Dentists always play a key role in all fields of science, research, and technology. One of the important areas is national defense. The Defence Industry of India is a strategically important sector in India. With a strength of over 1.44 million active personnel, it is the world's largest military force. India has the world's largest volunteer military of over 5.1 million personnel. “Defence Production Policy of 2018” has a goal of becoming among the top five global producers of the aerospace and defense manufacturing with an annual export target of US$5 billion by 2025.[2,3] Defense is not just for men. Women are also heroic in serving their nation. All wings of the Indian Armed Forces allow women in combat roles (junior ranks) and combat supervisory roles. Indian Air Force had 13.09% and 8.5%, Indian Navy 6% and 2.8% of women, and Indian Army 3.80% and 3% in December 2018 and December 2014, respectively.[4,5]
The field of defense is solely relied on workforce. Any soldier who fights for the country should be fit and sound. Here comes the role of medical and health-care professionals to ensure that every citizen who wants to be a part in the field of defense is fit enough for it. When we say medically fit, it includes dental health too. A medical test (dental points) that is conducted by the Service Selection Board is a very crucial part of the entire selection procedure, and usually, the medically unfit rate goes up to 45%–55%. A candidate can be declared unfit medically for various health issues. Having 14 dental points is one of the essential criteria during medicals. The maximum number of points can be 20–22, and the minimum number of points required to be declared medically fit are 14 points. It is the duty of the dentists to motivate the public to change their behavior and planning for the prevention and control of dental diseases. Hence, every dentist should be aware of the requirements and criteria that make a normal citizen into a soldier who serves his country.
A survey was conducted among the dentists and army aspirants to analyze the awareness of criteria in the Service Selection Board. This study helps to educate people to maintain their oral hygiene which they tend to neglect and thus leads to the loss of teeth which ultimately results in the loss of score which decreases his/her chances of selection. Thus, dentists and particularly orthodontists have a huge responsibility to formulate an appropriate treatment plan, keeping patients' aspirations and requirements in mind.
MATERIALS AND METHODS
A cross-sectional study was conducted among 257 dentists and 253 defense aspirants. The study was conducted from February 2020 to April 2020.
Sample size determination
Sample size was determined using the formula for research methodology:
Z(1−α) = 1.96 (for 95% confidence interval)
P = 0.50 (based on the probability that approximately 50% of the dentists and defense aspirants are aware of dental scoring systems for selection)
Q = 1 − P
δ (margin of error) = 0.05
N = 384.16, rounded off to 400
The sample size n = 400.
Anticipating 15%–20% of nonresponse rate for online surveys, the sample size is inflated to 500. Hence, the total sample size needed for the present study will be 500 participants.
Hence, each group, i.e., dentist group and defense aspirant group, will consist of 250 participants.
Two hundred and fifty seven (257) dentists and 253 defense aspirants were included in the study. A self-administered questionnaire [Appendix 1] was formulated separately to the dentists and to the defense aspirants to assess the awareness about dental points, in which six questions were common for both the dentists and the defense aspirants.
The recorded data were entered into Microsoft Excel 2013 computer program, and descriptive statistics were carried out using SPSS version 20.0. Released 2013, IBM Corp., Armonk, NY, USA. The level of significance was set as P < 0.05. An Independent Chi-square test was used to compare the participant's responses for specific common questions between the two groups. Chi-square goodness-of-fit test was used to compare the differences in the responses to the questions specific to the dentist and defense aspirant groups.
The study was conducted to assess the awareness about dental points among 257 dentists and 253 defense aspirants [Table 1]. Figure 1 indicates the responses among 2 groups about dental scoring system and its calculation. It shows that 56.9% of the defense aspirants and only 35.8% of the dentists were aware about scoring system which is necessary for defense selection. Moreover, 39.1% of the defense aspirants and 20.6% of the dentists knew how it is calculated. Table 2 describes the comparison of participants' responses for specific common questions between the two groups using Chi-Square test. [Tables 3 and 4] describes the comparison of differences in the responses to the questions specific to dentist group and those specific to defence aspirants group, respectively, using Chi-Square Goodness of Fit test.
Figure 2 shows the distribution of responses between the two groups for minimum and maximum scores needed for candidate for selection in defense. Although 56.9% of the dentists did not know about the scoring system, many have chosen the correct option for the questions regarding maximum and minimum values, as the greatest and lowest values in the options leaded them to choose these options.
Figure 3 shows that 31.5% of the dentists have come across few defense aspirants who want to know about their scores before the selection of candidates for defense. 25.7% of the defense aspirants have approached their dentist to know about their scores which are required for the selection of the candidates in defense.
Figure 4 shows that responses among the dentists and defense aspirants had different opinions about the factors that would affect the dental score, in which 36.2% of the dentists and 44.7% of the defense aspirants considered dental caries as the most important factor for the loss of score during selection, while 5.8% of the dentists felt hypersensitivity to be the least significant factor. With 1.6%, malocclusion scores the least among the defense aspirants. Moreover, 22.5% of the defense aspirants were totally unaware about the factors responsible for defense selection.
Figure 5 shows the distribution of responses specific to the dentist. 80.2% of the dentists were aware of dental examination which is necessary for the selection of candidates in defense. 19.8% of the dentists had no idea about this. Seventy-seven percent of the dentists feel that it is important during case history to ask about his/her interest in joining defense. Twenty-three percent differed in their opinion. 75.5% of the dentists were more interested in knowing about the scoring systems and 24.5% seem to be disinterested.
