly and is intended fr cmmand levels A, B, C, D, a n d E f r t h e R e g u l a r A r m y a n d t h e A r m y N a t i n a l G u a r d / A r m y N a t i n a l Guard f the United States, and D and E fr the U.S. Army Reserve (medical activities nly); and fr cmmand levels B, C, D, and E fr the Regular Army and the A r m y N a t i n a l G u a r d / A r m y N a t i n a l Guard f the United States, and D and E f r t h e U. S. A r m y R e s e r v e ( a l l t h e r activities). Cntents (Listed by paragraph and page number) Chapter 1 Intrductin, page 1 Purpse 1 1, page 1 References 1 2, page 1 Explanatin f abbreviatins and terms 1 3, page 1 Respnsibilities 1 4, page 1 Preventive dentistry plicies 1 5, page 1 *This regulatin supersedes AR 40 35, dated 2 August AR July 2016 UNCLASSIFIED i

4 Cntents Cntinued Army Preventive Dentistry Prgram bjectives 1 6, page 1 Chapter 2 Respnsibilities, page 2 The Surgen General 2 1, page 2 Deputy Chief f Staff, G 1 2 2, page 3 Cmmander, U.S. Army Training and Dctrine Cmmand 2 3, page 3 All Army persnnel 2 4, page 3 Chapter 3 Army Dental Readiness Prgram, page 3 Sectin I Prgram Respnsibilities, page 3 General 3 1, page 3 Dental Public Health Staff Officer fr the Office f The Surgen General s Dental Crps Chief s Office 3 2, page 3 Dental Public Health Staff Officer fr Army Public Health Cmmand 3 3, page 4 United States Army Dental Cmmand Preventive Dentistry Officer 3 4, page 4 United States Army Dental Cmmand Health Prmtin Directr 3 5, page 4 Reginal dental cmmand dental readiness fficer, preventive dentistry fficer, and high caries risk pint f cntact 3 6, page 5 Dental activity, dental clinic cmmand, r dental unit dental readiness fficer 3 7, page 5 Dental activity, dental clinic cmmand, r dental unit preventive dentistry fficer 3 8, page 5 Clinical rles 3 9, page 5 Cmmanders f deplyed dental units (separate dental units, Prfessinal Officer Filler System, r brigade dentists) 3 10, page 6 Cmmanders f U.S. Army Medical Activities and U.S. Army Medical Centers 3 11, page 6 Installatin cmmanders 3 12, page 6 All unit cmmanders 3 13, page 6 Cmmander, U.S. Army Training and Dctrine Cmmand 3 14, page 7 All Army persnnel 3 15, page 7 Sectin II Implementatin Guidance, page 7 Prgram methds 3 16, page 7 Prcedures fr care within the Army Dental Care System 3 17, page 8 Reserve Cmpnent dental readiness and the Reserve Cmpnent-directed Army Selected Reserve Dental Readiness System 3 18, page 9 Using the DD Frm , page 10 Organizatinal guidance 3 20, page 10 Chapter 4 Clinical Oral Health Prmtin and Disease Preventin Prgram, page 11 General 4 1, page 11 Implementatin guidance-examinatin and risk assessment 4 2, page 11 Implementatin guidance-preventive interventins 4 3, page 12 Chapter 5 Cmmunity Oral Health Prmtin and Disease Preventin Prgram, page 12 General 5 1, page 12 Implementatin guidance 5 2, page 12 Appendixes A. References, page 14 ii AR July 2016

5 Cntents Cntinued B. Internal Cntrl Evaluatin, page 16 Glssary AR July 2016 iii

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7 Chapter 1 Intrductin 1 1. Purpse This regulatin defines preventive dentistry and establishes plicies that direct the executin f preventive dentistry prgrams and services. It assigns respnsibilities fr imprving and sustaining ral health and dental readiness thrughut the Army; implementing Department f Defense directives (DODDs) and Department f Defense instructins (DODIs), including thse listed in appendix A; prviding preventive dentistry resurces, services, and technical supprt; prviding preventive dentistry guidance, strategy, dctrine, and versight; identifying, develping, and prviding military-specific standards, criteria, and guidelines fr ral health interventins and measures; cnducting cmprehensive, crdinated military ral health surveillance activities t include ral epidemilgy f disease and nn-battle injuries; cnducting ral health prgram evaluatin; and implementing the Army Preventive Dentistry Prgram, which includes the Dental Readiness Prgram fr active duty Sldiers and the Oral Health Prtectin Prgram. It applies t all Army rganizatins, installatins, and perating bases References See appendix A Explanatin f abbreviatins and terms See the glssary Respnsibilities See chapter Preventive dentistry plicies The plicy f the Army is t a. Enhance and sustain ptimal levels f ral health and fitness f all Army persnnel by applying the principles f dental public health (DPH) t prmte ral health and prevent and minimize the impacts f ral diseases and injuries as defined in paragraph 1 6. b. Incrprate evidence-based ral disease preventin principles and DPH practice int all relevant Army plicies, prgrams and initiatives. c. Operate a system f ral disease surveillance t (1) Prvide ppulatin health assessments in rder t establish military DPH pririties and supprt decisins n ral health resurce utilizatin. (2) Identify ral health threats t Army persnnel and ther Military Health System beneficiaries. (3) Mnitr prgress tward ral health gals and targets. (4) Mnitr and assess the ral health status f all Army persnnel thrughut their service. (5) Reprt the ral health status f Army units and the impact n readiness. (6) Archive data fr future analyses. d. P r v i d e D e f e n s e H e a l t h A g e n c y w i t h r e q u i r e m e n t s t s u p p r t A r m y p r e v e n t i v e d e n t i s t r y i n f r m a t i n management. e. I n f r m A r m y p e r s n n e l f r a l d i s e a s e t h r e a t s, r i s k s, a n d a p p r p r i a t e u n i t a n d i n d i v i d u a l p r e v e n t i v e cuntermeasures. f. Acquire, archive, and stre ral health-related data using nly apprved military health infrmatin systems and prcedures that will cmply, when applicable, with the prvisins f the Health