Army dentists want dental emergencies written into war-game casualty models

A casualty scenario is a demand forecast. It tells a commander how many patients to plan for and how many evacuation slots to hold back. Leave a category out and the forecast is short by whatever that category consumes in practice. In the Iraq war, dental emergencies accounted for 19% of all treatment at military hospitals near the front lines ^[3], roughly one patient in five ^[19].

The remedy costs capacity before the fight rather than during it. Lt. Col. Jesse Thietten argues the broader force needs more dental work done before troops deploy, along with smaller, more mobile dental teams that can operate close to units in the field ^[14]. Both are peacetime line items. The authors reported that almost all patients treated by forward dental teams returned to duty after one or two visits ^[5], while a soldier who has to travel farther for care can be off duty for as long as a week ^[6].

A skeptic would say Iraq is a poor guide, because air superiority and a mature hospital network are not what planners now assume. The dentists' argument runs the other way. The proliferation of attack and surveillance drones across the Ukrainian battlefield has made quick evacuation largely impossible ^[9], and Air Force Col. Anita Shade said "Asymmetric/hybrid drone warfare shows us that we now need to plan and prepare for prolonged patient management in the field due to the unpredictability of patient transport" ^[17]. Harder transport makes an unmodelled case type more expensive, not less.

Dental care "is a low-hanging-fruit solution for medical as a whole. Military medicine needs solutions to account for the anticipated systemic medical overload in [large-scale conflicts,]" Thietten said in a military news release for a healthcare training event ^[10]. He put dental emergencies among the top five most common likely reasons for casualty evacuation in such a fight ^[11], and said that for troops deployed abroad in multinational settings alongside partner forces, dental concerns are "the number one reason" for casualty evacuation ^[12].

The cheap fix is the one getting scarcer. "Deployable dental capabilities continue to decline," the authors wrote, citing an "urgent need for accurate dental emergency modeling in war-gaming" ^[8]. Shade, chief of dental services for the 21st Medical Group, said that within the Air Force "less than 1% of the service's dentists deploy" (more than 99 in 100 do not) ^[15][21], and that "Our dental teams are often disconnected from the heart of the readiness mission that we work to support, day in and day out" ^[16]. Two Army dentists preparing for a unit exercise found their field equipment had not been used in nearly a year, and wrote about broken kit and missing supplies hampering training ^[18].

The general form of this is familiar to anyone who has written a continuity plan. The failure modes left out of the scenario tend to be the cheap ones, and their cheapness is why they get left out; the expensive ones are the reason the exercise exists at all. But a cheap case and an expensive case draw on the same constrained resource, whether that is a vehicle or a clinician's hour, and the plan reserves capacity only for what it counted. The Army's own record puts a number on the omitted category: dental disease and other non-battle injuries made up nearly 16% of all medical evacuations among troops fighting the Islamic State in Iraq and Syria ^[4], about one evacuation in six ^[20].