Traveler's Guide to Safe Dental Care

Congratulations! You've decided to finally visit that corner of the world you've always dreamed of seeing. The flights are booked, the hotel reservations made....
Most likely, dental care is not on any traveler's Top 10 list of "Things to Do," but what should you do if you get a toothache, or crack a filling?
Most of us are aware of the high U.S. standards for infection control and safety in health care. But in many parts of the world, gloves, sterile instruments, disposable needles, and safe water are not routine elements of dental practice. Furthermore, the standards for educating and licensing dental professionals vary widely.
In case of a dental emergency, knowing what to look for when seeking dental care in a foreign country can help a traveler avoid unnecessary risks.

Take steps to ensure a healthy trip free of dental emergencies.
No one wants to have a trip ruined by a toothache. To minimize the risk of a dental emergency, visit your dentist for a check-up before your trip. Schedule your appointment to allow enough time to complete any necessary or outstanding dental work before your departure date.
• Before you leave on your trip, tend to decayed teeth, broken fillings, and other dental problems. Inform your dentist of your travel plans and ask about any other potential dental problems.
• Have your teeth cleaned by the dentist or hygienist. This is particularly important if you have periodontal (gum) disease.
• If you will be away for an extended time, consider having partially exposed lower wisdom teeth removed. The fleshy covering over the tooth creates a food trap that can cause pericoronitis, a potentially serious infection that can spread to parts of the head and neck.
• All root canal treatment should be completed before travel to avoid potential infections and pain due to pressure changes during air travel. If the work cannot be completed, ask your dentist to insert a temporary paste filling to reduce the risk of problems.
Most insurance policies don't provide coverage for care delivered overseas, so it makes sense to take care of any potential problems before leaving home.

Vaccinations
In the United States, most dentists have been vaccinated against hepatitis B virus, a serious bloodborne infection affecting the liver. In the developing world, however, hepatitis B infection rates remain high.
• Consider hepatitis B vaccination if you will be traveling to areas where many people are infected. Immunization requires three injections given over a six-month period, so plan far enough ahead to receive the complete series.
• Consult the Centers for Disease Control and Prevention, an agency of the U.S. Department of Health and Human Services, for hepatitis B and other immunization recommendations before traveling outside U.S. borders. Call 877-FYI-TRIP or visit www.cdc.gov/travel

Finding a dentist
Even with the most thorough examination, no dentist can guarantee a dental emergency will not arise. So what should a traveler do if a dental problem occurs far from home?
• If staying in a hotel, the concierge or senior management staff may be able to suggest a dentist. American Embassy or military personnel-or even other American expatriates living in the area-also may be good sources for a recommendation.
• If you do not speak the local language, a dentist proficient in English is preferred to allow effective communication of the dental problem and treatment as well as questions about infection control practices.

Assessing infection control practices in the dental office
Once you have found a dental office, examine its level of compliance with basic infection control and safety standards. "Infection control" seeks to prevent the transmission of disease-causing organisms by:
• reducing their numbers (for example, through cleaning, disinfection, and sterilization of instruments or surfaces);
• preventing exposure by using barriers like gloves, masks, gowns, and protective eyewear, or by covering surfaces to keep them from becoming contaminated; or
• improving a person's ability to resist disease causing agents through the use of vaccines and antibiotics.
The most successful approaches use a combination of all three.
Practicing universal precautions means that the dentist and staff wear a new pair of rubber or vinyl gloves for each patient and wear face masks and protective eyewear for all procedures that generate spatter or splash. It also means that all instruments used on patients are either disposed of or are properly cleaned, then disinfected or sterilized after use.
In the developed world, most dental offices apply the principles of universal precautions, which are based on the assumption that any patient could be infected with a bloodborne virus such as the human immunodeficiency virus (HIV) or hepatitis B and C viruses. As such, the highest standards of protection are always applied.
Basic hygiene remains important. Experts in medicine and dental infection control agree: Handwashing is the single most important element in preventing the spread of infection. Dentists and staff should always wash their hands immediately before donning gloves as well as immediately after removing them.
Gloves protect both patients and healthcare workers from disease transmission. The dentist and all assistants involved in treatment should use new gloves for each patient. Gloves should never be washed and reused. It degrades the material and compromises its ability to provide an effective barrier.
Injection needles are no longer reused in most parts of the industrialized world because they pose a high risk of spreading bloodborne viruses. Unfortunately, because disposable needles are more expensive, re-usable needles may still be in use in some developing countries.
Heat-sterilizing instruments in an autoclave or dry-heat sterilizer kills all potential disease-causing agents that might remain after patient treatment. All heat-stable instruments that are exposed to a patient's blood should be processed in this manner, including the dental drill. Any instruments that cannot tolerate high temperatures should be thoroughly cleaned and soaked in disinfectant chemicals.
All instruments used for surgery, including tooth extraction, must be heat sterilized and should be stored in a sterile wrap or container until it is used.
Items that are used only outside the mouth, or that never contact blood, can be cleaned and then wiped or soaked in less powerful disinfectant chemicals.
Highspeed dental drills and other devices used in dental treatment need water to work properly. In many parts of the world, safe drinking water is not always a fact of life. Water that is unsafe to drink is also unfit for dental treatment, especially surgery. In areas that lack potable water, dentists can use bottled water delivered using a bulb syringe. Boiled water is considered acceptable, although bottled sterile water is preferred for surgery.

Choosing Medications
Protection against potentially harmful drugs is nonexistent in some countries.
• Do not buy medications "over the counter" unless you're familiar with the product.

Checklist for Obtaining Safe Dental Care
Before you leave:
• Visit your dentist for a check-up to reduce the chances you will have a dental emergency.
• Consider appropriate vaccinations.
• When seeking treatment for a dental emergency during your trip:
• Consult hotel staff or the American Embassy or consulate for assistance in finding a dentist.
• If possible, consider recommendations from Americans living in the area or from other trusted sources.
If the answers to any of the asterisked (*) items are "No," you should have reservations about the office's infection control standards. If the answer to a two-star item (**) is "No," consider making a swift but gracious exit.

When making the appointment, ask:
• Do you use new gloves for each patient?*
• Do you use an autoclave (steam sterilizer) or dry heat oven to sterilize your instruments between patients?**
• Do you sterilize your handpieces (drills)?* (If not, do you disinfect them?)**
• Do you use new needles for each patient?**
• Is sterile (or boiled) water used for surgical procedures? ** (In areas where drinking water is unsafe, the water also may cause illness if used for dental treatment.)

Upon arriving at the office, observe the following:
• Is the office clean and neat?
• Do staff wash their hands, with soap, between patients?
• Do they wear gloves for all procedures?
• Do they clean and disinfect or use disposable covers on surfaces touched during treatment?
While it is important to be sensitive to cultural differences when making inquiries about the safety of dental care, remember that it is your health and well being that are at stake.
Bon voyage and safe smiles!

Courtesy: OSAP. - http://www.osap.org

OSAP, the Organization for Safety and Asepsis Procedures Foundation is pleased to present these guidelines for obtaining safe dental care for international travelers. One of the goals of the OSAP Foundation is to raise the standard for dental infection control practices everywhere. By providing guidance and educational materials to individual dentists, professional associations, and dental schools worldwide, we hope that someday this pamphlet will be unnecessary.
 

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