Insurance Prtability and Accuntability Act (HIPAA), Public Law , 110 Stat (1996) Army Preventive Dentistry Prgram bjectives The bjective f Army Preventive Dentistry Prgram is t imprve and sustain dental readiness and ral wellness fr all Army beneficiaries in accrdance with DODI , AR 40 3, AR 40 5, and AR The Army Preventive Dentistry Prgram includes the Dental Readiness Prgram and the Oral Health Prtectin Prgram. a. The bjective f the Army Dental Readiness Prgram is t maintain unit readiness fr deplyment and reduce nncmbat dental casualties during deplyments r ther assigned missins by minimizing the ral disease and injury burden f Sldiers prir t and during deplyment. The Army Dental Readiness Prgram applies t all active duty and Reserve Cmpnent (RC) Sldiers. b. The bjective f the Oral Health Prtectin Prgram is t ensure that all Department f Defense (DOD) beneficiaries have access t infrmatin and resurces necessary in rder t prevent ral disease, thereby ptimizing their ral wellness and general well-being. c. The Oral Health Prtectin Prgram has tw cmpnents: (1) Clinical Oral Health Prmtin and Disease Preventin Prgram. AR July

8 (2) Cmmunity Oral Health Prmtin and Disease Preventin Prgram. Chapter 2 Respnsibilities 2 1. The Surgen General The Surgen General (TSG), based n guidance frm the Assistant Secretary f Defense fr Health Affairs, prvide plicy directin cncerning develpment, administratin, rganizatin, and management f the Army Dental Readiness and Oral Health Prtectin Prgrams and its integratin int the Armywide health service system. The TSG will a. Ensure that the Chief f the United States (U.S.) Army Dental Crps will (1) Establish plicy cncerning issues f dental practice within the Army Dental Readiness and Oral Health Prtectin Prgrams. (2) Make recmmendatins t TSG cncerning dental readiness and ral health prtectin. (3) Nminate a Public Health Dentistry Cnsultant (PHDC) fr appintment by TSG. (4) Advise TSG n the dental readiness f all Army cmpnents. (5) Advise the Assistant Secretary f Defense fr Health Affairs n the dental readiness f the Army. b. Ensure that the PHDC will (1) Advise n all matters pertaining t public health dentistry, including clinical and cmmunity preventive dentistry, and health prmtin. (2) Review the Preventive Dentistry Reprt (PDR) semiannually and reprt significant findings t the Office f the Chief f the Dental Crps. c. Ensure that the Cmmander, USADENCOM will (1) Assume respnsibility fr the administratin f plicies in this regulatin. (2) Appint a dental staff fficer as the USADENCOM dental readiness Officer (DRO) t mnitr dental readiness fr the cmmand. The USADENCOM s DRO will advise the Cmmander, USADENCOM n the cmmand s Dental Readiness Prgram. (3) Appint the USADENCOM DPH specialist as the USADENCOM preventive dentistry fficer (PDO) t mnitr dental wellness and versee ral health prmtin and disease preventin activities fr the cmmand. If USADEN- COM des nt have a DPH specialist assigned, then the cmmander will assign anther dental staff fficer whse backgrund and training makes him r her best suited fr the psitin (see para 3 4 fr prgram respnsibilities). d. Ensure that cmmanders f reginal dental cmmands (RDCs) will (1) Ensure cmpliance with this regulatin. (2) Appint n rders ne r mre dental fficer(s) as the RDC DRO, PDO, and high caries risk (HCR) pint f cntact (see para 3 6 fr prgram respnsibilities). e. Ensure that cmmanders f Dental Activities (DENTACs), dental clinic cmmands (DCCs), and separate dental units (Regular Army (RA)) will (1) Ensure cmpliance with this regulatin. (2) Appint n rders a dental fficer as the DENTAC, DCC, r dental unit DRO (see para 3 7 fr prgram respnsibilities). (3) Appint n rders ne r mre dental fficer(s) as the DENTAC, DCC, r dental unit PDO (see para 3 8 fr prgram respnsibilities). (4) Appint n rders a dental hygienist as the DENTAC, DCC, r dental unit health prmtin directr (HPD). If the cmmand des nt have a dental hygienist available, an expanded functins dental assistant r preventive dentistry specialist (military ccupatinal specialty 68EX2) can be appinted until ne becmes available. The HPD, where assigned, will assist the DRO and the PDO as requested. Respnsibilities will include the planning, develpment, and administratin f the Oral Health Prtectin Prgram. (5) Appint, if apprpriate, additinal fficers t represent designated units, activities, r patient catchment areas n the installatin. (6) Ensure that fficer, enlisted, civilian, and cntract dental staff members f all DENTACs, DCCs, and dental units cnduct clinical peratins cnsistent with gd preventive dentistry practices and supprt cmmunity health prmtin and wellness prgrams. (See para 3 9 fr clinical rles and respnsibilities.) (7) Advise unit cmmanders, n a mnthly basis, n the dental readiness f their cmmand; assigning staff t train unit dental readiness liaisns (UDRLs) and/r unit cmmanders n hw t access dental readiness infrmatin thrugh the Medical Prtectin System (MEDPROS) and mnitr dental appintments using the Crprate Dental System (CDS) Unit Classificatin View (UCV). (8) Identify requirements fr training dental persnnel in ral disease and injury preventin and health prmtin. (9) Supprt the Family Advcacy Prgram n Family Vilence in accrdance with AR AR July 2016

