What is wilderness expedition dentistry?

Wilderness expedition dentistry (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 potentially hazardous and longer expeditions. But the role of the wilderness expedition dentist also involves many additional topics, including:

• secondary care follow-up, sustaining the patient to the end of the expedition
• evaluating experience and issuing updated training to expedition medics
• epidemiological studies
• humanitarian dentistry regarding organising, running and issuance of guidelines for running dental camps in remote access areas for the local population, or in the increasing number of refugee camps.

How did you get involved?

The best way to describe my journey to wilderness expedition dentistry would be to tell you about my first dental camp, somewhere in a deep rural part of Maharashtra, India, in June 1986. There was a heavy monsoon, and transport to the destination was a four-hour, back-breaking bus journey - we got stuck twice!

When we arrived at the village, we saw a long line of villagers outside the school. We presumed there was another function going on, but a welcoming committee guided us to our 'clinic' (a school classroom) and proudly stated that the long line was for us!

Seven hours later, after various yogic postures (both myself and the patients'), a community effort in providing light and crowd control, forced interruptions caused by power cuts and flooding from a leaky roof, we were back in our rickety back-breaker bus heading for home.

I loved it. The communal team of medics, dentists and paramedics, who went there as strangers, had become the best of friends. The locals, who were initially in awe of these doctors from the city, were laughing, joking and exchanging food recipes by the end. Our grateful patients wanted to give us a full mango orchard and a goat (we declined - the goat could have got travel sick!). Since then I have been volunteering, begging, pleading and bargaining to get onto as many expeditions as possible. In fact, this has become my biggest goal through my career.

What are the benefits to getting involved in wilderness expedition dentistry?

I've often been asked, 'Can expedition dentistry be your full-time job?' Simply put, the answer is no. The amount of money you can get from it won't buy you a fancy sports car - maybe (possibly) the wheel nut of one - so what's so rewarding about it?

Imagine yourself in a clinic as a patient vociferously complains of the 20 minute delay and comments strongly that NHS is getting as bad as health services in the third world. You remember the queue of patients in pouring rain and their gratefulness of the treatment provided ' and a benign smile creeps across your face. Or perhaps you are trying a crown and it doesn't fit. Agitation starts creeping in, but the memory of you chasing baby seals to do their oral swabs makes it all go away.

It's the memories and experiences of expedition dentistry that make it so special. It's this that gives me the Dalai Lama-type serenity to deal with those loose lower dentures, units of dental activity (UDA) quota and other minor irritations of everyday dental life.

What extra qualifications are needed?

If you're reading this and getting excited, you may be wondering what additional training is necessary. A bit more experience and working knowledge in oral surgery is definitely a plus point, and an expedition medicine course like the one run by World Extreme Medicine is well worthwhile. You can meet and network with other like-minded healthcare professionals, and you'll receive general outlines of expedition medical problems and how to deal with them, which will be really useful if you are attached to an expedition where you are supporting the expedition doctor.

The importance of maintaining your physical fitness cannot be under-estimated, especially if you are supporting an expedition. You have to carry your dental stuff on top of your regular things. Be prepared to do your work at the end of a physical day - it can be exhausting but you will be rewarded by unforgettable experiences.

Conditions, situations and expeditions

Essentially there are two types of expeditions. The first type is a dental camp, where you volunteer to provide dental services to the local people in a remote area in the global south (Africa, Latin America and developing Asia). The organisation you go with will have advertised and spread the word, so a long line of patients will be awaiting you. Dental equipment for these is better, and they may actually have luxuries like a bright light, portable chair, etc.

These types of expeditions are a good first introduction. They are easy to get onto, but you might have to pay for travel, boarding and lodging. A rudimentary dental clinic will be in place and the locals will be used to a visiting dentist. And as an added bonus, you come back glowing with a halo of well-being that all those years of training have been used to help a very appreciative group of people who don't take their dental treatment for granted.

The second type of expeditions are the more adventurous ones. Here your goal is to provide dental emergency care as and when the need arises. This would mainly be for the participants of the expedition, but could involve treating local people en route.

You carry your own dental clinic with you (or, if you are lucky, someone else does). Your clinic can become anywhere your patient can sit or sleep. When you are not doing dental work, you are supporting the expedition doctor, scientists and other participants in their work.

In the past I've judiciously spent this time helping to weigh penguins and check their stomach contents, oral swab baby seals, make coffee, suture a leg or two and other such stuff. These expeditions are harder to get into, but they often pay for your travel, boarding and lodging.

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 and on the spot decision-making, creative thinking and improvisation.

There are loads of courses available, and I strongly recommend you research well and check the reviews. The ones I've had personal experience with are:

• World Extreme Medicine
• Diploma & Masters in Expedition and Wilderness Medicine - RCPS of Glasgow
• Msc in Extreme Medicine - University Of Exeter

Dento-legal concerns

First, the good news. People who participate in outdoor ventures are more likely to accept responsibility for a risk activity. They are grateful for the help they have been given in difficult circumstances and are therefore less likely to sue.

Then there's the Good Samaritan Act. Technically this will apply only if you were on an expedition as a lay person and an emergency arose that required you to exercise your medico-dental skills. If, however, you agreed to take part in an expedition in the capacity of a dentist, you would not fall into this category.

Dental emergencies account for 16% of all medivacs. In view of this, the Faculty of Prehospital Care at the Royal College of Surgeons, Edinburgh, has stated the importance of basic dental training for all expedition medics in its guidance for medical provision for wilderness medicine.

To help facilitate this, we have set up the Wilderness Expedition Dentistry website as an educational resource with no copyright restrictions. This allows dentists worldwide to get freely available access to resources enabling them to run workshops and lectures training expedition medics in managing dental emergencies. This is an evolving website where we aim to add videos and pictorial slides to reinforce this training.

Find out more at wildernessdentistry.com