22 04 09
APPROVED DOCTOR’S GUIDANCE 11
9.1 DENTAL INSPECTION
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 very limited. Studies on offshore workers
and in the military 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, when they are booking 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.
22 04 09
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.
1. Does the health of teeth and gums (gums alone if edentulous and with
well fitting dentures in good repair) appear to be good, with no complex
Yes – Fit category 1
No – go to 2.
2. Has the seafarer had a dental check-up in the last year, had any
recommended treatment completed and not been aware of any new
problems since completion? (In cases of doubt about the history
require the person to obtain confirmatory letter from treating dentist
before taking decision.)
Yes –Fit category 1
No – go to 3.
3. Does the seafarer work on near coastal shipping where access to
emergency dental facilities is normally within 24 hours and where being
absent from vessel because of treatment will not lead to safety critical
problems in relation to manning levels or to other safety critical
problems (e.g. oil rig emergency standby vessels)?
Yes – Restricted category 2. Limited to work on specified duties that
meet these criteria. Advise on need for dental assessment and
consider time limitation to check that treatment obtained.
No – Temporarily unfit category 3. Inform the seafarer that they need
to consult with a dentist prior to issue of certificate:
22 04 09
- if complex prostheses or orthodontic appliances present obtain
written dental confirmation, or telephone confirmation to examining
doctor, that risk of malfunction leading to disabling dental pain is
anticipated to be less than 10% p.a.
- otherwise obtain written dental confirmation, or telephone
confirmation to examining doctor, that dental health is good, that
there is no excess risk of a dental emergency and that treatment is
planned and agreed to or that all recommended treatment has now
Has confirmation been received?
Yes – Fit category 1
No – Temporarily unfit category 3 if resolution anticipated.
Permanently unfit category 4 if risk will remain or person non-compliant with dental recommendations. May consider near coastal restricted option (as above) as alternative to permanent unfitness.
Note Some forms of maritime employment may be such that the
consequences of severe dental pain at sea will be very disruptive for the operation of the vessel, e.g. work in Antarctica or on nuclear materials transport vessels. Employers in such circumstances may require a certificate of dental fitness on all crew members prior to engagement and regular dental checks thereafter.