9 (10) Serve n the installatin Cmmunity Health Prmtin Cuncil (CHPC), as directed by AR Cmmanders may designate their appinted DRO r HPD t represent them n the CHPC when necessary. f. Have versight f cmmanders f deplyed dental units, be they separate dental units, Prfessinal Officer Filler System, r brigade dentists (see para 3 10 fr prgram respnsibilities). g. Have versight f cmmanders, U.S. Army Medical Activities and Cmmanders, U.S. Army Medical Centers (see para 3 11 fr prgram respnsibilities). h. Have versight f installatin dental readiness (see para 3 12 fr installatin dental readiness respnsibilities). i. Have versight f unit dental readiness (see para 3 13 fr unit dental readiness respnsibilities) Deputy Chief f Staff, G 1 The DCS, G 1 will a. Nminate a DPH specialist t serve as the DPH staff fficer fr the Tri-Service Center fr Oral Health Studies, in crdinatin with the Dental Crps Chief and the Public Health Dentistry Cnsultant. b. Appint a dental public health specialist t serve as the DPH staff fficer fr OTSG Dental Crps Chief s ffice, in crdinatin with the Dental Crps Chief r a Public Health Dentistry Cnsultant delegated authrity. c. Appint a dental public health specialist t serve as DPH staff fficer fr Army Public Health Cmmand, in crdinatin with the Dental Crps Chief r a Public Health Dentistry Cnsultant delegated authrity. d. Appint a DPH specialist t serve as USADENCOM DPH staff fficer, in crdinatin with the Dental Crps Chief r a Public Health Dentistry Cnsultant delegated authrity Cmmander, U.S. Army Training and Dctrine Cmmand The Cmmander, U.S. Army Training and Dctrine Cmmand (TRADOC) will be respnsible fr prviding ral disease preventin and dental readiness training and ensuring dental safety during initial entry training (IET), advanced individual training (AIT), ne statin unit training (OSUT) and the Basic Officer Leadership Curse (BOLC) (see para 3 14 fr additinal prgram respnsibilities) All Army persnnel All Army persnnel will maintain their dental readiness (see para 3 15 fr persnnel guidance). Chapter 3 Army Dental Readiness Prgram Sectin I Prgram Respnsibilities 3 1. General Unit cmmanders, the dental care system, and the Sldier share respnsibility fr dental readiness. The Dental Readiness Prgram prvides the methds t reduce the risk f Sldiers becming nncmbat dental casualties when such an event wuld jepardize missin accmplishment. The Dental Readiness Infrmatin Center Web site cntains infrmatin abut the prgram DOD is implementing fr all active and reserve military, at mil Dental Public Health Staff Officer fr the Office f The Surgen General s Dental Crps Chief s Office The DPH staff fficer will a. Prvide a DPH perspective during the develpment f plans, plicies, and prgrams acrss the Army. b. Critique and synthesize scientific literature and translate study findings int ral disease preventin plicy recmmendatins. c. Evaluate DOD and Army public health plicies and regulatins and advcate mdificatins t prtect and prmte the public s ral health. d. Cmmunicate and cllabrate with DOD and Army grups and individuals n ral health issues (nutritin, dental readiness, and s n) and integratin f ral disease preventin infrmatin int Army and DOD ppulatin health prgrams. e. Cmmunicate and cllabrate with DOD and Army grups t incrprate ral health metrics int Army and DOD ppulatin health and quality f life surveillance systems. f. Prvide guidance n utilizatin f and updates t the DOD Oral Health and Readiness Classificatin System. AR July

10 g. Cmmunicate and cllabrate with DOD and Army grups t update and mdify current dental terminlgy cde structure and utilizatin guidelines fr DOD Dental Public Health Staff Officer fr Army Public Health Cmmand The DPH staff fficer will a. Mnitr and evaluate dental disease and nn-battle injury (DNBI) rates f Sldiers deplyed in supprt f verseas cntingency peratins t identify predminate causes f DNBI and develp preventin strategies. b. Prvide cnsultative supprt t integrate ral disease preventin principles and infrmatin int the Army Wellness Centers Operatin Prgram. c. Ensure inclusin f apprpriate ral health prmtin and ral disease preventin infrmatin int U.S. Army Public Health Cmmand health prmtin prducts and versee develpment f all ral health prmtin prducts. d. Assist the USADENCOM DPH staff fficer with dental prgram evaluatin. e. Facilitate implementatin f the Cmmunity Oral Health Prmtin and Disease Preventin Prgram United States Army Dental Cmmand Preventive Dentistry Officer The USADENCOM PDO will a. Prvide a DPH perspective during develpment and implementatin f plans, plicies, and prgrams within the cmmand. b. Critique and synthesize scientific literature and advise the Cmmander, USADENCOM, regarding interventins and strategies fr the preventin and cntrl f ral diseases and prmtin f ral health. c. Develp resurces, implement and manage the Army Preventive Dentistry Prgram and the USADENCOM Oral Wellness and Oral Health Prtectin Prgram, peridically mnitring and measuring key perfrmance indicatrs against prgram gals. d. Mnitr and evaluate activities f the USADENCOM Dental HPD. e. D e s i g n a n d c n d u c t p r g r a m e v a l u a t i n u s i n g C D S r t h e r d a t a s u r c e s t s u p p r t D e n t a l C m m a n d decisinmaking. f. Cnslidate the PDR frm all subrdinate units semiannually and submit it t the Cmmander, USADENCOM, TSG s cnsultant fr DPH, and the OTSG DPH staff fficer. (1) The reprts will be in a frmat prescribed by the TSG s cnsultant fr DPH. (2) Data fr the reprting perid f 1 Octber t 31 March will be submitted by 31 May. The 1 April t 30 September reprt will be due by 30 Nvember. (3) The reprts will cntain cmments and data as apprpriate t reflect effrts in the three majr areas f the Army Preventive Dentistry Prgram as utlined in chapters 3 thrugh 5. T prvide unifrmity, the fllwing headings will be used: (a) Army Dental Readiness Prgram. This sectin shuld be a narrative statement f hw well the units served by the DENCOM and/r dental unit are cmplying with the Health Affairs (HA) 95 percent dental readiness gal. It shuld describe prgrams r initiatives that are implemented t imprve the dental readiness f units that are nt in cmpliance, dcument the effect f these prgrams, and