pre-travel dental tips
TRANSCRIPT
Laura MacDonaldAssociate Professor
School of Dental HygieneUniversity of Manitoba
Fran’sTravel
Tip— After the fact.
Two months before Fran’s year long bike trip coast to coast, Fran was experiencing a twinge, a slight ache in the area of her right top back tooth. It came and went. Immunizations, bank account, mail delivery...all the important items had been crossed off her ‘things to do list’before leavingFran is in Riding Mountain National Park camped for the night . She wakes in the middle of the night with severe pain in her tooth, in fact, the whole right side of her face
She can’t think rightShe is ‘crazy’ with painShe is no where near a dental clinicShe is in trouble!
To Do: dental
check up!
My To Do list
(wish I had this one for my last trip)
Get dental check‐upGet any dental work done before I leaveKeep my mouth healthy‐‐basicsPack traveller’s dental kit Print off ‘What to do in case of dental emergency”Buy oral hygiene suppliesMake list of safe/credible dental clinic locations in places I plan to visitCheck insurance plan
Setting camp in Riding Mountain National Park,
Manitoba. That night I had the worst ever,
horrible pain in my head—it was that tooth!
Should have had a dental check up before leaving.
Note to self: Add to ‘to do list’
Get a dental check up
Inform dental practice I am travelling—ask them for tips
Get dental work doneDental decay
Infection in the toothBacteriaImmune response
UntreatedInfection will reach pulp of tooth (nerves/blood supply)
AbscessTooth deathSystemic infection
Wisdom teethUneruptedErupted
Crowns and implantsBraces (on or off)Denture fit and repairTeeth chipped, broken
Mouthguard made
http://images.google.ca/imgres?imgurl=http://www.temelink.com/wdg/air/cavities.jpg&imgrefurl=http://www.mahalo.com/Tooth_Decay&usg=__n‐
Tl2GDkAO4RjQR48_KE6qDGMZU=&h=431&w=599&sz=25&hl=en&start=10&um=1&tbnid=Ih4KZBMMa6lR3M:&tbnh=97&tbnw=135&prev=/images%3Fq%3Dtooth%2Bdecay%26hl%3Den%26rlz%3D1T4ADBF_enCA311CA312
%26um%3D1
MouthguardStock
Available in storesWorn without modification
Least expensive, inferiorCommercial
Boil and biteNot expensive, lacks good fit/comfort
Custom‐fabricatedProfessionally made to fit your teeth
Cost $70‐150; comfort, durability, ability to breath and speak, and most NB FIT!
CDHA Position Statement on Mouthguards
2005
http://ypcommando.com/blog/category/internet‐yellow‐pages/
7
- Involving gums, bones, supporting tissues around tooth
- Acute and chronic
- Signs:
- Early: Bleeding gums when you brush or floss
- Later: Pus, loose teeth, bad breath, bad taste,
itchy gums
- Not necessarily painful
Get periodontal therapy (aka teeth cleaned)...prevent periodontal disease
Periodontal therapy is not about cleaning your teeth for cosmetic reasons.
It is about treating an infection or potential for infection.
Nasty odour with
diseased gums (and
decayed teeth too)
...don’t want to be
the one to ‘perfume”
the tent
8
Dental check up includes looking for oral cancer and other diseases
Approximately 5% of all cancers
Poor prognosis Many think cancer doesn’t occur in the mouthMany ignore small sores/bumps… many are found too late
Look! Look! Look! Yourself and Professional
Risk factors:Tobacco use (smoke/chew/spit)Alcohol abuseTobacco + alcohol = significant increaseSunlightAgeNutrition deficiency—eat those fruits and vegies!
Quit Smoking
Oral Health~Health
ConnectionPeriodontal Disease a chronic disease (bacteria associated)Body immune system ‐‐ inflammatory responseResearch on effect on the body of chronic inflammatory response
Bi‐directional relationship with diabetesEvidence is convincing and mounting
Heart diseaseStrokeRespiratory illnessOsteoporosis...
Take Periodontal Disease Risk Assessment Test (online)...know your periodontal health status before you travel American Academy of Periodontology
Keep my mouth healthyBasic every day mouth care (twice is nice)
Brush my teeth, twiceWhole toothAim at gum line
Clean in between my teethFloss or ‘something’...ask dental hygienist
Use fluoridated toothpasteClean my tongue
Fluoride therapyChew sugar free gum after eatingProfessional check upsQuit tobacco use today!
