Burjor is an Honorary Clinical Professor of Extreme Medicine, WED Module Lead on the University of Exeter’s MSc Extreme Medicine and travels the world running dental camps around his UK clinical practice. Irina is a doctor and postgraduate student in Global Health and Tropical Medicine based in the Netherlands. In this article they outline the importance and scope of expedition dentistry and routes into the field for both dentists and non-dentists. They also share the stories of their own initiations into WED, highlighting the immense value that dentistry can bring to the wilderness and expedition environment.
What is Wilderness Expedition Dentistry?
Are you a medic, paramedic, or dentist? Are you relatively fit? Do you enjoy lateral thinking and thrive in a challenging situation? Do you love travelling and exploring new places? If so, Wilderness Expedition Dentistry (WED) could be for you.
WED is a branch of medicine that addresses prevention, assessment and management of accidents and emergencies associated with the orofacial region in remote settings, where definitive care is often days or weeks away. This is a rapidly evolving field of increasing importance as more people engage in longer and potentially hazardous expeditions. WED includes:
- Expedition planning and clinical care
- Evaluation of experience and issuance of updated training to other expedition medics
- Epidemiological studies
- Humanitarian dentistry including organising and running emergency dental clinics in remote access areas for local populations or in refugee camps
How did we get into it?
Fresh out of dental school, doing his masters in Oral Surgery and madly interested in the outdoors, Burjor was invited to a dental camp in a rural area of Maharashtra, India in June 1986. There was a heavy monsoon and transport to the destination was a four-hour, back-breaking bus journey. The clinic was a classroom. Seven hours and 56 dental extractions later he was hooked. The communal team of medics, dentists and paramedics, went as strangers and left the best of friends. They are still in touch, still doing dental camps.
Irina’s first experience was as a medical doctor on a World Extreme Medical Expedition Course in Slovenia. There were several practicals on expedition dentistry. Realising how significant the impact of dental emergencies can be in remote settings and how much you can do with so little, made her excited to learn more.
What are the benefits of getting involved in Wilderness Expedition Dentistry?
WED can be extremely rewarding. Imagine yourself in your home country, as a patient vociferously complains about the 20-minute delay to be seen. You remember the patients you treated on your last expedition, many of whom may have waited months to access this care. Their gratitude reminds you that through WED, you can use your skills where they are most urgently needed, to help communities who lack regular access to dental care.
We have often been asked “can expedition dentistry be your full-time job?” Simply put, no. Though your financial rewards will be minimal, your payment in experiences, memories, skill improvements and mental wellbeing will more than make up for the monetary loss.
How can you balance your personal and professional life with expedition dentistry?
It is a compromise between professional ambitions, relationships with friends and family and the stimulation provided by going on expeditions. Essentially, it will vary depending on what stage of life you are in and where you want to go. You cannot consistently spend months taking a break from your training and sustainable income. However sometimes the opportunity will be well worth the sacrifice. To go or not to go? Only you can decide.
What advice do you have for anyone interested in becoming an expedition dentist?
The common themes of all WED expeditions are:
- Limited equipment
- Environmental extremes
- On the spot decision making/creative thinking and improvisation
There are many courses available. We recommend that you research well and check the reviews. We have had personal experience with:
What extra qualifications are needed?
If you are a dentist reading this (and getting excited) you may be wondering what additional training is necessary. Some experience and working knowledge in oral surgery is definitely a plus. In addition, an Expedition Medicine course will give you various useful skills. On these courses you can meet and network with other like-minded medics. You will receive general outlines of expedition medical problems and how to deal with them, which is useful if you are supporting an expedition doctor.
If you are a medic or paramedic concerned with your lack of dental knowledge and want to round off your training so you can be prepared for every eventuality (including those irritating dental ones) there are many ways to improve your skills. You can attend the numerous wilderness expedition dental hands-on workshops available, shadow your local maxillofacial or dental teams and learn from the open-access articles and videos on Adventure Medic and Wilderness Expedition Dentistry. The importance of maintaining your physical fitness cannot be underestimated. You have to carry your medical and dental equipment on top of your regular kit and be prepared to do your work at the end of a physical day. It can be exhausting but you will be rewarded with unforgettable experiences.
Two main types of expeditions
The first type applies to qualified dentists. This is a dental camp. Here you volunteer to provide dental services to local people in remote areas, often in low-income regions. The organisation you go with will have spread the word, so a long line of patients will be waiting. These are usually rudimentary dental clinics and may actually have luxuries like a bright light and a portable chair. This is a good first introduction. They are easy to get onto, although you might have to pay for travel, boarding and lodging. The second type of expedition applies to medics, paramedics and dentists who have completed WED training. Here your goal is to provide dental emergency care as and when the need arises, mainly for participants of an expedition. You (or a team member) carry your dental emergency kit. Your clinic can become anywhere your patient can sit or lie.
Indemnity and medicolegal matters
First the good news: persons who participate in outdoor ventures are more likely to accept personal responsibility for their health, risky activities and the limitations of their remote location. They are grateful for the help they receive in difficult circumstances and therefore, are less likely to sue.
The Good Samaritan Act: technically this will apply only if you are somewhere as a lay person and an emergency arose which required you to exercise your medico-dental skills. If, however, you agreed to take part in an expedition in the capacity of a medic you would technically not fall into this category.
A court considering standard of care would not expect a medic to provide the same standard in remote wilderness as in a well-equipped emergency room, but would expect that medic to provide a similar standard to a competent medic in a similar emergency situation. The particular situation in which the incident occurred will be taken into account. You may be protected from legal liability for negligence if you do your job well and in accordance with the standards for the wilderness expedition medical professional. In our experience, as long as you will be performing standard dentistry procedures, i.e. fillings and extractions on your expedition, insurance is usually straightforward to obtain from the DDU. Further information is available for doctors on medicolegal aspects of expedition medicine, paramedics and by contacting your own indemnity provider.
Want to know more?
Dental emergencies account for 16% of all Medivacs.1 In view of this, the Faculty of Prehospital Care, RCSEd2 have stated the importance of basic dental training for all expedition medics. To help facilitate this we have created the Wilderness Expedition Dentistry website, an educational resource with no copyright restrictions. This allows medics worldwide free access to resources enabling them to run workshops and lectures to train expedition medics in managing dental emergencies. This is an evolving website where we aim to add videos and pictorial slides to reinforce this training.
All photographs courtesy of Eric Linder, Founder/ Team Leader, Team 5 Foundation.
1. Küpper, T., Hettlich, M., Horz, H.P., Lechner, K., Scharfenberg, C., Conrads, G., et al. Dental Problems and Emergencies of Trekkers – Epidemiology and Prevention. Results of the ADEMED Expedition 2008. High Altitude Medicine and Biology, 2014; 15: 39 – 45. DOI: 10.1089/ham.2013.1108.
2. Mellor, A., Dodds, N., Joshi, R., Hall, J., Dhillon, S., Hollis, S., et al. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine. Extreme Physiology and Medicine, 2015; 4: 22. DOI: 10.1186/s13728-015-0041-x.