Travelling abroad

When people are travelling abroad from the UK, especially to rural or remote locations, they may seek advice on immunisations. However, they often fail to consider a dental check-up before they go.

When you Google ‘dental health of travellers’ you get thousands of hits referencing the Gypsy/Traveller population. Similarly, a search on ‘dental health of travellers abroad’ focusses on people going abroad for dental treatment, ie ‘Medical Tourism’, a growth industry, particularly for dentistry in Eastern Europe.1 A literature review saw this as an area of increasing travel.2 High costs in the UK private sector and limited availability in the public sector together with low costs in Eastern Europe were cited as the motivation.

In spite of global insecurity and Brexit uncertainties, travellers from the UK made 70.8 million visits abroad in 2016, travelling for a variety of reasons, mostly for holidays.3 Europe is the top destination with Spain and France the most popular. Cruising, eco-tourism and ‘micro-adventures’ to remote areas are increasingly popular.4 More direct flights from the UK to, for example, Chile and Vietnam, have made long-haul travel more accessible and affordable.

Travel health services

Most travel health services in the UK are provided in general practice settings and delivered by nurses. Private travel clinics are increasingly common, many led by pharmacists. Delivering travel health advice is becoming more complex. Age is no barrier and with travellers of all ages looking to experience different countries and cultures, an individual pre-travel risk assessment is essential.5 This is an in-depth evaluation, exploring the individual, their itinerary and potential health risks. Identifying pre-existing medical conditions or disabilities is important especially if activities are to be undertaken in a remote destination far from medical assistance, importantly for solo travellers. Vaccination advice is important but a wider conversation needs to be had and tailored advice offered.

Travel associated disease

Schlagenhauf et al. identified sex and gender differences in travel associated disease.6 Men and women presented with different profiles of travel-related morbidity: women were proportionally more likely than men to present with oral and dental conditions.

Major sporting events encourage people to visit countries they'd never otherwise consider, for example the 2018 FIFA World Cup in Russia, where there are 11 match destinations, some with vast distances between them.7 Student and volunteer groups often work in remote locations with little or no access to medical facilities. Sending agencies, for example Voluntary Services Overseas (VSO), will assess the risk for their groups but unidentifiable providers on the Internet may offer wrong, or no advice.

Travel kits

Commercial medical kits from basic to advanced are widely available and can be customised to specific needs. General kits may fail to mention or include how to deal with dental emergencies, although specific dental kits are available. Toothache, losing a filling or a crown during an expedition is likely to cause misery for the individual and can lead to travel disruption for the extended group. For adventurous travellers going off the beaten track carrying a comprehensive medical kit is recommended. Such travellers would be advised to have a pre-departure dental check-up but if travel is imminent this may not always be practical or possible. More serious oral or dental emergencies may require hospital treatment abroad. If the destination is a resource-poor country where blood-borne viruses are endemic and skills, equipment and hygiene lacking, there is a risk of more serious harm, eg Hepatitis B, Hepatitis C or HIV infection. Travelling to a reputable centre or returning home may be indicated. Treatment costs incurred abroad can be high. Comprehensive travel insurance covering repatriation is essential for all travellers and is the individual's responsibility. The Foreign & Commonwealth Office (FCO) provides advice (FCO Travel Aware).8

Credit: ©Nick Veasey/Untitled X-Ray/Getty Images Plus

How can dental team staff help?

Dental teams can provide help and advice to individuals planning to travel abroad in a number of ways:

  • Raising awareness of the importance of having a dental check-up before travelling abroad

  • Posters and leaflets in the waiting room and through sending e-messages

  • Opportunistic conversations about possible travel plans

  • Advising local school/university groups going on foreign field trips

  • Reminding patients about taking out comprehensive insurance for trips abroad, ensuring dental health provision is included

  • Ask patients to consider carrying a dental kit overseas

  • Consider holding a few dental travel kits for purchase

  • Recommend websites for information on dental health abroad.

A neglected area

Dental health would appear to be a somewhat neglected area for overseas travellers. Information is sparse and mostly related to expedition medicine. Even those with medical experience in this area may not be familiar with or adept at treating dental problems. As prevention is key, alerting travellers to the possibility of a dental problem during their travels and how to deal with it will go a long way to making their trip problem free and may limit the risk of more serious health problems.