dcument any plicies r cnditins that impeded the prgrams. (b) Clinical Oral Health Prmtin and Disease Preventin Prgram. This paragraph shuld include infrmatin n implementatin and cmpliance, and hw well units are cmplying with the 65 percent ral wellness gal. (c) Cmmunity Oral Health Prmtin and Disease Preventin Prgram. This paragraph shuld include a sectin n cmpliance with cmmunity water fluridatin (if applicable), participatin n CHPCs, cmmunity educatin successes and/r barriers, and Nutritin Envirnment Assessment results. Deplyed dentists shuld include a sectin describing their deplyed envirnment dental readiness threat assessment results. g. Appint a Health Educatr with additinal ral health training as the USADENCOM HPD United States Army Dental Cmmand Health Prmtin Directr The USADENCOM HPD will a. Assist the USADENCOM PDO with versight f the ral health prmtin and disease preventin activities fr the cmmand, including implementatin f the Oral Health Prtectin Prgram. b. Assist the DENTAC, DCC, r dental unit DROs, PDOs and DENTAC, DCC, r dental unit HPD with btaining health prmtin training, preventive dentistry materials, ral wellness infrmatin and resurces fr lcal ral health prmtin activities. c. Assist the USADENCOM PDO with cnslidating the reprts f prgram activities frm all subrdinate units semiannually. 4 AR July 2016

11 3 6. Reginal dental cmmand dental readiness fficer, preventive dentistry fficer, and high caries risk pint f cntact RDC DRO, PDO, and HCR pint f cntact will a. Assist DENTAC r DCC cmmanders, dental unit cmmanders, r directrs f dental services in implementing the Army Preventive Dentistry Prgram. b. Ensure that all dental persnnel understand their rle in implementing the Army Preventive Dentistry Prgram. c. Ensure that DENTAC cmmanders, DCC cmmanders, r dental unit cmmanders under their cmmand submit a PDR, semiannually, n lcal Oral Health Prtectin Prgram activities. d. Review and apprve the PDRs prir t submissin t the USADENCOM HPD. Data fr the reprting perid f 1 Octber t 31 March will be submitted t USADENCOM by 30 April. The 1 April t 30 September reprt will be due by 31 Octber Dental activity, dental clinic cmmand, r dental unit dental readiness fficer DENTAC, DCC, r dental unit DRO will a. Assist DENTAC r DCC cmmanders, dental unit cmmanders, r directrs f dental services in implementing the Army Dental Readiness Prgram. b. Ensure that all dental persnnel understand their rle in implementing the Army Dental Readiness Prgram Dental activity, dental clinic cmmand, r dental unit preventive dentistry fficer DENTAC, DCC, r dental unit PDO will a. Serve as the pint f cntact fr the HCR Prgram and will plan, rganize, implement, and evaluate the activities f the Oral Health Prtectin Prgram, including the HCR Prgram. Where apprpriate, the DENTAC, DCC, r dental unit PDO may seek the assistance f the USADENCOM HPD in implementing these prgrams. b. Receive and interpret preventive medicine activity and installatin water engineer reprts n fluride cncentratins in terms f its relevance t fluride prescribing and treatment practices fr children and adults. The PDO will prvide subject matter expertise and cnsultatin cncerning fluride practices t health care prviders, water engineers, and preventive medicine activities. (See Technical Bulletin Medical (TB MED) 576). c. Submit, thrugh DENTAC cmmanders, DCC cmmanders, r dental unit cmmanders, a PDR, semiannually, n lcal Oral Health Prtectin Prgram activities t the RDC PDO. d. Ensure that all dental persnnel take an active rle in the Oral Health Prtectin Prgram. The PDO will prvide fficer, enlisted, civilian, and cntract dental care prviders with current USADENCOM infrmatin n all aspects f ral disease risk assessment, ral health prmtin, and ral disease preventin activities Clinical rles Clinical rles and respnsibilities fr each f the fllwing will include, but are nt limited t a. Dentist. (1) Infrmatin gathering and infrmatin updating: diet histry, ral hygiene practices, review f fluride use t include cnsumptin f fluridated water, use f ver-the-cunter fluride tthpaste, use f ther ver-the-cunter fluride prducts, use f xylitl prducts, saliva testing, bacterial testing, radigraphs, and cmpliance (mst f these items can be tasked t ancillaries). (2) Oral disease risk assessments. (3) Diagnsis f existing ral diseases and cnditins. (4) Treatment planning, including apprpriate ral disease risk reductin strategies. (5) Restrative and specialty care. (6) Patient educatin. (7) Oversight and crdinatin f team members. b. Hygienist. (1) Infrmatin gathering and updating. (2) Treatment (t include prphylaxis, sealants, prfessinally applied tpical fluride, and applicatin f ther chemtherapeutics). (3) Patient educatin. (4) Dispensing chemtherapeutics as directed by dentist and educating patients regarding their use and benefits. c. Preventive dentistry specialist. (1) Infrmatin gathering and updating. (2) Treatment (t include prphylaxis, sealants, prfessinally applied tpical fluride, and applicatin f ther chemtherapeutics). (3) Patient educatin. (4) Dispensing chemtherapeutics as directed by dentist and educating patients regarding their use and benefits. d. Dental assistant and expanded functins dental assistant. AR July