Figure 6 shows the distribution of responses to the question on different intentions to know more about the scoring system among the dentist group. Fifty percent of the dentists were interested in gaining knowledge about dental points. 21.2% of the dentists felt that knowing about dental points will help in proper diagnosis and treatment planning. 15.2% of the dentists thought that knowing about this will improve the treatment quality and increase the score. 13.6% of the dentists wanted to know to create awareness.
Figure 7 shows the distribution of responses to the questions specific to defense aspirants, in which 85.4% of the defense aspirants were self-motivated to join defense. Moreover, 71% of the defense aspirants were aware of total number of teeth present in their mouth and 23.2% were closer to the normal range. 5.8% were negligent about the number of teeth.
Figure 8 shows the distribution of responses among the defense aspirant group for question on awareness of dental scores for each tooth and the form lead to increase in awareness of importance of teeth for selection. Fifty-three percent of the defense aspirants were aware that each tooth has a score whereas 47% were unaware. After filling the questionnaire, 59.7% of the defense aspirants realized the importance of dental health in defense selection and 40.3% did not realize the importance.
Medical test (dental points) is conducted by Services Selection Board which is very important during the selection procedure. In general, in each batch, the medically unfit rate goes up to 45%–55%. Candidate can be declared unfit medically for one or various health issues. Fourteen dental points are one of the must-have things during medicals. Teeth which are not considered necessary for efficient work are given with 1 point each. Teeth assumed to be essential are allotted with 2 points each. Each incisor, canine, 1st, and 2nd premolar holds 1 point, provided their corresponding lower teeth are present. Each 1st and 2nd molar and well-developed 3rd molar holds 2 points, provided they are in good opposition to corresponding teeth in the lower jaw. If 3rd molar is not well developed, it holds only 1 point. When 16 teeth are intact in the upper jaw with a good functional opposition to corresponding teeth present in the lower jaw, the total points can be 20–22 which is the maximum score based on the 3rd molars, whether well developed or not). The minimum number of points required to be medically fit are 14 points.
When asked about important dental issues that would lower the score, many dentists and defense aspirants chose “missing teeth.” Although it is a single condition, missing teeth may be due to various reasons such as dental caries, periodontal illness, and trauma. Losing a tooth will make an aspirant to lose his carrier. Hence, every dentist should consider extraction as the last resort. Various treatment options are available to save a tooth, which includes like restorations, RCT. Tooth-colored restoration should be preferred over amalgam, as the amalgam restoration tends to expand in higher atmospheric pressure which ultimately leads to pain. Malocclusion is yet another important factor. Conditions such as anterior open bite and Class III malocclusion are considered as an important factor during the selection of candidates. Being a soldier, this becomes a disability for using grenades. Hence, such type of malocclusion should be treated at the earliest. Furthermore, a proper case history should be taken in order to know the patients' interest toward defense and treatment planning should be done accordingly.
Suppose if a patient presents with severe malocclusion, extraction of teeth is mandatory in such situations. But extracting a tooth might reduce the score. In such cases, alternative treatment planning should be done which doesn't require extraction.
A proper knowledge about these criteria is essential for a dentist to treat the patients, especially those who want to join defense. Nearly 59.9% of the dentists did not have adequate knowledge about the scoring system. To treat effectively and efficiently, it is essential that the dentists are first educated about the need for treatment that prioritizes the defense scores, as the dentists play a very important role in creating awareness among the patients. When the aspirants were asked, if they realized the importance of dental health in defense after answering the questionnaire, 40.3% of them answered negatively. Dental problems are always the last in patients' concern. “A stitch in times saves nine,” like ways a treatment done at the earliest and at the right time can save a whole lot of complications ahead in patient's life and also there is no need of compromises in patients' career. Hence, it is always the duty of the dentist to educate the people at the earliest. According to “World Population Prospects: The 2015 revision Population Database of United Nations Population Division,” India has the world's highest number of 10–24-year-olds, with 242 million despite having a smaller population than China, which has 185 million young people. Hence, dentists should conduct dental health educational programs among all the youth who want to join defense in order to increase the awareness about the dental points and the criteria required for the selection of the candidates.
So far, no studies have been undertaken to check the awareness of dental points among dentists and defense aspirants. Creating awareness is the first step of oral health education. In a society like ours where most of the dentists and defense aspirants were not aware about dental points and its consequences, the main reason behind this is due to lack of awareness about dental points and the criteria needed for the selection of candidates in defense. Hence dental health educational programs should be actively conducted in all health sectors of India to increase the awareness about dental points.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Questions asked to defense aspirants
- Motivation for joining army?
- Motivated from family members
- Are you aware of total number of teeth present in your mouth?
- NoIf yes, how many
- Are you aware that each tooth of yours has a score?
- Do you know how it is calculated?
- NoIf yes, what is your score?
- Are you aware that dental points are necessary for a selection?
- What is the maximum score for the selection?
- What is the minimum score for the selection?
- Have you visited a dentist to calculate your points?
- List out the dental problems you know that will make you lose your score?
- Has this question form increased the awareness of importance of teeth in selection?
Questions asked to Dentists
- Are you aware of dental examination is necessary for the selection of candidates in defense?
- Are you aware of 20–22 dental points scoring system for selection of candidates?
- Do you know how it is calculated?
- What is the maximum score for the selection?
- What is the minimum score for the selection?
- Have you come across any patient who wants to know their score prior to the selection?
- List out the dental problems you know that will make him/her lose their score?
- Do you think it is important to ask about his/her interest in joining defense during case history?
- Would you be more interested in knowing about the scoring system?
- NoIf yes, why?