1United States Public Health Service
DENTAL NEWSLETTER
A publication of the Dental Professional Advisory Committee
Volume IV, Issue #2 (Issue #12 overall)
July 2004
In this Issue of the Newsletter
DePAC Chair’s Report…………....pg. 2
Vice-Chair’s Report……………….pg. 3
CDC………………………………...pg.3
NOHC Meeting Report………….. pg. 4
Eugene Buell Dental Award…….. .pg.5
Jack D. Robertson Award ………..pg. 5
Senior Clinician Award………….. pg. 5
New ADA PHS Delegate elected….pg. 6
RADM Charles Grim……………. pg. 6
AMSUS Update…………………….pg.7
HDA……………………………….. pg. 7
Officer Profiles…………………….pg. 8
Hepatitis C…………………………pg.9
CCRF………………………… pg. 10-11
NHSC Ready Responder
Training……………………………pg.10
COA Photos………………….. pg. 11-13
The next issue of the newsletter will be published
in early September 2004. The deadline for
submitting articles is Aug15, 2004
If you have suggestions or comments about this
newsletter, or would like to submit an article,
please contact the Editor. If you would like to
comment on organizational or agency reports,
contact the Section Co-Editor. If you have
comments or suggestions regarding clinical
articles, contact the Clinical Perspectives Co-Editor.
Submitted by CDR Elmer Guerrero
Anchorage, Alaska was the location for the 2004 COA meeting. Denali
gave a spectacular backdrop for the last two days as the clouds parted and the skies
were blue. The opening ceremonies began with the PHS Ensemble playing the PHS
March and the National Anthem. Two of our dentists participated in the Ensemble.
CDR Randall Mayberry and CDR Saville played soprano saxophone and trumpet
respectively.
Dental Category day included the following speakers: CDR Carol
McDaniel, IHS Alaska; RADM Charles Grim, Assistant Surgeon General, Director,
IHS; Eugene Sekiguchi, DDS, MSEE, BSEE, President, ADA; Peter Milgrom, DDS,
Professor, Univ. of Washington; CDR Thomas B. Brewer, IHS Alaska; and CAPT
William G. Kohn, Division of Oral Health, CDC.
LCDR Stella Wisner; Shawn Hinton, DDS and James Hicks, DDS; CDR
Ruth Monina Klevens; CDR Randall Mayberry; CAPT Scott Presson; LCDR Phillip
D. Woods; and CDR Renee Joskow gave paper presentations.
CDR Elmer Guerrero and CDR Suzanne Saville were the moderators for the
day.
We want to acknowledge CAPT Jeanine Tucker for hosting the Dental Category
Day.
Many thanks to our photographer, CDR Jose Rodriguez.
The USPHS Dental Directory, the first-ever comprehensive directory of CS and CC dentists, is now online. The purpose of this directory is
to facilitate communication between PHS dentists, increase recruitment opportunities, and provide the Chief Dental Officer with the names
and addresses of PHS dentists in times of crisis or emergency, http://www.phs-dental.org/depac/newfile48.html
Page 2
USPHS Dental Newsletter
Message from the Chief Dental Officer
Our All-Hands Meeting for the Dental Category held in May
at the U.S. Public Health Professional Conference in
Anchorage provided a lively forum to discuss a large number
of questions and issues. The questions covered the topics of
the newly proposed legislation, pay and benefits, billets,
promotion, recruitment and retention, and communication
among other issues. I thank CAPT Larry Furman who
attended and responded to many questions including ones on
emerging policy issues and the roles of the Office of
Commissioned Corps Force Management and the Office of
Commissioned Corps Operations.
Some of the questions related to the focus of The Lewin
Group contract. Participants were interested in knowing if
and how this contract will help resolve issues. We recently
learned The Lewin Group’s contract has been extended
through December 2004 and they are close to completing the
first phase of their project that has been comprised of panel
discussions and focus groups. The contract is designed to gain
input from the Corps and other groups on three major task
areas: design of force management systems, approaches for
recruitment communications and for training of new officers
and career development. The newly revised DePAC website
provides general background on the transformation and The
Lewin Group (www.phs-dental.org/depac/newfile44.html).
To date several panels explored billets from various
perspectives, and looked at billets and missions, hardship and
hard-to-fill billets, and billet standards. Another panel
discussion reviewed the USPHS website and focus groups of
junior officers and of professional associations (including
those related to dentistry) also have been held. While the
panels and focus groups have included predominately officers,
additional input was obtained from a panel of agency
representatives. The input from these panels and focus group
discussions are contributing to an interim report. It is my
understanding that the interim report of The Lewin Group will
be disseminated to agencies and officers in the near future.
The transformation will take time. While elements of a
general direction are emerging, multiple steps are needed to
move from concepts to reality. Your ideas, input and patience
are needed.
