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
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
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
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.
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
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
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
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.
Protection against potentially harmful drugs is nonexistent in
• 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
• 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
• 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. -
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.
Medical and Dental Health Care Scenario in India with health
tourism in perspective.
Dental tourism - Facilities we offer at our clinic
Tourist information on Kochi.
Traveler's Guide to Safe Dental Care