title: Dental problems and emergencies of trekkers--epidemiology and prevention. Results of the ADEMED Expedition 2008.
abstract: OBJECTIVE
  Dental problems are rarely mentioned in the training of medical students or physicians in travel medicine, and there are little data on dental problems of travellers in the literature. We studied the epidemiology of dental problems amongst trekkers in Nepal to develop strategies for preventive care during/before travelling and propose a curriculum for dental First Aid training.
  
  
  METHODS
  We undertook a prospective, cross-sectional questionnaire and clinical dental survey of Trekkers at Manang (3550 m, Annapurna Circuit, Nepal). The questionnaire was developed based on published literature and clinical experience (exploring: availability of dental kits, dental history, current dental problems, and nutritional behavior). Dental examination included: dental status, papillary bleeding index (PBI), and plaque index (Quigley and Hein; QH). Questionnaire and clinical findings were compared to data of the Annapurna Conservancy Authority about the number of days of trekkers in the region to estimate the incidence of dental problems of trekkers.
  
  
  RESULTS
  None of the 309 participants carried a dental first aid kit. Dental problems, potentially treatable with a dental first aid kit, were reported by 50/309 (16.5%). Oral hygiene en route was significantly worse than home hygiene practice; overall increased plaque indices were found (Median QH: 2.25 in women; 2.36 in men). Participants who visited a dentist ≤6 months before departure had significantly fewer problems, and had lower PBI [males 0.07 (IQR 0.0 to 0.29), females 0.0 (IQR 0.0 to 0.11)]. Combining our findings with data of the park authorities on person days in the region (2007), we found a risk of dental problems as follows: any dental problem 1:23.7 trekking days; gingival bleeding 1:37.7 trekking days; dental pain 1:145.2 trekking days; lost fillings 1:339 trekking days; fractured teeth 1:509 trekking days.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Institute of Occupational and Social Medicine, RWTH Aachen University , Aachen, Germany .
authors.forename: Thomas
authors.initials: T
authors.lastname: Küpper
authors.forename: Malaika
authors.initials: M
authors.lastname: Hettlich
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Horz
authors.forename: Karin
authors.initials: K
authors.lastname: Lechner
authors.forename: Christine
authors.initials: C
authors.lastname: Scharfenberg
authors.forename: Georg
authors.initials: G
authors.lastname: Conrads
authors.forename: Said S
authors.initials: SS
authors.lastname: Yekta
authors.forename: Friedrich
authors.initials: F
authors.lastname: Lampert
authors.forename: Claudia
authors.initials: C
authors.lastname: Gore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D003753:Dental Health Surveys; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent; D003945:Diagnosis, Oral; D004630:Emergencies; D005101:Expeditions; D005260:Female; D005392:First Aid / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009051:Mountaineering; D009390:Nepal / Q000453:epidemiology; D009910:Oral Hygiene; D010510:Periodontal Diseases / Q000175:diagnosis / Q000453:epidemiology*; D010512:Periodontal Index; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014082:Tooth Fractures / Q000453:epidemiology*; D014098:Toothache / Q000453:epidemiology*; D057236:Travel Medicine / Q000193:education; D055815:Young Adult