July 2004
Dushanka V. Kleinman, D.D.S., M.Sc.D.
Assistant Surgeon General
I appreciated the opportunity to meet with officers in
Anchorage and invite interested officers to schedule a
telephone conference if you have any issues you would like to
address. My email address is Dushanka.Kleinman@nih.gov.
The USPHS Dental Newsletter is now published and
distributed electronically through the USPHS Dental Bulletin
Board, agency distribution lists, and the USPHS Dental
Directory.
The next issue of the newsletter will be published in
September 2004. The deadline for submitting articles is
August 15, 2004.
Page
USPHS Dental Newsletter
July 2004
Ronald E. Bajuscak, D.M.D., M.S.
CAPT, USPHS
The year has been going by very quickly. It is important that we continue to strive to complete important tasks and always flow in a
positive direction in our lives. We have seen a lot of accomplishments already and I am most impressed with the many talents,
dedication and creative genius that my colleagues in the U.S. Public Health Service continually demonstrate.
This year’s Commissioned Officer’s Association (COA) went wonderfully. CAPT Jeanine Tucker and her team performed at an
exemplary level. The lectures, luncheon, and evening social gatherings were a prime opportunity to meet with each other and our
leaders. Our lunchtime speaker, Dr. Eugene Sekiguchi, the President of the American Dental Association delighted us with his warmth
and kindness, as he impressed us with his knowledge and experiences (it was also wonderful to meet his wife). RADM Charles Grim,
IHS Director, presented an outstanding presentation as our “ David Satcher Keynote” Speaker. CAPT Dean Coppola, Chairman of the
COA Board of Directors, did a superb performance introducing many of the meetings leaders and posing as a model, with his wife
Penny, in traditional Native American clothing during an evening show. Those who attended enjoyed a great week of fellowship and
networking with each other and officers from other categories.
Congratulations to this year’s award winners, CAPT Lee Shackelford (Jack D. Robertson Award); CAPT Mark Rosenburg (Senior
Clinician Dental Award) and LCDR Robin Scheper (Ernest Eugene Buell Dental Award).
Gary L. Pannabecker, D.D.S.
CAPT, USPHS
Let me preface this column by saying I am generally
skeptical of the ability and commitment of senior leadership of
a large bureaucracy to be aware of and responsive to issues,
concerns of the general staff of an organization, whether it be
a governmental agency or corporation. With that said, I have
had the opportunity to represent CAPT Bajuscak at the April
combined meeting of the Surgeon General/Chief Professional
Officer PAC and also attend the recent Annual Commissioned
Officer Association meeting in Anchorage. Several
discussions at both meetings with senior PHS leadership
focused on nitty gritty issues of officers in the field including
promotion, funding for BOTC, and the need for senior
leadership to thoroughly inform supervisors within agencies
about the transformation. There was frank acknowledgement
of issues that have progressed well, and those that could have
been handled better.
Our Chief Dental Officer, RADM Dushanka
Kleinman, held a “town meeting” with all interested PHS
dentists at the COA meeting to personally address and make
note of concerns. CAPT Larry Furman (Director, Office of
Commissioned Corps Force Management, OCCFM, and a
dentist!) attended the session, tirelessly addressing concerns of
several officers regarding the transformation.
While the transformation primarily involves the
Commissioned Corps, it has brought attention to the entire
PHS system including civil servants, contractors, and tribal
hire employees. This time of reevaluation, scrutiny, and rapid
change provides a rare opportunity for all of us to provide
input to our leadership. CAPT Furman as well as CAPT
Denise Canton (Director, Office of Commissioned Corps
Operations, OCCO) have asked that input be forwarded
through the Professional Advisory Committees (PAC’s) and
Chief Professional Officers CPO’s); so please feel free to send
your comments to CAPT Bajuscak (rbajuscak@bop.gov),
myself (mailto:Gary.Pannabecker@mail.ihs.gov) or any other
DePAC member (see DePAC website for rosterhttp://www.phs-dental.org/depac/newfile.html
Page 4
USPHS Dental Newsletter
July 2004
Update on National
Fluoridation
In times of scarce public
health resources, cost effective prevention measures are
critical. Community water fluoridation prevents cavities and
saves money, both for families and the health care system. For
example, in communities of more than 20,000 people, where it
costs about 50 cents per person to fluoridate the water, every
$1 invested in fluoridation yields $38 savings in dental
treatment costs. In 2000, 162 million Americans, or 65.8% of
those on public water systems, were receiving fluoridated
water. One of the highest priorities at CDC’s Division of Oral
Health (DOH) is to support state oral health programs in their
fluoridation efforts. Briefly, DOH supports:

The quality of fluoridation. DOH provides training,
guidance, and technical assistance for the overall
operation of state fluoridation equipment and the
monitoring of water systems through the DO”H
Water Fluoridation Reporting System (WFRS) and
the DOH Fluoridation Proficiency Testing Program.