12 (1) Infrmatin gathering and updating. (2) Treatment (t include prphylaxis and sealants by an expanded functins dental assistant, prfessinally applied tpical fluride, and applicatin f ther chemtherapeutics). (3) Patient educatin. (4) Dispensing chemtherapeutics as directed by dentist and educating patients regarding their use and benefits. e. Administrative assistant. (1) Scheduling appintments and prviding appintment reminders t patients. (2) Respnding t patient questins regarding health prmtin and disease preventin r directing patients t clinic persnnel wh can address these questins Cmmanders f deplyed dental units (separate dental units, Prfessinal Officer Filler System, r brigade dentists) These cmmanders will ensure that their dentists a. Reprt dental treatment wrklad and dental DNBI incidents f Sldiers deplyed in supprt f verseas cntingency peratins using the CDS wrklad reprting tl and DNBI mdule. b. Crdinate with the preventive medicine unit and the nearest dietitian and perfrm a quarterly envirnmental assessment fr dental readiness threats. c. Request implementatin f measures t cunter dental readiness threats. d. Cnduct cmmunity health prmtin and disease preventin activities, when they d nt interfere with the prvisin f emergency care r with necessary dental services fr active duty Sldiers Cmmanders f U.S. Army Medical Activities and U.S. Army Medical Centers These cmmanders will a. Prvide the necessary administrative and lgistical supprt required t ensure successful Army Dental Readiness and Oral Health Prtectin Prgrams. b. Prvide water quality reprts that include fluride cncentratin t the DENTAC, DCC, r dental unit cmmander (r designated representative), and gegraphically dispersed dental facilities under their general cmmand and cntrl, n at least a quarterly basis (see TB MED 576). c. Encurage health care prviders t integrate ral disease screening, preventin cunseling, and indicated dental referrals int rutine visits fr pediatric, bstetric, and diabetic patients, as well as fr patients with cardivascular disease Installatin cmmanders These cmmanders will a. Ensure that Sldiers see the TRICARE Web site at r the medical e l e m e n t e q u i v a l e n t, d u r i n g i n - p r c e s s i n g r u t - p r c e s s i n g, i n a c c r d a n c e w i t h A R a n d D A P a m The TRICARE Web site r the medical element equivalent persnnel will (1) Prvide all in-prcessing Sldiers with infrmatin and cunseling n the TRICARE Dental Prgram enrllment prcess, and the prcedures fr btaining dental care in accrdance with paragraph 5 2b. (2) Encurage married Sldiers t invite their spuses t participate in these in-prcessing activities. (3) Prvide applicatins r Internet enrllment instructins fr the TRICARE Dental Prgram insurance benefits fr the Sldiers Family members. b. Ensure that all Family Readiness Grup (FRG) supprt assistants are aware f the lack f availability f dental care fr Family members at pst facilities and understand hw t assist Sldiers with enrllment in, and use f, the Family member dental insurance plan fr treatment at civilian facilities. c. Direct pst water engineers t ensure that pst water supplies are ptimally fluridated accrding t the recmmendatins f the Centers fr Disease Cntrl and Preventin, as per Memrandum, USD ATL, 18 March 2013, subject: Fluridatin at DOD Owned r Operated Ptable Water Treatment Plants. This will include effrts t reduce fluride levels in areas where the natural fluride cncentratin exceeds 4 parts per millin. d. Direct pst water engineers t include fluride cncentratins n water quality reprts that are sent t the preventive medicine fficer f the U.S. Army Medical Activity r Center fr the installatin, and t the PDO f the installatin DENTAC r DCC All unit cmmanders Unit cmmanders are respnsible fr dental readiness f their units and will a. Enhance unit readiness and maximize human resurces by hlding all Sldiers, bth RA and RC, accuntable fr maintaining their dental readiness. b. Ensure persnnel are available t cmplete required dental care (bth annual examinatins and treatment) in a 6 AR July 2016

13 timely manner, thus imprving bth dental readiness (dental readiness classificatin (DRC) 1 r 2) and ral wellness (DRC 1) f unit persnnel. c. Assure that persnnel in DRC 3 r 4 are available fr expedited dental care. d. Assure that their unit persnnel administratr prvides the UDRL and the assigned dental clinic with the mst current unit rsters at least mnthly, s that the UDRL can crrect persnnel assignment errrs in the CDS, since errrs in the CDS will cause MEDPROS inaccuracies. e. Assure that the unit dental readiness psture meets the gal established by the Secretary f Defense fr Health Affairs, which is t have 95 percent f all active duty frces in DRC 1 r 2 (see HA Plicy ). f. Encurage Sldiers t attain and maintain DRC 1 in rder t meet r exceed the wellness gal f 65 percent f persnnel in DRC 1 established by the Secretary f Defense fr Health Affairs fr active duty Service members and selected reserve persnnel (see HA Plicy ). This includes aviding harmful habits, btaining an annual dental examinatin, seeking treatment when they experience signs f a prblem, and cmpleting all necessary treatment as quickly as pssible. g. Demnstrate psitive effrts t deglamrize the use f all frms f tbacc prducts, and encurage tbacc cessatin. h. Require muth guard use during physical training r unit sprts activities that may invlve injury t the face r muth as a result f head-t-head cntact, falls, tth clenching, r blws t the muth, including, but nt limited t, ftball, basketball, sccer, pugil stick cmbat, individual weapn, baynet training, bstacle/cnfidence curse, and cmbatives. Muth guard use shuld be encuraged during parachute and cmbat vehicle peratins. i. Appint a UDRL t (1) Use MEDPROS t generate unit dental readiness reprts, track the dental readiness f Sldiers, and ntify Sldiers at bth 60 and 30 days befre the Sldier s annual exam due date. (2) Crdinate with the UCV accunt manager f their assigned dental clinic t btain a UCV accunt, and use the UCV t update their unit s persnnel infrmatin in CDS mnthly. (3) Crdinate with the DENTAC, DCC, r dental unit cmmander t identify available treatment times, use UCV t make and mnitr dental appintments within their