FGDP(UK) member and GDP, Kausar Undre, reflects on patients' concerns about travelling overseas with perceived dental issues.
It’s surprising how a trip abroad can create an idiopathic pain in teeth and the surrounding supporting tissues. In the thick of the holiday season, the incidence of such dental pain is peaking. In the last month I have had several patients requesting an elective course of antibiotics in order to travel with a peace of mind.
A new patient, an elderly lady, presented with a complaint of ‘dental abscess’ arising two days prior to a scheduled holiday to Europe. The patient was adamant that she must have an abscess as her gum was so painful and she would feel so much happier to leave with a course of antibiotics. On examination, there was mild gingival inflammation and tenderness around an interdental papilla which had been traumatised by overzealous prophylactic cleaning by the patient. In the absence of any signs of infection, I decided to have a discussion with the patient. I discovered she suffered from a ruptured eardrum and was afraid that it may happen again. She was doubly afraid that her tooth may flare up and then she would have two problems on the plane and would not be able to cope. Gentle reassurance that her teeth were sound came as a wave of relief to the patient and she was content with the home remedy warm salt water mouthwash to help ease the tenderness in her gums. Within minutes, the tension was gone.
This incident was soon followed by another regular patient who complained of needing a root canal in a tooth that had been restored six months previously. The patient presented with vague symptoms of intermittent pain and was convinced that she needed pulp therapy. Nonetheless she would be content to leave with a course of antibiotics. Well, in the absence of symptoms of pulpitis, I subsequently took to talking to the patient and learned that she had a vacation booked for the following week. It was no surprise that the tooth was symptom-free until a month prior to the appointment, most likely due to the knowledge that the holiday was looming. Reassurance and monitoring were once again the treatment of choice, and lo and behold, there was no further pain once the patient had returned from her break.
There were several similar cases where patients requested a prescription as a precaution, and vowed that they would not take the antibiotics unless they needed to. But how can we oblige to such a request when the grip (and rightly so!) around administration of antimicrobials is tightening day by day. It can be a challenge to convince the patient of appropriate usage of antimicrobials especially when they are in pain. In times where there are increased pressures on dentists with regard to antimicrobial prescribing, perhaps there needs to be greater education and awareness of access to dental care in other countries and perhaps we should direct the patients to their dental insurers for greater assurance of their support should there be a dental emergency whilst abroad.
Patients must do their own due diligence and ensure their travel insurance covers dental as well as medical issues – and this should be the first point of call should there be an event of dental emergencies overseas.
For further information regarding dental treatment abroad, please follow this link - https://www.gdc-uk.org/information-standards-guidance/information-on-dental-treatment/going-abroad-for-dental-treatment