Forty states are using some aspect of WFRS and
several have increased their participation, including
submitting quality data monthly or providing state
data for the My Water’s Fluoride and Oral Health
Maps components of the CDC Oral Health Web site
(http://www.cdc.gov/OralHealth). Twenty-seven
states are participating in these two new features. The
number of tribal groups participating in WFRS also
continues t increase, from 4 in 2002 to 22 in 2003.
 The education of the public and decision makers
related to the initiation or maintenance of
fluoridation, including conducting research to better
understand
community
factors
influencing
fluoridation decision-making.
 National organizations to evaluate the health effects
of fluoride in drinking water and promote appropriate
policies. DOH is currently providing input to the
National Research Council to aid their efforts to
evaluate the health effects of fluoride in drinking
water and guide EPA policy.
 Research to demonstrate cost effectiveness of
fluoridation.
 Development and updating of national guidelines or
recommendations by coordinating efforts of national
experts on fluoride and fluoridation.
 Systems to track and promote state and national
progress toward national Health People 2010
objectives.
 Technical and financial support to communities in
several states, including, for 2003, ones in Colorado
(Colorado Springs, Ft. Collins), Montana (Billings),
Florida (Palm Beach County), Wisconsin (Antigo),
and Oregon (Beaverton). Recognition of states and
communities for achievements in water fluoridation.
In summary, CDC’s DOH has many activities to support and
promote fluoridation in the United States. Readers interested
in learning more about these activities can contact Dr. Scott
Presson at skp4@cdc.gov.
Lights, Camera, Call to Action:
Spotlight on Oral Health
Jane Weintraub, D.D.S., M.P.H.
AAPHD President-Elect
National Oral Health Conference
From the time I called for the lights to come on in the
darkened ballroom to start the meeting, to the ending standing
ovation for Rob Reiner after he received the American
Association of Public Health Dentistry (AAPHD) public service
award, the fifth joint conference for AAPHD and the Association
of State and Territorial Dental Directors was a jam-packed
National Oral Health conference. We broke many records and had
a very high quality scientific meeting. We had a record breaking
705 registrants, up 56% from just three years ago in Portland and
102 participants contributed papers and posters, more than twice
the number from just five years ago.
We also had our first HRSA-funded workshop for dental
public health residents in conjunction with this annual meeting.
More data will be available after the evaluation forms are
tabulated, however, the statistics won’t completely capture the
spirit of the meeting and the many Oscar-worthy performances.
There was a palpable buzz generated after the genomics sessions
presented by Hal Slavkin and Charles Shuler, the public health
implications reported by Maren Schenuer, and diary entries
shared by Mark Siegal as he tried to learn the difference between
genomics, proteomics and what it was the others were discussing.
The opening session that featured leaders from the ADA, dental
industry and public health, all focused on collaborating to further
the Surgeon’s General’s Call to Action and highlighted new
opportunities for partnerships.
The vigorous scientific discussion about the roles of
topical and systemic fluoride during the “Hershel Horowitz
Memorial Symposium on Recent Advances in the Fluoride
Legacy” would have made Hersh proud. A forthcoming special
issue of the Journal of Public Health Dentistry (JPHD) will include
presentations from this session. Emotions ranged from the laughter
generated by Steve Geiermann’s Power Point presentations that
paired photos of participants from previous meetings with movie
posters creating uncanny resemblances, to the tears shed at an
impromptu memorial held for Keith Heller who had passed away a
few days earlier. We experimented with new formats including
three poster discussion sessions and “Regis and Kelly” type
interviews of four distinguished dental school deans.
Page 5
Many thanks to everyone who helped plan the Los
Angeles, Hollywood.
USPHS Dental Newsletter
July 2004
LCDR Robin Scheper accepts the
Ernest Eugene Buell Dental Award
Robin A.G. Scheper, D.D.S., LCDR, USPHS, was the Area
Regional Dental Consultant for the Division of Medicine and
Dentistry in the Bureau of Health Professions, Health Resources and
Services Administration (HRSA). She was responsible for
monitoring Dental Public Health Residency grant programs and
cooperative agreements that incorporates oral health care education
to non-oral health care providers. Prior to joining HRSA, Dr.
Scheper practiced general dentistry for four and a half years with
the Indian Health Service. Her first tour of duty was for two years
on the Navajo Reservation in Chinle, Arizona. She then accepted
another tour on the Warm Springs Reservation in Warm Springs,
Oregon. After completing that tour, she transferred back East and
accepted a position with HRSA. Dr. Scheper currently maintains her
clinical skills at a HRSA Ryan White clinic. She is a member of the
USPHS Dental Professional Advisory Council, Surgeon General’s
Honor Corps, and Commissioned Corps Readiness Force (CCRF).