Pack My Dental/Hygiene KitToothbrushes (a TB usually last about 3 months)Floss (“I hear by promise to myself I will floss every day”)Toothpaste (It is the fluoride I’m going for...topical dose)Sugar free gum (Helps with saliva flow...return mouth ph to normal...helps prevent cavities)Hand sanitizer lotion/packs...clean hands in the mouthTraveller’s Dental Kit (ask dentist which one is best)
Be very careful if you are going to carry a syringe—and you know whyTea bags are sometimes suggested...oolong tea studied as antibacterial agentTake pain medication (Tyenol) don’t put it directly on the tooth
Mouthguard (and carrying case)Head gear (I put it here to remind me I wear it to also protect my head...if I hit my head, I might fracture a tooth)Dental emergency tips fact sheets (I downloaded from ADA...wouldn’t remember them all anyways)
Travel Dental Kit: Common ItemsTooth ache
Pain relief medicationDental waxTemporary filling mix/cementTeabag (Oolong—antibacterial)
DentureRepair material such as acrylic
GeneralTweezersCottonGauzeDental floss
Antibioticswww.travmed.com
Instruction Manual
Carrying PrescriptionsAntibiotics, pain medication, etc
Label on the original drug containerIdentifies you as you appear on your passportName of pharmacyName of the medication and the dosage
Copy of your prescriptionKeep a record of each drug’s generic and trade names
Know if you are using OTC and/or alternative approaches if the substance is banned in the country...contact embassy
Ignorance is not bliss
http://www.voyage.gc.ca/publications/pdf/bon_depart‐on_your_way‐eng.pdf
Example of Dental Emergency Tip
Knocked out a toothFind the toothGently rinse it off
Clean water (remember that sanitation applies now and always)Don’t scrub any tissue off it
Put it back in the socket (now, not later)Just hold it thereIf you can’t put it back, put it beside your cheek
You are simply keeping it in it’s ‘normal environment’Or if it isn’t clean to do this, put it in a plastic bag—keep it wet
Milk is suggested as a liquid to keep it wetGet to a reputable dentist—now! You may be able to save it!
If you hit your face hard enough for a tooth to be knocked out, think what else might be injured‐‐best not to wait and find out
Make list of safe/credible dental clinic locations in places I plan to visit
International Association for Medical Assistance to Travellers (IAMAT)Organization for Safety and Asepsis Procedures (OSAP)American Dental Society of EuropeAmerican Dental Association (has list of international dental associations)FDI World Dental Federation (has list of dental schools)EmbassyHotel managementReferrals from people I trustEducate self about ‘Dental Tourism’
Dental Tourism: Know what you are buyingApparent growing industry
Ex. InciDental Tourist (Mexico and China; Canada based)Market for less expensive dental care; save money; vacation at same time
Ask self is patient testimony a reliable means of evaluating effectiveness, safety, cost
Investigations by credible bodies is underwayEducation of providerInfection control?Equipment?Continuity of care?Liability?
Quality of careTurner, L. (2009)
Health care is
not ‘buyer
beware’
When you need a dentist... and you are away
http://images.google.ca/imgres?imgurl=http://www.funtoosh.com/pictures/images/new_dentist_in_town.jpg&imgrefurl=http://kingoffunny.blogspot.com/2008/08/monkey‐dentist‐in‐
town.html&usg=__IHh5lVSVU89amw2DrKeBQeIUKlA=&h=384&w=500&sz=36&hl=en&start=215&tbnid=1pTPth2vBWsA5M:&tbnh=100&tbnw=130&prev=/images%3Fq%3Ddentist%26gbv%3D2%26ndsp%3D20%26hl%3Den%26rlz%3D1T4ADBF_enCA311CA312%26sa%3
DN%26start%3D200
http://images.google.ca/url?source=imgres&ct=ref&q=http://www.budapestsite.com/budapest‐
dental‐service/&usg=AFQjCNFBD_0N3QNmeTDm0zNU_7eYfLA25w
http://www.main.nc.us/openstudio/tinamanley/Guatemala/dentist.ht
m
http://images.google.ca/imgres?imgurl=http://i11.photobucket.com/albums/a199/don_veto/Dentist.jpg&imgrefurl=http://don‐
veto.blogspot.com/2006_12_01_archive.html&usg=__2SKGVdfty8UTRtnp_2KLUMrfL2Y=&h=543&w=800&sz=330&hl=en&start=139&tbni
