Travel insurance and health.

Travel insurance normally underwrites travel, medical, and dental expenses incurred by travelers abroad and arranges aeromedical evacuation of travelers under conditions specified by the travel insurance policy. Because of the costs of medical and dental treatment abroad and the high cost associated with aeromedical evacuation, all travelers should be advised of the need for comprehensive travel insurance and be advised to read their policies carefully to see what is covered and to check for any exclusions. In particular, those travelers who have known preexisting conditions, who are working overseas, or who are going to undertake any form of hazardous recreational pursuit may need to obtain a special travel insurance policy, which may attract a higher premium. Conservatively, it is estimated that between 30-50% of travelers become ill or injured whilst traveling. Relative estimated monthly incidence rates of various health problems have been compiled elsewhere. The risk of severe injury is thought to be greater for people when traveling abroad. These risks should be covered by travel insurance to protect the traveler, however it is not known what proportion of travel agents or airlines give advice routinely on travel insurance. Travel insurance is the most important safety net for travelers in the event of misadventure, and should be reinforced by travel health advisers. Although only 4% of general practitioners (GPs) in a late 1980's study in the United Kingdom would advise a traveler going to Turkey about travel insurance,4 more recent studies have shown about 60% of GPs in New Zealand and 39% of travel clinics worldwide usually advised travelers concerning travel insurance. In addition, 54% of GPs in New Zealand usually also advised travelers about finding medical assistance abroad, but only 19% of GPs recommended travel insurance companies as a source of medical assistance while traveling.

Culturing primary human gingival epithelial cells: comparison of two isolation techniques.

BACKGROUND: Cultured epithelial cells offer many potential clinical applications. There have generally been two techniques that have been used to cultivate oral keratinocytes, which include the direct explant technique and the enzymatic method. Little work has been done comparing these two techniques and their capacity to isolate and cultivate oral keratinocytes. OBJECTIVES: The objectives of this study were to (1) investigate the difference in the percentage of keratinocyte isolation between the direct explant technique and the enzymatic method of human gingival epithelial cell culture and (2) to examine the effect of age and sex of the subjects providing the tissue samples on (a) the success in cultivation and (b) the growth patterns of gingival keratinocytes. MATERIAL AND METHODS: Gingival tissue was obtained from healthy human subjects and was used for keratinocyte isolation using the direct explant technique or the enzymatic method. Epithelial cell cultures from each of the two culture techniques were selected randomly for flow cytometry analysis for cell expression of vimentin and cytokeratin. Growth rate assays were also conducted. RESULTS: The success rate for cultivation from the direct explant technique was higher (82%) than in the enzymatic method (57.9%). The success rate of both methods was not significantly associated with either age or sex of the subjects providing the tissue. From flow cytometry, the average percentage of cells that was positive to anti-pan cytokeratin was nearly the same for both methods at about 97%. It was noted that the cells from the enzymatic method gave significantly higher percentages of cells that were positive to anti-pan cytokeratin only. CONCLUSION: Both the direct explant technique and the enzymatic method can be used for isolating and culturing human oral keratinocytes. The direct explant technique appeared to be more successful in culturing human oral keratinocytes than the enzymatic method, although there were limitations found with both methods. The age and sex of the subjects providing the gingival samples did not appear to be a factor influencing the success rate in culturing the keratinocytes. However, contamination by oral microbiological flora from the gingival tissue samples remained an ever present problem. Further studies are needed in the investigation of clinical applications of these two epithelial cell isolation methods.

Bacterial aerosols in the dental clinic: a review.

A number of sources of bacterial aerosols exist within and outside the dental clinic. The concentration of bacterial aerosols and splatters appears to be highest during dental procedures, especially those generated by some procedures such as ultrasonic scaling, or using a high speed drill. Several infectious diseases could be transmitted to staff and patients by airborne bacterial and other contaminants in the dental clinic. Air-conditioning and ventilation systems should be regularly maintained to reduce environmental contaminants and to prevent recirculation of bacterial aerosols. Pre-procedural rinsing by patients with mouthwashes as well as vacuum and electrostatic extraction of aerosols during dental procedures could also be employed. Dental staff should also consider appropriate immunizations and continue to use personal protective measures, which reduce contact with bacterial aerosols and splatters in the dental clinic.

Travel insurance claims made by travellers from Australia for dental conditions.