As a result of being a CCRF member, she has been deployed to
Camp Lejeune Marine Corps Base, NC, for Operation Dental
Readiness in December 2003 and to New York City in September
2001 to assist in the identification of victims from the World Trade
Center. Dr. Scheper graduated with her Doctorate in Dental Surgery
from the Ohio State University in 1995. She joined the U.S. Public
Health Service immediately upon graduation.
CAPT Lee Shackelford accepts the 2004 Jack D.
Robertson Dental Award
CAPT Lee Shackelford received a DDS degree from the
University of Nebraska College of Dentistry in 1982. After
practicing privately and in various dental groups, he entered the
Commissioned Corps in 1992 and was assigned to the Federal
Bureau of Prisons site in Florence, Colorado. From 1998 to 2000 he
served as the Area/Regional Dental Consultant for the North Central
Region. He then was detailed as the Area Dental Consultant in the
Western Region for the Division of Immigration Health Services
from 2000 to January 2002. He assumed his current position as
Chief, Complex Dental Unit, Northern Navajo Medical Center in
Shiprock, New Mexico in February 2002. He administers a program
providing dental care to 60,000 patients spread over an area the size
of Rhode Island. He is responsible for a budget in excess of $4
million, and manages one main and three satellite clinics with over
60 employees. He also remains a “wet-fingered” clinician! He has
received many PHS and non-Federal medals and awards during his
PHS career. CAPT Lee Shackelford has distinguished himself as a
creative leader, an initiator, a dedicated dentist and an extremely
committed Commissioned Officer in the U.S. Public Health Service.
He is an asset to his colleagues, his profession, and the United
States Public Health Service.
CAPT Mark Rosenberg accepts the 2004 Senior
Clinician Award
CAPT Mark Rosenberg received his DDS degree from New York
University College of Dentistry in 1977. After doing a general
practice residency he served in the NHSC from 1978 to 1994 as
chief of the dental units at centers in Hatch, New Mexico and El
Paso, Texas. He then transferred to the Indian Health Service where
he assumed the position of Chief of the Dental Service Unit in
Fairbanks, Alaska, from 1994 to 1999. Since 1999, he has been
chief of the General Dental Service Unit in the Reno-Sparks Indian
Colony in Reno, Nevada. CAPT Mark Rosenberg is an example of
what clinical dentists in the Public Health Service hope to become.
He has distinguished himself over a 25-year career as an
outstanding clinician and leader. CAPT Rosenberg has
distinguished himself through multiple national awards, community
recognition, multiple collaborative efforts with the U.S. military,
numerous national and regional presentations, a commitment to
continuing dental education (FAGD), and a commitment to the
mentoring of young officers in the USPHS. CAPT Rosenberg’s
actions throughout his career represent the kind of senior leadership
the PHS expects, and reflects highly upon himself, the Indian Health
Service, and the USPHS Dental Category. He has had a positive
impact on many people over the last 25 years.
Page 6
USPHS Dental Newsletter
July 2004
RADM Charles W. Grim Delivers Surgeon
General David Satcher Keynote Lecture at
2004 COA Annual Meeting
RADM Charles W. Grim, Director, Indian Health Service, was
selected as the 2004 Surgeon General David Satcher Keynote
Lecturer. This is the third year that the dental category has
sponsored this lecture at the annual COA meeting. The
presentation highlights leaders who exemplify the broad based
health promotion and disease prevention accomplishments of
former Surgeon General Satcher. RADM Grim is the first dentist
to hold a position of director of one of the Public Health Service
Agencies. As the IHS Director, RADM Grim administers a
nationwide multi-billion dollar health care delivery program
composed of 12 administrative Area (regional) Offices, which
oversee local hospitals and clinics that provide preventive,
curative, and community health care to approximately 1.6 million
American Indians and Alaska Natives.
ADA Session coming October 2004
By CAPT. Paul S. Wood
It is my honor to now be serving as your delegate to the American
Dental Association.
I am a Captain in the USPHS and a board certified Oral and
Maxillofacial Surgeon. I currently serve as the IHS National
Consultant in Oral and Maxillofacial Surgery.
The ADA Meeting this year is in Orlando, Florida from Sept 30
to Oct 3. The House of Delegates will meet Oct 1 to Oct 5 at the
Orange County Convention Center (West Complex), Valencia
Ballroom, fourth level.
This year the ADA is introducing a new concept in the ADA
Marketplace where they will group the exhibitors into four areas:
Over the Counter and Pharmaceutical, Dental Services, Materials
and Infection Control, and Instruments and Equipment. This will
allow the attending dentist more opportunity to compare the
different products being offered.
The speakers this year include John Major the former prime
minister of the United Kingdom, Captain James Lovell Jr. and
Bill Cosby. There will also be many tours available for your
family and of course theme parks. This would be a great year to
attend the annual session with your family.
