Oral health and dental inspection (ILO/IMO Guidelines Appendix E K 01-06)

Impairment and risks

• Severe dental pain is a common cause of medical emergencies at sea. The individual will be incapacitated or severely limited in their duties. Effective pain relief and treatment normally requires transfer to an onshore dentist.
• Less severe problems such as hot, cold or pressure sensitivity of teeth can make eating difficult or impossible.
• Severe gum disease can lead to difficulty in eating and bleeding from the gums while eating or when teeth are cleaned. This can be distressing but is rarely a medical emergency.
• The presence of orthodontic devices implies a continuing need for adjustment and treatment, as well as the need for urgent access to dental services in the event of breakage.
• Complex prostheses can break, with repair restricted to a limited number of technicians or dentists. The individual may have spent a large sum of money on the dental work and hence expects to see a dentist competent in the techniques used urgently to avoid the need to have further expensive re-design work.

Rationale and justification

• The evidence base on the frequency and severity of dental emergencies in seafarers is small but it confirms the findings in related. studies on offshore workers and in the military, which indicate that dental pain is one of the commonest medical emergencies requiring urgent transfer to medical care
• A well maintained dentition and healthy gums reduce the risk of emergencies, however very extensive dental work is also prone to failure in use.
• Dental treatment will almost always reduce risk to a level that is compatible with work at sea.
• The optimum frequency of dental check-ups is disputed.

Clinical assessment and decision taking

Note: Seafarers should be advised, prior to their appointment, that a fitness certificate will not be issued if there is evidence of poor dental health. If they have not had a dental check up in the last year, have any dental symptoms or missing fillings they should be advised to make a dental appointment prior to the medical in order to save time, should their dental fitness be in doubt.

Examining doctors will not usually be competent to do more than a general inspection of the teeth and gums to identify damaged teeth, missing fillings, the presence of prosthetic devices and obvious gum disease. Symptoms can be elicited but not reliably used as the basis for making specific dental diagnoses. The history of dental check-ups and treatment can be obtained.

• All seafarers should be asked if they have any dental symptoms (dental pain, hot/cold/pressure sensitivity, sore/swollen or bleeding gums), the date of their last check-up and whether they are currently receiving dental treatment. They should be asked if they have had any teeth replaced other than by normal filling and crowning procedures.
• The teeth and gums should be inspected and any caries, badly broken teeth, large missing fillings, sore/swollen/retracted/bleeding gums noted. The presence of prostheses should be identified.
• Complex prostheses or orthodontic appliances may fail and require repair or adjustment, less commonly they may lead to dental pain. The seafarer should be advised that, while dental pain can be considered an emergency at sea, malfunction is not and so they are likely to have to wait until the end of their period of duty for any repair or adjustment.