d=g4beNEzga657_M:&tbnh=97&tbnw=143&prev=/images%3Fq%3Ddentist%26gbv%3D2%26ndsp%3D20%26hl%3Den%26rlz%3D1T4A
DBF_enCA311CA312%26sa%3DN%26start%3D120
http://www.7is7.com/otto/travel/photos/20041205/xia
men_dentist.html
http://images.google.ca/imgres?imgurl=http://1.bp.blogspot.com/_3Xb2jlba9IY/R9Rbs3B3IgI/AAAAAAAAAAg/j5OiXJz
CQ5w/S660/young%2Bgirl%2Bdentist.JPG&imgrefurl=http://heartandsolar.blogspot.com/2008/03/rice‐and‐beans‐
lice‐and‐
parasites.html&usg=__XOI70oE_YoqnfICvgMI_jUWu2Qk=&h=440&w=660&sz=58&hl=en&start=425&tbnid=z0ANzvB
qxff2EM:&tbnh=92&tbnw=138&prev=/images%3Fq%3Ddentist%26gbv%3D2%26ndsp%3D20%26hl%3Den%26rlz%3D1T
4ADBF_enCA311CA312%26sa%3DN%26start%3D420
• Know who• Know what• Know why• Know when• Know where• Know how
Good time for
those W5’s
Quality and SafetyNot all dentists are created equally
Check the national guidelines for dentistry in the countryPrevention of transmission of bloodborne pathogensHand hygienePersonal protective equipmentContact dermatitis and latex hypersensitivitySterilization and disinfection of patient‐care itemsEnvironmental infection controlDental unit waterlines, biofilm, and water qualitySpecial considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories)
U.S. Centers for Disease Control and Prevention
That tooth ache is a matter of life and death
http://www.scrapbookpages.com/mauthausen/Town/town04.html
Infection Control—very real!Protect yourself (person to person and environmental to person)
Your mouth has ‘body fluids’ and ‘body tissues’...so does the next person’sDental pliers are surgicial instruments
“Yes, it is sterilized.”Sterilization: process (chemical and/or physical) that destroys/eliminates all microbiological life
Some products/processes may state ‘sterilization’ but actually only be ‘disinfection’Disinfection: process used to eliminate many, but not all, and not spores
Low to high level disinfectant process; but none eliminate bacterial sporesGermicides: Antiseptic (living tissue) and ‘cidal’(inanimate objects) are often misused words
Be very weary of infection controlJust because the instrument came out of a package doesn’t mean it is sterilizedColored water is colored water—not a disinfectant
Hand washing with contaminated water is hand washing with contaminated water
Know what effective handwashing looks like—watch your care provider do itCarry your own gloves (latex and otherwise)Masks too
(http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf)
Check insurance planAm I covered?
Employment basedProvincialOther
What am I covered for?Who is covering me?
Own planSpousal/partner plan
Are there stipulations?Dentist must be registered with credible organizationMust be dentist, not other other oral health/health care professionalReceipt must be submittedClaim due within ‘x’ monthsInform provider prior to trip
If treatment fails and I need new treatment...is it covered
ResourcesTravel books with reference to dental
Oxford Handbook of Expedition and Wilderness Medicine (Oxford Handbooks Series) by Chris Johnson, Sarah Anderson, et al. Expedition and Wilderness Medicine by Gregory Bledsoe, Michael Manyak and David TowneField Guide to Wilderness Medicine by Paul Auerback, Howard Donner, Eric Weiss
WebpagesOrganization for Safe and Asepsis Procedures aka OSAP (has a Tavelers Guide to Safe Dental Care)Canadian Dental Association, Canadian Dental Hygienists Association, American counterpartsNational Institute of Dental and Craniofacial ResearchMedline Plus, National Library of Medicine and Institutes of HealthAmerican Academy of PeridontologyCenter for Community Oral Health, Faculty of Dentistry, University of Manitoba
Your oral health professional
My To Do list—I did it...off kayaking
Got dental check‐upGot dental work done before I leftKeeping my mouth healthy‐‐basicsPacked traveller’s dental kit Printed off ‘What to do in case of dental emergency”Bought oral hygiene suppliesMade list of safe/credible dental clinic locations in places I plan to visitChecked insurance plan
Checking out my
equipment before leaving
for Kayak trip
Thailand...smiling because I
am thinking of last time—
whew, no tooth ache! Just a
smile