The ADA has lobbied on our behalf on many issues. The special
pays that we receive would not have been enacted without the
ADA. The IHS continues to suffer from staff shortages in dental
providers with vacancies of 100 or more at any given time. The
ADA is our best ally in obtaining the resources to alleviate our
shortages.
(RADM Charles Grim delivering the 2004 SG David Satcher
Keynote Lecture)
This year the ADA has a goal of 75% of licensed dentists in the
U.S. being members. I encourage your continued support of the
ADA and if not a member I encourage you to join. If you have
any questions about the ADA House of Delegates or ADA issues
as the meeting approaches please contact me. 1-580-353-0350
ext 235.
Page 7
USPHS Dental Newsletter
July 2004
charters of the Hispanic Dental Association for students. This
interaction between the organization and the dental student
component strengthens the bond between both parties. As the
student sponsors, he or she helps to coordinate dental related
activities within the dental school Hispanic community and the
students. Some of the activities have revolved around helping other
Submitted by CAPT Carolyn Tylenda and CDR
students and faculty members, to better communicate with Hispanic
Carol Baxer
patients. They have created visual means to help with patient.
communications. There are other activities that the student charters
have been involved with under the auspices of the Hispanic Dental
Public Health Service dentists who are members of the
Association. This year the annual conference will be held in San
American Dental Association elected CDR Dan Hickey to be
Juan, Puerto Rico, from October 14-16. I plan to attend and promote
the next delegate from the U.S. Public Health Service to the
the work that the USPHS dentists do for other underserved
ADA House of Delegates. CDR Hickey will begin a four-year
communities. Hope to see some of you at this meeting
term on July 1, 2004, when he will replace CAPT Paul S. Wood
as an alternate delegate. CAPT Wood will advance to the
voting delegate position, which is currently held by CAPT
Dave Clemens, who will have completed his four-year term.
The Public Health Service is allowed two voting delegate
positions. The second voting delegate position is held by the
Chief Dental Officer, RADM Dushanka Kleinman.
During dental school CDR Hickey was a recipient of a National
Health Service Corps (NHSC) scholarship, and following
graduation, he was stationed with the NHSC at Whitefish Bay
Medical-Dental Center, Brimley, MI. His present position is
Chief, Basic Dental Unit/Expanded Mission, Federal Bureau of
Prisons, Federal Correctional Institution, Morgantown, WV.
CDR Hickey is a member of the Dental Professional Advisory
Committee (DePAC) and was the DePAC chairperson in 2003.
CDR Hickey received the Dental Medicine (D.M.D.) degree
from the University of Pittsburgh School of Dental Medicine.
Congratulations to CDR Dan Hickey!
Submitted by CDR Jose C. Rodriquez, USPHS
Hispanic Dental Association Liaison
The Hispanic Dental Association’s mission is to “optimize the oral
health of the Hispanic community.” In order to achieve this mission,
the Hispanic Dental Association as placed emphasis on the Hispanic
dental student community. Some of the nations dental schools have
AMSUS Meeting Update
By CAPT Ron Bajuscak
110th Annual Meeting Theme Announced
Lieutenant General James B. Peake, MC, USA became President of
AMSUS at the end of the 109th Annual Meeting. He has announced
the theme for the 110th meeting to be “AMSUS: Supporting a Nation
at War”. This year’s meeting will be held on 14-19 November
2004, in Denver, Colorado. Tentative Dental Day agenda includes
speakers from all DoD, VA and USPHS representatives.
Colonel Ted Wong, USA, is this year’s program coordinator. Topics
include: Cranioplasty, Reserves initiatives and Readiness
Management, Deployment of U.S. Coast Guard Forces by our own
CAPT Deborah Noyes, Operational Dental Research and assorted
clinical topics. For further information contact:
Colonel M. Ted Wong, DDS, MHA
Senior Dental Staff Officer
Office of The Surgeon General
5109 Leesburg Pike
DASG-HS-CD
Falls Church, VA 22041
DSN 761-3033
FAX 703-681-3035
Ming.wong@atsg.amedd.army.mil
Page 8
USPHS Dental Newsletter
July 2004
LCDR Scott Trapp
Cadillac, Michigan
Submitted by CDR Robin Scheper
LCDR Scott Trapp has focused his interest on information
technology through his efforts with the American Dental
Association, where he serves as Vice-chairman of the ADA’s
Standards Committee on Dental Informatics and is a member of
the ADA’s Dental Content Committee.
In June of 2003, LDCR Trapp made the decision to leave a
successful private practice to take on a new challenge of
making his mark on public health as a Commissioned Officer
by applying his analytical healthcare techniques to improve the
lives of those less fortunate. LCDR Trapp was selected to be a
part of the Health Resources and Services Administration,
National Health Service Corps Ready Responder program. The
NHSC Ready Responders is a special group of primary care
clinicians, each member of which is a newly Commissioned
Corps Officer with the U.S. Public Health Service. LCDR
Trapp was assigned to a dental clinic in Cadillac, Michigan.
