Phillip Woods, left, examines Peggy Timothé's teeth with Mincie Calixte at the Codman Square Health Center.

Engaged in a war on terrorism, the US military needs able-bodied troops, yet imagine that otherwise healthy servicemen could not be sent into battle–because they have cavities. Seem farfetched? It’s not, says MPH student and dentist Phillip Dexter Woods, who is studying the dental health of army recruits and their resulting availability for deployment.

Woods is an Army reservist, who came up with his study idea last summer during a basic training session for officers. He had already been accepted to HSPH and HMS as a Commonwealth Fund/Harvard University Fellow in Minority Health Policy, when he became aware of an oral health survey of military recruits conducted by the Department of Defense (DoD) in 2000. The survey indicated that an increasing number of recruits were coming to the service with oral health problems while the number of practicing military dentists was decreasing, said Woods.

"Dental health is taken seriously by the Army because a soldier who is in the field, in pain, and nowhere near a dentist will be distracted and less focused," said Woods. "His or her effectiveness will be compromised."

Last fall, as part of his MPH program, Woods decided to conduct a secondary analysis of the DoD survey, using data specifically about the army recruits.

The US Army oversees the world’s largest comprehensive dental system, taking care of about 480,000 active-duty soldiers and 95,000 family members, said Woods.

When new soldiers enlist, they undergo dental exams and are then classified according to four categories. If they fall into Class One or Two, they can be deployed. However, if they fall into Class Three or Four, they have dental conditions, including cavities, that are considered serious enough to sideline a soldier until the teeth are fixed.

In the 2000 DoD recruit survey, more than 40 percent of the 1,672 soldiers examined fell into Class Three.

Because soldiers can be held back due to dental conditions, one could argue that oral health is a security issue, said Woods.

Aside from assessing "dental readiness" of recruits, the DoD survey also examined the prevalence of oral diseases and tobacco use. Findings were compared to a similar DoD survey done in 1994.

In his secondary analysis, Woods plans to take the DoD survey a few steps further. He wants to explore whether race, gender or education influence disease prevalence and compare his findings to those found among American civilians. If he identifies health disparities, he will not be surprised. He has seen such disparities play out in his professional practice.

Several years ago, Woods was a dentist at a practice in middle-class Needham, MA, where he saw few cavities among children.

"I thought ‘We dentists have been so successful in preventing caries (cavities) that we’ve done ourselves out of a job’," said Woods.

Then he started working in the predominantly minority area of Codman Square in Dorchester, MA, finding notable numbers of young children with major dental problems. Some had teeth rotted to the gum, he said. Others had life-threatening abscesses that required hospitalization.

The problems result from several factors, said Woods. There are approximately 43 million Americans without health insurance and more than 100 million without dental coverage.

"Dentists historically have had less of a voice in the total health care picture," said Woods.

Compounding the lack of insurance are other factors. For decades, scientists have known that fluoride significantly reduces tooth decay, yet there is no national water fluoridation program in the US, and more than 40 percent of Massachusetts towns have chosen not to add fluoride to their water systems.

Cultural norms, such as rewarding behavior with candy, play a role, as does lack of education about oral health. Woods would like to see the emergence of school-based clinics, and last year he secured funding for such a clinic at a high school in Dorchester.

"School-based clinics are a great way to engage kids, parents and teachers, while offering health care and lessening the patient load at community health centers," he said.

Woods came to HSPH to broaden his knowledge about public health.

"A lot of time, I dealt with cavities and gum issues, but the real problems in some of these communities have to do with broader issues of housing, education and unemployment, as well as access to health care," said Woods. "I was beginning to feel that what I was doing on an individual level wasn’t making much of a difference. What drew me to public health was its relationship to social justice."

Woods was one of two dentists to be named a 2001-2002 Commonwealth Fund/Harvard University Fellow in Minority Health Policy, a program that helps create physician-leaders who will pursue careers in minority health and health policy. This is the first year dentists have been named as fellows.

As part of the program, Woods will begin working at the Health Resources and Services Administration in Washington, DC this summer. He plans to explore issues of diversity and health related to children and to immigrant populations.