units, and act t reduce failed appintments. (4) Crdinate with the DENTAC, DCC, r dental unit cmmander t audit and mnitr dental health recrds and recrd accuntability. (5) Ensure that Sldiers are prvided with knwledge f the mst current and effective ral hygiene and dietary ral disease preventin techniques Cmmander, U.S. Army Training and Dctrine Cmmand Cmmander, TRADOC will a. Ensure that ral disease preventin training and dental readiness training are prvided t all Army Sldiers during IET, AIT, OSUT, and BOLC as part f their preventive medicine training and medical readiness training. b. Ensure that all ral disease preventin training is reviewed and apprved at least every 2 years by the TSGappinted Public Health Dentistry Cnsultant fr cmpleteness and accuracy. c. Require muth guard use during pugil stick cmbat, individual weapn and baynet training, the bstacle/ cnfidence curse, cmbatives, and physical training r unit sprts activities that may invlve injury t the face r muth as a result f head-t-head cntact, falls, tth clenching, r blws t the muth, such as ftball, basketball, and sccer. Mandatry muth guard use during the abve training activities is prven t reduce rfacial injuries All Army persnnel Recmmended guidance fr all Army persnnel includes a. Practicing ral disease preventin techniques daily, t include (1) Prper nutritin and aviding harmful ral habits such as frequent cnsumptin f sugared beverages and/r snacks, and tbacc prducts. Infrmatin n the mst current and effective ral hygiene and dietary ral disease preventin techniques is available n the Army Knwledge Online My Dental pages at page/ (2) Twice daily ral hygiene using fluride tthpaste. b. Using a muth guard during physical training r unit sprts activities that may invlve injury t the face r muth as a result f head-t-head cntact, falls, tth clenching, r blws t the muth, such as ftball, basketball, and sccer. Sectin II Implementatin Guidance Prgram methds All Sldiers will be assigned a dental readiness classificatin by a dentist: AR July

14 a. Annual dental exam requirement. Annual dental examinatin requirement in which a dental classificatin f the risk f having a nncmbat dental emergency is assigned t each Sldier. b. Dental readiness classificatin. DRC, which is a dentist s best judgment f the risk f a patient having a dental emergency. Criteria are prvided t assist the dentist in making the judgment (see HA Plicy ). Cmplete guidance is in Department f the Army pamphlet (DA Pam) (1) Class 1. These Sldiers have a current dental examinatin and d nt require dental treatment r reevaluatin fr disease. DRC 1 Sldiers are wrldwide deplyable. (2) Class 2. These Sldiers have a current dental examinatin and require nn-urgent dental treatment r reevaluatin fr ral cnditins that are unlikely t result in dental emergencies within 12 mnths. DRC 2 Sldiers are wrldwide deplyable. (3) Class 3. These Sldiers require urgent r emergent dental treatment. DRC 3 Sldiers nrmally are nt cnsidered t be wrldwide deplyable. (4) Class 4. These Sldiers require sme type f peridic r ther dental examinatin. c. Required reprts. Ensuring mnthly dental readiness reprts are visible t unit cmmanders. d. Pririty f care. In accrdance with AR 40 3, DTFs will priritize care fr Sldiers at high risk f a dental emergency r withut recent dental examinatins (DRC 3 and 4), and give mbilizing DRC 3 and 4 Sldiers first pririty Prcedures fr care within the Army Dental Care System The Army Dental Care System (ADCS) prcedures include the fllwing: a. Sldiers recrds will be screened n arrival at a new permanent duty statin. (1) Regular Army in-prcessing, permanent-duty Sldiers, t include U.S. Military Academy (USMA) cadets, whse dental recrds indicate n examinatin within the previus 6 mnths, r wh are designated as DRC 3 r 4, must have a dental examinatin at the lcal dental clinic prir t cmpleting their in-prcessing prcedures. Every effrt will be made t achieve DRC 1 r 2 fr all in-prcessing Sldiers prir t the Sldier reprting t his r her unit. (2) Sldiers and cadets in the third r furth year f training will have their next annual dental examinatin n later than 15 mnths frm the date f cmpletin f their last annual dental examinatin (see HA Plicy and DODI ). (3) Recrds will als be screened t ensure a panramic radigraph is present in the Army Dental Digital Repsitry (ADDR) and that it is f adequate quality fr diagnstic and identificatin purpses. If n panramic radigraph is present in the ADDR, ne will be taken and submitted. There is n time requirement n updating panramic radigraphs. Hwever, the radigraph must adequately represent the current ral cnditins f the Sldier. b. Department f the Army (DA), TRADOC, Installatin Management Cmmand, USMA, and United States Army Medical Cmmand will crdinate t ensure dental services are prvided t enlisted and fficer Sldiers in training and cadets within the ADCS with the gal f achieving an verall dental readiness rate f 95 percent upn graduatin frm AIT, OSUT, BOLC, r USMA. (1) The ADCS will prvide a definitive dental examinatin t all Sldiers in training and cadets fr all Army cmpnents n active duty status fr training. (2) Active duty Sldiers in training and cadets identified as DRC 3 will be treated within the ADCS dependent upn the cnstraints f available resurces and access t Sldiers r cadets during the available training perid. This is dne with a gal f 95 percent f the Sldiers dentally ready upn graduatin. Any Sldiers r cadets wh d nt receive an examinatin prir t graduatin must be examined by the ADCS upn in-prcessing at their first permanent duty statin in the cntinental United States and, if fund t be DRC 3, receive immediate care t restre them t a minimum DRC 2 status. All active duty Sldiers assigned utside the