During the past year LCDR Trapp has been responsible for
reestablishing a hospital-based dental program, which serves
mentally, challenged and pre-cooperative children in a
controlled environment. In addition to his primary care duties,
he has developed an information technology based tracking
system to monitor the oral health of the population he serves
and benchmark this to the Healthy People 2010 objectives.
In November LCDR Trapp was deployed to Camp Lejeune to
support Operation Dental Readiness. He noted “this was an
extremely gratifying experience knowing that in our own way,
as a Public Health dentist, a contribution has been made to the
War of Terrorism effort by preparing our marines to reenter the
battlefield”.
LCDR Trapp gives credit to his success to the strength and
support he receives from his wife and 2-year-old daughter. He
also enjoys relaxing by woodworking where he primarily
makes cherry furniture for his family’s home.
The USPHS Dental Newsletter is now published and
distributed electronically through the USPHS Dental Bulletin
Board, agency distribution lists, and the USPHS Dental
Directory.
The next issue of the newsletter will be published in September
2004. The deadline for submitting articles is August 15, 2004.
CDR Pete Preston
Greenville, Illinois
Submitted by CDR Robin Scheper
CDR Pete Preston received his Bachelor of Science degree
from the University of Iowa in 1975 and his Doctorate of
Dental Surgery in 1987. He began his Public Health Service
career upon graduation from Iowa.
During his tenure with the PHS, he has served exclusively in
Isolated Hardship and/or Hazardous Duty stations, and all have
been traditionally “hard to fill” assignments.
His first
assignment was with the Indian Health Service in Kotzebue,
Alaska.
After Alaska, CDR Preston served as Chief Dental Officer at
the Many Farms basic dental clinic on the Navajo Reservation
in Arizona. He then served as Deputy Chief Dental Officer at
the Chinle Comprehensive Health Care Facility, which has
three dental clinics (Chinle, Many Farms and Tsalie) in the
service unit. From Chinle, CDR Preston moved to southern
Arizona to work at the PHS Indian Hospital in Sells, Arizona.
In 1997 CDR Preston then chose to do an agency and
geographic change, and joined the Federal Bureau of Prisons in
Greenville, Illinois. CDR Preston currently is the only dentist
at his facility, and has direct responsibility for all dental care
for approximately 1600 inmates at two separate locations;
includes providing dental care to many high risk patients (HIV,
hepatitis).
CDR Preston has enjoyed the experiences that the Public
Health Service has presented to him, in particular the
opportunity to serve in remote areas. He encourages continued
appreciation for officers willing to serve in such areas, as often
overlooked factors, such as those affecting the officer’s spouses
and children, can become significant in remote locations. CDR
Preston also has appreciated the change of perspective that the
interagency change has offered him, and feels that being
exposed to the different strengths and weaknesses of each
agency
has
helped
broaden
his
career.
Page 9
USPHS Dental Newsletter
July 2004
Hepatitis C Facts and Information for the Clinician
By CDR Stephen P. Torna, Co-editor
Hepatitis C virus (HCV) is the leading cause of liver
transplantation in the United States.4 In a 1999 article from the
New England Journal of Medicine, HCV was revealed as a
number one cause of chronic liver disease and HCV was
labeled as the “ most common chronic blood-borne infection in
the United States”. 5 It is estimated that approximately 4
million people (2% of the population) in the USA are infected
with HCV and 40,000 new cases occur annually. This estimate
is considered low.3,4,6,7 Chronic HCV infection may result in
cirrhosis, hepatocellular carcinoma (HCC), and liver failure.
Every year, nearly 10,000 people die from HCV infection. 6
HCV is transmitted through percutaneous exposures to blood.
Intravenous drug users are at the greatest risk for infection.
Blood transfusions, health care accidents, tattooing and
perinatal transmission are all possible.8 CDC estimates that IV
drug use is responsible for 60% of all HCV cases in the US. 7
It is estimated that 90% of intravenous drug users are infected
with HCV. 1 Garfein conducted a study involving 716 people
that had been injecting intravenous drugs for between 1 to 6
years.
In this study, a seroprevalence of 85% HCV was
observed. 9 This study demonstrated the relative infectivity of
HCV following repeated percutaneous exposures.