BACKGROUND: Little is known about dental problems suffered by travellers abroad. This study was designed to investigate travel insurance claims made by travellers from Australia for dental conditions, particularly examining demographic factors, type of travel insurance coverage, nature and duration of travel, when dental treatment was sought during travel, use of emergency assistance, type of treatment, and claim outcome, including cost. METHODS: 1,289 claims submitted during 1998-99 to a major Australian-based travel insurance company were examined for dental claims. RESULTS: 104 (8.1%) claims for dental conditions were submitted, of which 45 (43.3%) were made by male and 59 (56.7%) by female travellers. The majority of claimants were in the 60 years and over age group 54 (52.4%). Dental conditions reported required conservative (mostly fillings) 31 (29.8%), endodontic (mostly root canal treatment) 19 (18.3%), prosthodontic 27 (26.0%), periodontal 8 (7.7%), oral and maxillofacial surgery 2 (1.9%) and other or multiple 17 (16.3%) treatments. Use of the travel insurance emergency telephone service for dental conditions was reported in only seven cases (6.7%). Almost two-thirds 64 (61.5%) of claims were accepted. Claims for prosthodontic treatment were significantly less likely to be accepted. The majority of dental conditions did not require further medical investigations, 74 (71.2%). The mean cost of payouts to claims was AU$238.06 for males and AU$182.58 for females. Claims for endodontic and prosthodontic treatment were significantly more expensive than other types of treatment. CONCLUSIONS: Claims for dental conditions represent a noteworthy proportion of travel insurance claims made by Australian travellers abroad. More than three-quarters of claims for dental conditions were for conservative, endodontic or prosthodontic treatment. Travellers should be advised to have a dental check-up before departure overseas and to take care with pre-existing dental conditions, which may not be able to be claimed on travel insurance.

Health of dentists in southern Thailand.

OBJECTIVE: The aims of this study were to investigate the prevalence and nature of some health and lifestyle problems of dentists in southern Thailand. METHOD: The design was a cross-sectional study using a self-report questionnaire distributed to all 220 dentists working in 14 provinces in southern Thailand in 1997. RESULTS: One hundred and seventy-eight 178 (80.9%) dentists aged 22-54 years responded. Only about one third of dentists 65 (36.7%) reported exercising on a regular basis. Almost one fifth of dentists 35 (19.1%) reported that they consumed alcohol on a weekly basis. Few dentists 4 (2.4%) reported regular smoking. Almost all dentists reported that their practice of dentistry has increased stress or stress-related problems 171 (96.1%). More than two thirds of respondents had had some known or unknown systemic health problem since graduation 112 (71.8%), although most dentists reported having no systemic disease at present 104 (59.1%). CONCLUSIONS: The present study has indicated that dentists in southern Thailand report a high career prevalence of stress, a moderate career prevalence of work-related problems which may be related to job satisfaction, and moderate career prevalence of systemic disease. Further continuing education and investigation of appropriate interventions to improve rates of exercise amongst dentists in southern Thailand is needed.

Occupational health problems of dentists in southern Thailand.

AIMS: To investigate the prevalence and nature of some occupationally related health problems in dentists in southern Thailand. DESIGN: A cross-sectional study using a self-report questionnaire distributed to all 220 dentists working in 14 provinces in southern Thailand in 1997. PARTICIPANTS: One hundred and seventy-eight dentists aged between 22 to 54 years responded. RESULTS: The most common occupational health problems were musculoskeletal pain (78 per cent) and percutaneous injury (50 per cent). Associated factors were analysed using multivariate analysis. About 22 per cent of these dentists had a history of contact dermatitis mostly caused by allergy to latex gloves, 15 per cent had eye problems, and 3 per cent had hearing problems. CONCLUSIONS: Continuing education in the avoidance of percutaneous injuries would be beneficial, as exposure to potential infectious agents is of concern. Further studies are needed to identify causes of musculoskeletal pain and to identify appropriate interventions to reduce its prevalence, as would similar measures to reduce exposure to agents which may be producing contact dermatitis.

Bacterial aerosols in the dental clinic: effect of time, position and type of treatment.

OBJECTIVES: The objectives of this study were to investigate changes in the concentration of total bacterial aerosols before, during, and after the working period at different positions within the same multichair dental clinics. Also to investigate the contribution to total bacterial aerosols, if any, of the aerosols generated from different types of dental procedures, as well as the environment. METHODS: Air sampling using a Slit-to-Agar air sampler at three positions in a multichair dental clinic, performed three times per day over a three week period before work, during work and after work. The second part of the study, in another multichair dental clinic, was performed before working and during three types of dental procedures. RESULTS: The concentration of total bacterial aerosols and Bacillus sp. in air which circulated in the dental clinic was lower at the end of the day than at the beginning. There was no significant change in the concentration of total bacterial aerosols in different positions in the dental clinic or after the three types of dental treatments. The concentration of Bacillus sp. in air not mainly generated during dental procedures and which may come from an environmental source, was reduced. CONCLUSIONS: This study suggests that the proportions of different types of bacteria in air may change before, during and after dental treatment. Preventive measures may need to be instituted to reduce build up of bacterial aerosols in the dental clinic during non-working periods.

Occupational hygiene practices of dentists in southern Thailand.

