{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:21:08Z","timestamp":1790961668574,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/open-government-licence\/version\/3\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The U.K. Armed Forces (UKAF) use the Northern Alliance Treaty Organization (NATO) Dental Fitness Categorization (DFC) template to categorize Service Personnel (SP) dental health, in turn, enabling the prioritization of treatment and informing command of force dental readiness. The inconsistent application of DFC may lead to under-estimation of dental risk, potentially leading to increased risk of Disease and Non-Battle Injury (DNBI). This service evaluation established the impact of online training at standardizing the application of DFC by UKAF dentists. The study had institutional approval following organizational ethical policy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>The NATO DFC template was standardized to 7 dental disease domains (impacted mandibular third molars [M3M], endodontic disease [ED], dental trauma [DT], dental caries [DC], periodontal disease [PD], crown and bridge [C\u2009+\u2009B], and tooth wear [TW]) by an experienced clinical working group. A baseline assessment of UKAF Dentists\u2019 application of NATO DFC was undertaken via survey, using clinical cases. Clinical training on the disease-standardized NATO DFC template was subsequently delivered via 4 webinars. The impact of training on DFC application was assessed via comparison of results from a second survey, distributed to 4 U.K. DPHC regions at different time periods post webinars (1, 6, 8, and 13 months), against the baseline results. Analysis was undertaken using odds ratios with 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred twenty-four dentists completed the initial survey, with 3,224 correct responses (66%). Following online training, 90 clinicians completed the second survey (630 responses), with NATO DFC application significantly improved to 71% (OR 2.26, 1.82-2.81). Of the disease domains, greatest improvement in DFC application was as follows, in descending order of significance: ED (OR 61.88, 40.35-94.89), M3M (OR 2.28, 1.33-3.92), DT (OR 3.75, 2.29-6.14), and TW (OR 1.86, 1.05-3.29).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This UKAF project significantly improved workforce alignment to the application of the NATO DFC against dental diseases, although complete standardization was not achieved. The utility of online training, for educating a disparate clinical workforce on organizational policies, was supported.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag219","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:44:24Z","timestamp":1777031064000},"source":"Crossref","is-referenced-by-count":1,"title":["The Standardization of the NATO Dental Fitness Categorization Template Against Dental Diseases, Within the United Kingdom Armed Forces"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0994-7412","authenticated-orcid":false,"given":"Graeme","family":"Bryce","sequence":"first","affiliation":[{"name":"Defence Centre for Restorative Dentistry, Aldershot , Hampshire GU11 2LS,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Smith","sequence":"additional","affiliation":[{"name":"Defence Primary Healthcare (Dental), Coltman House, Lichfield , Staffordshire WS14 9PY,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9018-2455","authenticated-orcid":false,"given":"Nicholas","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Defence Centre for Restorative Dentistry, Aldershot , Hampshire GU11 2LS,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026052022194828100_usag219-B1","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1038\/sj.bdj.2011.765","article-title":"The policy context for skill mix in the national health service in the United Kingdom","volume":"211","author":"Brocklehurst","year":"2011","journal-title":"Br Dent J"},{"key":"2026052022194828100_usag219-B2","doi-asserted-by":"publisher","first-page":"542","DOI":"10.7205\/milmed.170.6.542","article-title":"Dental risk assessment for military personnel","volume":"170","author":"Richardson","year":"2005","journal-title":"Mil Med"},{"key":"2026052022194828100_usag219-B3","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1038\/s41415-021-2834-1","article-title":"Defence dentistry: an occupationally focused health service with worldwide deployable capability","volume":"230","author":"Armstrong","year":"2021","journal-title":"Br Dent J"},{"key":"2026052022194828100_usag219-B4","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1038\/s41415-019-0147-4","article-title":"A bridge too far? 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