Studies have shown that the risk of HCV infection among
dentists and other health care workers (HCW) is no greater than
that of the general population. In 1992, Thomas conducted a
study in which 343 oral surgeons and 305 dentists were tested
for HCV infection. The data from this study indicated that the
presence of anti-HCV (antibodies to HCV) among dentists was
similar to that of the general population. An increased
prevalence of anti-HCV was detected among the oral surgeons,
but some of these dentists were at an increased risk due to a
history of blood transfusion prior to routine blood donor
screening. The prevalence of anti-HCV amongst dentists in
this study was 2% for oral surgeons and .7% for the general
dentist.1
Another study conducted by Klein and colleagues, showed a
much higher prevalence of HCV infection among New York
City dentists. In his study, 456 dentists were tested for HCV
infection. This data showed that 1.7% of the general dentists
and 9.3% of the oral surgeons tested positive for HCV. 2
Practitioners that participated in the Klein study were treating
high volumes of intravenous drug users.
Polish and colleagues published a study in which 1677 hospital
employees were tested for anti-HCV. They found a prevalence
of 1.4%, similar to that of the general population. There was an
increase in HCV infection for employees that had a history of
blood transfusion and frequent needle stick injury. 3 In this
study and other studies it has been shown that people with
positive anti-HBV also have a higher rate of anti-HCV.
Hepatitis C, formerly known, as non-A non-B hepatitis is the
most common type of hepatitis and no vaccine or cure is
available. The initial stages of illness are often sub-clinical as
the disease is insidious by nature. Eighty percent of those
infected have no signs or symptoms and the same percentage of
people go on to develop chronic disease. Those at the highest
risk for acquiring HCV include injection drug users and
recipients of blood clotting factors prior to 1987. Dialysis
patients, people with a history of blood transfusion prior to
1992, and babies born to infected mothers are considered by
CDC to be at a medium risk. Health care workers and people
who have had multiple sex partners are at a low risk. 7
HCV is an RNA virus and it is detected via measuring antiHCV. Enzyme immunoassay (EIA) and recombinant
immunoblot assay (RIBATM) are the two major tests for the
presence of anti-HCV. Gene amplification (RT-PCR) may also
be utilized for the diagnosis of HCV. This technique actually
detects HCV RNA. 7 Elevated alanine aminotransferase (ALT)
is an indication of the severity and acute or chronic status of the
infection.8 An overview of treatment guidelines, clinical
management, and post exposure prophylaxis may be obtained
from the CDC (see reference 7).
It appears to me that the risk of HCV infection for dentists is
very real. High, moderate, and low risk categories for HCV
infection were outlined. The risk of HBV infection following
needle stick injury is between 6% and 30%. The risk of HCV
infection following needle stick is considerably lower. 3
However, the possibility of an HCV infection following
occupational percutaneous injury in dentistry does exist.
Chronic hepatitis, hepatocellular cancer, and liver failure are all
possible for the HCV patient. The consequences of exposure
are very serious and one cannot over state the need for standard
precautions in the dental clinic. Barrier utilization (PPE), and
good sharps management may prevent occupational exposures
to many blood borne pathogens including HCV, HBV, and
HIV.
References on page 13
Page 10
USPHS Dental Newsletter
July 2004
Operations
(OCCO).
We
understand
that
along
with
readiness
NHSC Ready Responder Training
standards,
we
hear
that
a
“name
change”
is
imminent
for the
By LCDR Scott Trapp
CCRF.
The
new
name
will
better
represent
CCRF’s
expanded
The NHSC Ready Responder dentists recently completed two
role in assisting officers to meet the now “Corps-wide”
weeks of training in the Washington D.C. area. During that
readiness and response standards as outlined in the Manual
time they attended courses in planning mass disaster exercises
Circular 375. A new Manual Circular is expected in July but we
and BOTC. The dentists also completed a one-week course
do no know what, if any, changes will be made to the current
covering the diagnosis and management of Dental and Oral
standards. According to the Federal Register, these policy
Facial Trauma provided by the National Naval Dental Center in
decisions are made at the level of the Assistant Secretary for
Bethesda directed by CAPT D.A. Bitoni, USN. The course
Health (ASH).
covered a variety of topics ranging from pain management to
In an effort to increase communication with officers in the
restoration and reconstruction of the trauma patient. Dentists
field, CCRF staff have produced 3 newsletters to date, that are
primarily attended the course from the BOP and USCG. Also
available on their website. As we “know it”, you “know it”.
noteworthy were two of our uniformed service colleagues from
Some key highlights of the newsletter are: Immunizations (the
Canada. Below are NHSC Ready Responder dentists, from left
requirements and a “how to guide”), the Respiratory Protection
to right are CAPT Arturo Brava, LCDR Bill Bucur, CDR
Plan, recent deployments, and upcoming advanced training
Hirofumi Nakatsuchi, LCDR Scott Trapp, LCDR Michelle
opportunities.
Robinson, CDR Lisa Cayous, and CDR Peter Perez.
If you are having problems reaching the CCRF
website (http://ccrf.hhs.gov), check to be sure that your
computer has not bookmarked the old address for the website.