OBJECTIVES: The aims of this study were to investigate the prevalence and nature of infection control, radiation control and handling of mercury, reported by dentists in southern Thailand. METHOD: A cross-sectional study with self-report questionnaire to all 220 dentists working in 14 provinces in southern Thailand in 1997. RESULTS: 178 dentists (80.9%) aged 22-54 years responded. All reported wearing personal protective measures, at least sometimes and using high level disinfection (formerly sterilisation) procedures for handpieces. Most (93.8%) reported changing sterilised handpieces for each patient. The most commonly reported method of high level disinfection was alcohol (37.1%). Just over two-thirds (68.0%) reported having HBV vaccination. Most (94.3%) reportedly took precautions when radiographs were taken and (89.9%) reported protecting their eyes with a UV/blue light shield or filter while using these units. About half of dentists (51.7%) reported storing excess amalgam under water compared with 20.1% that they stored it in a closed box. 77.7% reported using sealed mercury amalgam capsule systems, at least sometimes. Nearly half (47.1%) reported disposing of used capsules in the bin. CONCLUSIONS: The present study has indicated that occupational hygiene practices of dentists in southern Thailand are generally consistent with published guidelines for infection control and also with other populations of dentists studied in the areas of infection control and radiation protection. Further continuing education and investigation of appropriate interventions to promote good occupational hygiene standards may also be needed.

Cytotoxicity of polymerized commercial cyanoacrylate adhesive on cultured human oral fibroblasts.

Cyanoacrylate (CA) has been used as both a commercial and tissue adhesive. Dentists may have had the experience of patients repairing their own acrylic-based dentures using a cyanoacrylate (CA) adhesive known as 'super glue'. This study evaluated the cytotoxicity of commercial CA adhesives when fully polymerized, as well as the toxicity of substances released from polymerized commercial CA adhesives after incubation of these materials for various periods of time. Toxicity was tested on cultured oral fibroblasts. Dead cells found around the various CA-coated filter papers constituted inhibitory zones which varied from 200-1000 microns and which persisted for two weeks. Control oral fibroblasts grew to approach the wax-coated filter paper. Cell viability testing using MTT and crystal violet staining methods supported the conclusion that polymerized CA-coated filter paper released substances that are toxic to cells, while wax-coated filter paper gave the same result as the control. The crystal violet staining method was also used to investigate the cytotoxicity of various CA materials after incubation for one, three, seven and 14 days and showed that CA continued to release cytotoxic substances at about the same level for at least two weeks. It can be concluded that, if CA adhesive is used for repair of broken dentures, it will release substances which are toxic to human oral fibroblast cells. This release of substances may persist for at least two weeks.

Release of methyl methacrylate from heat-cured and autopolymerized resins: cytotoxicity testing related to residual monomer.

Three heat-cured and three autopolymerized acrylic denture bases with different mixing proportions and/or processing methods were investigated for the amount of residual monomer content and methyl methacrylate (MMA) released into saliva after incubation during the first and second 24 hours after processing. A corresponding range of concentrations of MMA was also used to test for cell cytotoxicity using a culture of human oral fibroblasts. The results showed that the amount of residual monomer was dependent not only on the type of polymerization but also on the amount of liquid in the mixture ratio and the processing method. The acrylic resin that had the lowest residual monomer also released the smallest amount of MMA but resins which have higher residual monomer may not necessarily release higher amounts of MMA. MMA, tested in the same range of concentration as the MMA found leached from acrylic resin in this study, was found to be toxic in the cell culture. Therefore, it is recommended that dentists attempt to reduce the amount of leachable substances before insertion of new dentures. In addition, it is recommended that dentists advise their patients not to wear newly made dentures overnight, as this may cause mucosal irritation from the potential accumulation of leachable substances.

Flow rate and composition of whole saliva in children from rural and urban Thailand with different caries prevalence and dietary intake.

The aim of this study was to compare the prevalence of dental caries, dietary composition and whole salivary flow rates together with some of the components of saliva between two groups of children aged 12-16 years, one group from an urban area and the other from a rural area of Thailand. A stratified random samples were taken by class from one schools in each area. The children who had mixed dentition and/or who had migrated from other area of Bangkok and 138 students were selected from a school in a rural area of Khon Kaen in northeast Thailand. Results of completed 24-hour dietary recalls for three consecutive days examining the average nutrient intake were compared looking for differences, if any, between these two groups of children. Dental examinations and whole salivary sampling were also undertaken and possible relationships between some nutrients and certain salivary factors were explored. The prevalence of dental caries was found to be higher in the students living in the urban area. The children in the rural area consumed a higher load of carbohydrate, which came mainly from sticky rice. There was no difference in the protein consumption between the two groups, although the children in the rural area consumed more protein from vegetable sources. The salivary flow rate and the concentrations of fluoride, calcium and phosphate were significantly higher (p < 0.05) in the group from the rural area, while the salivary pH, buffer capacity, concentrations of total protein and urea were higher in the urban area. There was no correlation between nutrient intake and salivary composition in the children from these two areas, which may suggest that dietary nutrients may not have a direct effect on salivary compositions but it was noted that salivary flow rate correlated with salivary urea, albumin and buffer capacity in both areas.