E.11.1 Acute and Long Term Harm

Dental problems affect more than 3.5 billion people around the world[1]. They are highly prevalent in seafarers and account for a large number of consultations with Telemedical Assistance Services and in foreign ports[2] [3]. The results of a 2016 survey also demonstrated the poor oral hygiene of seafarers[4] and looked at the possible reasons for this including a higher than average rate of smoking and poor diet.

Acute problems include dental caries and periodontal disease, whilst lost fillings and lost or broken teeth may also occur on board. Seafarers may present with tooth ache, bleeding from the gums or bad breath.

Poor oral hygiene has also been linked to other health issues including cardiovascular disease[5], respiratory disease, rheumatoid arthritis[6], poor control of diabetes and erectile dysfunction[7].

E.11.2 Risk assessment

The mouth should be examined as part of the examination at PEME, and similar principles applied to oral health as any other health issue. The ‘Guidelines on the Medical Examination of Seafarers’ advise that seafarers should only receive an unrestricted certificate if the ‘teeth and gums appear to be good…’Any seafarer noted to have any dental or oral health problem should be referred to the appropriate health care professional for an assessment and treatment before are given a medical certificate and join a ship[8].

E.11.3 Risk management

Appropriate assessment and completion of any urgent treatment before joining a ship is essential. Ideally seafarers should arrange to have a dental check and any required remedial measures while on leave.The management of dental problems on board is limited and care in foreign ports can be expensive and of varying quality. Seafarers will often end up with a tooth extraction that may have been unnecessary had the problem been managed before sea service. Those with dentures, bridges or other complex dental work should seek advice in advance on what to do should repair be needed.

Crewmembers should be advised to ensure that they have sufficient supplies of toothpaste, brushes, dental floss and other oral hygiene products with them to cover the duration of their time at sea.

In addition seafarers should have access to appropriate health promotion materials on oral hygiene at home and on board the ship. The 2016 survey noted that only 40% of those questioned brushed their teeth twice a day. Seafarers should also have access to a healthy diet and be encouraged to stop smoking and moderate alcohol intake (see xx).



[2] Radio Medical Danmark. Annual Report 2010. Esbjerg, 2011.

[3] Tomaszunas S. The work of ship’s doctors of Polish Ocean Lines. Bull Inst Marit Trop Med Gdynia 1985; 36: 51–58

[4] Syed Sarosh Mahdi, Fabio Sibilio, Francesco Amenta. Dental hygiene habits and oral health status of seafarers. Int Marit Health 2016; 67, 1: 9–13

[5] Batty GD, Jung KJ, Mok Y, Lee SJ, Back JH, Lee S, Jee SH. Oral health and later coronary heart disease: Cohort study of one million people. Eur J Prev Cardiol. 2018 Apr;25(6):598-605.

[6] Kriauciunas A, Gleiznys A, Gleiznys D, Janužis G. The Influence of Porphyromonas Gingivalis Bacterium Causing Periodontal Disease on the Pathogenesis of Rheumatoid Arthritis: Systematic Review of Literature. Cureus. 2019 May 28;11(5)

[7] Vijendra P. Singh, Sunil K. Nettemu, Sowmya Nettem, Rajesh Hosadurga, Sangeeta U. Nayak. Oral Health and Erectile Dysfunction. J Hum Reprod Sci. 2017 Jul-Sep; 10(3): 162–166.

[8] Accessed January 30th 2022