Any problems related to logging on or reaching the CCRF
website should be directed to: ccrf@osophs.dhhs.gov. Please
include detailed information about the difficulty you are
experiencing, your name, and your PHS serial number so that
the CCRF staff can best assist you.
I want to offer my assistance to anyone who has questions
regarding readiness, response, or immunization issues. Please
feel free to email me regarding your questions and I will
respond to your questions ASAP. Please contact the following
according to subject matter:
Training/education, immunizations, or Dental category
Rjoskow@osophs.dhhs.gov (CDR Joskow)
Respirator Fit-testing or training/education questions
eslawinski@osophs.dhhs.gov (LTJG Slawinski)
Deployment questions amartinelli@osophs.dhhs.gov (CDR
Martinelli)
IT or computer questions dbeck@osophs.dhhs.gov (CDR
Beck)
General questions ccrf@osophs.dhhs.gov
AWARDS
CDR Pedro Perez and CDR Hirofumi Nakatsuchi
CCRF
By CDR Renee Joskow
We have been very busy keeping up with all the changes that
have occurred as part of the transformation and restructuring of
Commissioned Corps. For example, at COA, the Surgeon
General announced the appointment of CAPT Denise Canton to
the position of Director of the Office of Commissioned Corps
CCRF deployed officers to support DoD’s medical and
dental staffing needs over the past year.
Dentists provided care at three Marine dental
commands for troops who were either on their way to Iraq or
had just returned. I am thrilled to report that the Camp Lejeune
and Camp Pendleton dental deployments were approved by the
Surgeon General (SG) as a Crisis Response Service event. The
SG’s recognition of this event has led to the awarding of the
CRSA to the 37 dentists who deployed in support of Operation
Iraqi Freedom. RADM Babb, Director of CCRF, wrote the
successful award submissions to recognize the deployed
dentists.
Page 11
USPHS Dental Newsletter
July
2004
Photos from COA 2004
CAPT Lee Shackelford accepts the
Jack D. Robertson Dental Award
CDR Randall Mayberry presents his paper
Surgeon General Carmona, RADM Charles Grim and
B/Gen Thomas Bailey, USAF Dental Corps Chief
RADM Kleinman thanks CAPT Jeanine Tucker for a
successful Dental Category Day
CDR Renee Joskow discusses CCRF
We were honored to have BrigGen Thomas S. Bailey, the
Federal Dental Chief for the Air Force, join us at COA
CDR Elmer Guerrero introduces the next presenter
Shawn Hinton, DDS and James Hicks, DDS coauthored and co-presented their paper
Page 12
USPHS Dental Newsletter
LCDR Phillip D. Woods discusses Dental Readiness
CAPT Scott Presson from the CDC presents his paper
on Oral Disease Prevention
July 2004
LCDR Stella Wisner presents her paper on Combat
Casualty Care Course
CDR Saville introduces Peter Milgrom, DDS
5. Alter MJ, Moran D, Nainan OV, McQuillan GM, Gao
CAPT Monina Klevens reviews Alcohol-based hand
cleaners
Continued from page 9
References
1.
2.
3.
4.
Thomas DL, Gruninger SE, Siew C, Joy ED, Quinn
TC. Occupational risk of hepatitis C infections among
general dentists and oral surgeons in North America.
AM J MED 1996;100:41-5.
Klein RS, Freeman K, Taylor PE, Stevens CE.
Occupational risk for hepatitis C virus infection
among New York City dentists. Lancet
1991;338:1539-42.
Polish LB, Tong MJ, Coleman PJ, Alter MJ. Risk
factors for hepatitis C virus infection among health
care personnel in a community hospital. Am J
Infection Control 1993;21:196-200.
Gillcrist JA, Hepatitis Viruses A,B,C,D,E and G:
Implications for dental personnel .JADA,
1999;130:509-19.
F, Moyer LA, Kaslow RA, Morgolis HS. The
prevalence of hepatitis C virus infection in the United
States, 1988 through 1994. New England J Med 1999;
341:556-62.
6. Cleveland JL, Gooch BF, Shearer BG, Lyerla RL.
Risk and prevention of hepatitis C virus infection
implications for dentistry. JADA 1999;130:641-47.
7. CDC. Recommendations for prevention and control of
hepatitis C virus (HCV) infection and HCV related
chronic disease. MMWR 1998;47:1-40.
8. Strickland DK. Hepatitis C. eMedicine J. 2002;3:1Garfein RS, Vlahov D, Galai N et al. Viral infections
in short-term injection drug users: the prevalence of
the hepatitis C, hepatitis B, human immunodeficiency,
and human T-lymphotropic viruses. Am J Public
Health 1996;86:655-61.
9. CDC. Recommended infection control practices for
dentistry. MMWR 1993;42:1-12.
10. Infection control recommendations for the dental
office and dental laboratory. ADA council on
scientific affairs and ADA council on dental practice.