Development and field validation of a systematic dental data collection protocol for armed conflict settings: a proposal for standardized humanitarian oral health surveillance

Background: Oral health remains largely absent from humanitarian health frameworks despite being the most prevalent non-communicable disease globally. No validated field protocol integrates clinical examination, questionnaires, and quality assurance measures specifically for active conflict zones. This study aimed to develop and validate a systematic dental data collection protocol for armed conflict settings and propose recommendations for humanitarian oral health surveillance. Methods: A six-phase protocol was developed based on World Health Organization methodology and adapted for field conditions. The protocol integrated standardized Decayed, Missing, and Filled Teeth (DMFT) index assessment and structured questionnaires. Clinical examinations were conducted by a single trained examiner, with intra-examiner reliability assessed through re-evaluation of 30 consecutive patients. Implementation occurred during a humanitarian mission to conflict-affected Ukraine (September 17–30, 2025), enrolling 230 civilians aged 12–85 years. Feasibility was assessed through data completeness, reliability, and time efficiency. Results: The protocol demonstrated high feasibility: 100% data completeness, 86.7% intra-examiner agreement for DMFT, and mean examination time of 8.3 minutes. Substantial oral health burden was captured (mean DMFT 9.93 ± 6.21, active caries 61.7%, tooth loss 70.0%). A significant age gradient was observed, with DMFT increasing from 4.87 ± 3.33 in adolescents to 15.39 ± 7.62 in elderly adults (p < 0.001). Decayed teeth declined with age (80.0% to 45.5%, p = 0.02) while missing and filled teeth increased. Field experience identified the need for streamlined psychological screening instruments and nutritional assessment tools for future protocol iterations. Conclusions: This study presents a validated field protocol for systematic dental data collection in active conflict zones. The protocol is feasible, reliable, and capable of generating actionable epidemiological data. Based on field experience, we propose incorporating brief psychological and nutritional screening tools in future missions. Widespread adoption would enable standardized oral health surveillance in humanitarian crises and support evidence-based integration of dental care into humanitarian response frameworks.