cntinental United States must receive a dental examinatin and classificatin prir t the permanent change f statin, and receive DRC 3 remedial care if indicated. (3) RC Sldiers in training identified as DRC 3 will be treated within the available training perid within the ADCS, dependent upn the cnstraints f available resurces and access t Sldiers during the available training perid, with a gal f 95 percent dentally ready upn graduatin. (4) Upn release frm a perid f active duty, the U.S. Army Reserve Cmmand and Natinal Guard Bureau are respnsible fr directing the utilizatin f the Army Selected Reserve Dental Readiness System (ASDRS) t manage the dental readiness f RC Sldiers in training in the fllwing situatins: (a) Thse wh will have a break in training between basic cmbat training (BCT) and AIT, have been examined at BCT and identified as DRC 3 but have nt been treated t a minimum DRC 2 status during BCT by the ADCS, shuld cntact their assigned unit t crdinate fr DRC 3 treatment thrugh ASDRS upn return t hme statin and prir t returning fr AIT. (b) Thse wh did nt receive an examinatin prir t graduatin frm AIT, OSUT, r BOLC shuld cntact their assigned unit t crdinate fr an examinatin and, if indicated, DRC 3 treatment necessary t reach a minimum DRC 2, thrugh ASDRS upn return t their hme statin. (c) Thse wh have received an examinatin prir t graduatin frm AIT, OSUT, r BOLC and were identified as 8 AR July 2016

15 DRC 3 but were nt treated t a DRC 2 status prir t graduatin shuld cntact their assigned unit t crdinate fr DRC 3 treatment thrugh ASDRS upn return t their hme statin. (5) The ADCS will uplad examinatin, radigraphic, and treatment dcumentatin perfrmed n RC Sldiers in training int DENCLASS, the RC s electrnic readiness infrmatin system, and int the ADDR. Upn release frm active duty, dcumentatin f dental readiness care fr RC Sldiers perfrmed within the ASDRS such as examinatin, radigraphs, and treatment will be upladed t the ADDR. c. Sldiers and cadets in the third r furth year f training will receive a dental examinatin and have their DRC updated annually. At the cnclusin f treatment, the treating dentist shuld perfrm a peridic examinatin (00120) in rder t cnfirm that all necessary treatment is cmpleted and reset the peridic exam date. Refer t AR fr guidance n cnversin t DRC 4, a nndeplyable status. d. The ADCS will prvide dental treatment required fr Sldiers and cadets accrding t the fllwing pririty: (1) DRC 1 Sldiers require n treatment. (2) DRC 2 Sldiers will be cunseled n their dental needs and every effrt will be made t prvide treatment t mve that Sldier t DRC 1. (3) DRC 3 Sldiers will receive expedited treatment fr their DRC 3 cnditin(s) t prevent a prbable dental emergency. e. Prir t a Sldier s reassignment t an verseas lcatin, dental recrds will be screened and active duty persnnel fund t be in DRC 3 r 4 will nt be cleared fr verseas mvement until dental treatment places them in at least DRC 2 r unless therwise apprved in accrdance with HA Plicy This dental recrd screening shuld be cmpleted at least 7 days prir t the Sldier s actual rtatin date. f. Sldiers in DRC 3 and DRC 4 nrmally will nt deply (HA Plicy ). Under extreme circumstances, a waiver may be granted by the installatin cmmander, after a recmmendatin frm a dental fficer in the grade f O 6 r abve (see DA Pam ). When apprved, treatment may be authrized in the area f peratins and the individual may deply Reserve Cmpnent dental readiness and the Reserve Cmpnent-directed Army Selected Reserve Dental Readiness System Pursuant t 10 USC 1074a, the Assistant Secretary f the Army (Manpwer and Reserve Affairs) Plicy Guidance Memrandum f 3 September 2008, subject: Plicy Guidance fr Establishing the ASDRS, directs the Chief, Army Reserve and Directr, Army Natinal Guard t implement ASDRS in supprt f all Selected Reserve Sldiers assigned t Selected Reserve units, utside f mbilizatin, and achieve the DOD HA Plicy dental readiness standard (95 percent). a. Dental readiness is an RC cmmander s, and an individual Sldier s, respnsibility. b. The gal f ASDRS is t avid just in time dental examinatins and DRC 3 treatments when a Sldier is alerted fr mbilizatin. Prir t mbilizatin, unit cmmanders will use base prgram readiness funds t ensure Sldiers are prvided individual dental appintments with a dental hme. The dental hme will be at a hme statin netwrk dental prvider, and the funds will als be used fr any necessary fllw-up appintments with the same prvider when pssible. This apprach helps t prmte a preventive dentistry and cntinuity f dental care mindset while maximizing Sldier dental readiness utside f alert fr mbilizatin. c. Once alerted, mbilizatin date r trp prgram unit cmmanders may use ASDRS cntingency funds t ensure necessary remedial dental readiness care (dental examinatin and/r DRC 3 treatments) is prvided befre sending the Sldier t the Federal mbilizatin platfrm. The need t prvide just in time dental readiness care upn alert shuld be the exceptin, nt the rule. The ASDRS base prgram readiness funds shuld nt be depleted when ASDRS cntingency funds are authrized (after alert). d. The ASDRS plicy guidance requires Selected Reserve units t ensure that dcumentatin f DRC status (DD Frm 2813 (DOD Active Duty/Reserve/Guard/Civilian Frces Dental Examinatin)) and dental care perfrmed by cntracted dental prvider entities r intrinsic RC military dental persnnel is upladed int DENCLASS, the RC electrnic dental readiness infrmatin system, which electrnically updates the ADDR, and the Army s MEDPROS. The electrnic dental recrds system fr the RC (DENCLASS) entry is required in rder fr dental readiness dcumentatin, radigraphs, examinatin dates, treatment dates, and current DRC status t prperly update the ADDR and MEDPROS. As f 1 Octber 2009, all new RC dental dcumentatin is required t be entered int DENCLASS fr all Sldiers in Reserve units. As f 1 Octber 2010, each RC Sldier must have a digital panramic radigraph n file in the ADDR as part f his r her mbilizatin and deplyment requirements. e. Selected Reserve units must ensure that the statement f wrk with cntracted dental prvider netwrks includes the requirement fr DENCLASS data entry and that a quality assurance plan is in place and implemented. f. The Reserve Health Readiness Prgram, a DOD-cntracted prvider netwrk entity, is ne f the vehicles fr cntract dental readiness care prviding all ASDRS required capabilities. AR July

