Dental problems are common on expeditions and anxiety provoking for the lone practitioner. This is generally because there is a lack of exposure to dental presentations and procedures in clinical practice. Patients, on the whole, go to dentists if they have a dental issue. Doctors employed for prolonged remote placements, e.g. the British Antarctic Survey, undergo formalised dental training prior to deployment. Luckily dental issues on expeditions can be made very simple for the non-dental practitioner and the purpose of this article is to help create a framework to help you decide what you can deal with, what you cannot, what kit to take and the relative urgency of any medevacs that may be required.
Most medics will have had little experience with the specific regional blocks used in dentistry. That said, everyone should be happy to provide local infiltration of local anaesthetic and many of us will also be familiar with performing various peripheral nerve blocks. Dental anaesthesia is no different and builds on these basic skills.
When you are in a remote area and a great distance from help, dental extraction may be contemplated to avoid evacuation. It may also be an emergency procedure when evacuation is not likely in the near future. It is highly recommended that appropriate training and practice has been completed prior to departure, as the worst case scenario if an extraction goes wrong is a patient who is still in pain, still has an abscess but now has a fractured tooth that will require oral surgery.
Dental problems can pose significant discomfort for anybody travelling in regions with low/missing infrastructure. Improved awareness regarding dental first aid is essential and physicians counseling travellers in preventive strategies should advise a dental checkup pre-departure. Dental first aid and emergency treatment in the field should be included in the training curricula in travel medicine for both undergraduate and postgraduate students.
What Expedition Dentistry involves and what makes it so rewarding.
Two Medics on a ship are placed in a situation where they have to do dental extractions on 2 crew members. Without the correct equipment. A credit to their improvisation and lateral thinking. An expedition dental article worthy to read.
Discussing the controversies and challenges involved in the management of midface fractures.
Remote And Offshore Dental Emergency form. Establishing a standardised approach to refer dental problems for specialist attention. Easily downloadable form that can be used in offshore dental referral .
Wilderness expedition dentistry (WED) is a branch of medicine that addresses prevention, assessment and management of accidents and emergencies associated with the orofacial region in remote settings, where definitive care is often days or weeks away.
Given that most doctors will have had little experience dealing with the aftermath of dental trauma beyond referring to the Maxfax SHO, hopefully this summary will guide some decision making and initial treatment in the field.
Dental problems can wreck an expedition and be a source of considerable stress for medic and patient. Fortunately, it has never been so easy to prevent dental decay or control sensitivity as it is today. However, there is such a wide variety of toothpastes out there that the choice can be confusing. Indeed, not to choose the right one would be similar to an asthmatic climbing K2 without the right inhaler, and the best choice will depend on the activity, the location as well as the state of the mouth in question.
This article is a consensus of expert opinion.It aims to establish training and expectations for Remote Health Care Professionals around the Globe.
This is for health practitioners working in remote Oil & Natural Gas. My contribution was towards the Dental Training & Dental Emergency Management
This expedition dental article highlights and reviews an inexpensive, lightweight, highly portable dental system that allows the SOF medic to deliver vital dental services in the field.
Regional nerve blocks that can be used to reduce TMJ dislocation.
Establishing a vertical structure to splint the midface . This is a quick effective method to reduce bleeding following a midface fracture.
Most medics will have had little experience with TMJ dislocation, which only represents 3% of all joint dislocations.1 While it is not uncommon for these to be relocated under sedation or anaesthesia, they are very treatable without sedation, especially if attempted early.2 Therefore, all expedition medics should be comfortable to assess, diagnose and manage a dislocated temporomandibular joint.
Antibacterial mouthwashes may be detrimental to recovery. By killing the ‘good’ oral bacteria, less nitrates are converted into nitrites and thus less nitric oxide is available to widen the diameter of blood vessels after exercise. Therefore, tissue perfusion is reduced as well as post-exercise hypotension.
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