16 3 19. Using the DD Frm 2813 A DD Frm 2813 permits the dcumentatin f an annual dental examinatin and DRC by a civilian dentist and will be used as fllws: a. Regular Army Sldiers. RA Sldiers wh are statined in remte lcatins utside f the area f respnsibility f a DOD DTF, may use a civilian dental prvider, per plicies, t perfrm and dcument the annual dental examinatin requirement n a DD Frm b. Reserve Cmpnent Sldiers. RC Sldiers wh have private, civilian dentists nt cmpensated by the ASDRS, may have the dentist perfrm and dcument the annual dental examinatin requirement n a DD Frm Each f the RCs may direct specific implementatin instructins fr the frequency and use f a DD Frm 2813, such as requiring that a cmplete dental examinatin must be perfrmed by the ASDRS in lieu f a DD Frm 2813 in a specific multi-year time perid. Active Guard Reserve Sldiers wh use a DD Frm 2813 are required t submit the frm thrugh the prcess identified fr RC Sldiers. c. Cmpletin f DD Frm Sldiers using the DD Frm 2813 must ask their civilian dentist t cmplete the frm. The Gvernment is nt bligated t pay fr administrative csts (if any) incurred fr cmpleting the frm. All ADCS dental prviders (fr RA dental fficers, General Schedule civilians, and cntractrs) and ASDRS dental prviders (RC dental fficers r cntracted entities) will cntinue t dcument annual dental examinatins n Standard Frm (SF) 603 (Health Recrd-Dental) and, as applicable, SF 603A (Health Recrd-Dental-Cntinuatin). d. Dispsitin f DD Frm (1) Fr RA Sldier prtcl, g t the USADENCOM Dental Readiness Infrmatin Center (DRIC) Web site at t btain a DD Frm 2813 and read instructins pertaining t RA Sldiers. The frm and its dcumentatin data must be entered int the CDS as per current prtcl (frm DRIC Web site: Fax the DD Frm 2813 t the DENCOM Crprate Dental System (CDS) Help Desk at /Defense Switched Netwrk (DSN) ). (2) Fr RC Sldier prtcl, including Active Guard Reserve, g t the USADENCOM Dental Readiness Infrmatin Center Web site at t btain a DD Frm 2813 and read specific instructins pertaining t Army Natinal Guard Sldiers (cmpnent 2) r Army Reserve Sldiers (cmpnent 3). The frm and its dcumentatin data must be entered int DENCLASS as per current prtcl (frm DRIC Web site: Guard: Fax the cmpleted DD Frm 2813 t State Surgen s ffice f the Army Natinal Guard (Cmpnent 2) unit t which yu are assigned fr mbilizatin purpses. Army Reserve (Cmpnent 3): Fax the cmpleted DD Frm 2813 t (Sldiers may call , extensin 2833, extensin 2386 fr DD Frm 2813 inquiries). (3) After the infrmatin n the DD Frm 2813 is entered int either CDS r DENCLASS, unit cmmanders can review changes in DRC and exam dates in MEDPROS Organizatinal guidance a. Units. The unit cmmander is respnsible fr the dental readiness f all assigned persnnel. The unit cmmander will establish prcedures t carry ut the requirements f the Dental Readiness Prgram. Cmmanders will make their persnnel available fr appintments and maintain surveillance ver the prgram t ensure the fllwing: (1) Fr RA Sldiers and RC Sldiers assigned t a supprting military DTF the supprting unit s dental clinic will be the sle custdian f all unit persnnel dental recrds. Newly arriving persnnel will turn in their dental recrds t dental persnnel fr initial screening. (2) All persnnel will receive annual dental examinatins. Fr RA Sldiers and RC Sldiers assigned t a supprting military DTF, the unit (r its supprting persnnel activity) will (a) Prvide updated persnnel rsters mnthly t the dental facility that supprts the unit and use MEDPROS t generate a rster f DRC 3 and 4 Sldiers fr the cmmander. (b) Ntify persnnel wh require annual dental examinatins at 60 and 30 days prir t their exam due date, and ntify them again in case f nncmpliance. (c) Fr RA Sldiers and RC Sldiers assigned t a supprting military DTF, make persnnel identified as DRC 3 r 4, r thse wh require an annual dental examinatin, available fr cmpliance with the prgram. Unit cmmanders will ensure that persnnel wh are nt deplyed and are assigned t a DTF d nt remain in DRC 4 fr mre than 30 days r in DRC 3 fr mre than 90 days. (d) Establish prcedures t address Sldiers wh are in repeated nncmpliance. (3) All Sldiers are required t exercise prper ral hygiene t maintain their verall fitness fr duty and remain in a deplyable status. Sldiers wh fail t exercise gd ral hygiene are likely t develp ral disease(s) and risk becming unfit fr duty, which in turn impacts unit readiness. Sldiers wh repeatedly fail t exercise prper ral hygiene may be cunseled by their chain f cmmand as nted belw. (a) Fr RA Sldiers and RC Sldiers assigned t a supprting military DTF, unit cmmanders will maintain clse cmmunicatin with their servicing dental clinic. Any disclsure f a patient s prtected health r persnally identifiable infrmatin by a dental health care prvider t a unit cmmander must be in cmpliance with HIPAA. (b) A unit cmmander shuld cunsel identified Sldiers cncerned regarding the need t exercise prper ral hygiene and the ptential negative impact n the Sldier s health, fitness fr duty, and verall unit readiness. 10 AR July 2016