We're excited to present Mr. Burjor Langdana, one of our amazing speakers at Expedition Medicine this august. He has extensive theoretical and practical knowledge in the field of wilderness dentistry and is an avid tutor.
How and why did you specialize in wilderness dentistry?
Was always interested in traveling and dentistry. Hence was a no-brainer to combine both. Rural dentistry through " Dental Camps " was easy in India. There was a huge need, opportunity was plentiful, and was an excellent way to meet like-minded medics. Resulting in deep and long-lasting friendships.
What advice would you give others interested in the field?
- Get confident about surgical dentistry
- Broaden your knowledge in General Medicine and General Surgery, so you can assist
- Develop a relaxed attitude and a good sense of humor
- Do yoga, You will need a flexible back and a strong neck if you plan to do dentistry in the field. Poor visibility and compromised physical positions is the name of the game
On a hiking trip, a healthy adult falls and knocks out his front tooth.
- What should be done immediately?
- Take a deep breath - It's not the end of the world. It's not a life and limb-threatening emergency. It is however a tooth-threatening emergency. The faster you get it back in the socket the better.
- Quickly -
- Tell the patient to sit down and reassure him/her. Make sure no other major injuries. The key word is "Quickly".
- Pick up the tooth by the Crown
- Wash off any visible debris from the tooth without touching the root.
- Examine the root to make sure it's not fractured and the full tooth is out. Remember - The root is sacrosanct. It's where all the living cells are. Do not touch the root.
- Check adjacent teeth - Make sure you orient the tooth right way round.
- Push it in with firm digital pressure till it's approximately in alignment with the adjacent teeth.
- Tell the patient to bite on a large gauze, cloth, or tissue.
- Now you can relax a bit. The next step depends on how close help is.
- Should he evacuate?
The patient needs to go to a dentist ie Dentivac ASAP
How does the treatment depend on the distance to a dentist?
- If a dentist is 24 hours or less away - Concentrate on DentiVac, rather than spending time making a splint.
- If a dentist is more than 24 hours away - What you do next depends on what you have, your expertise, your materials, time, and your environment.
- Ideally, make a splint using a nasal clip of a face mask. Stick it to the teeth using Glass Ionomer Cement
- Follow this with broad-spectrum antibiotics, NSAIDs, scrupulous oral hygiene, and a liquid Diet. Check the Tetanus Booster situation.
- Arrange DentiVac. Reimplantation within 1 hour is associated with a success rate of 80 %, thereafter it drops to 20%.
- Remember you can only do your best so be kind to yourself.
What is the most common misconception?
- Dental problems happen on other peoples' expeditions.
- For yourself, a sub-standard dental emergency kit will somehow spiritually protect you from irritating dental emergencies.
Name 3 things you think everyone should know about wilderness dentistry.
- It can ruin an expedition
- Prevention is easy, general dental emergencies can be managed safely and effectively with basic training and minimal materials.
- Dental treatment is one of the most sought-after specialties in humanitarian deployments. The need is persistent and chronic. Dental clinics on these deployments have some of the longest lines. Not having a dentist on such deployments is ignoring that basic fact.
What do you always have in your first-aid kit?
Cavit or Coltasol, Glass Ionomer Filling material, Flat Plastic, Dental Excavator
About the speaker
Mr. Langdana is the Wilderness Expedition Dentistry (WED) Founder, a Wilderness and Expedition Dentistry Tutor, Honorary Fellow in Extreme & Wilderness Medicine, and Honorary Clinical Professor in Extreme Medicine. He is both a past consultant dentist for the British Antarctic Survey Medical Unit and a resident expedition dentist for AdventureMedic. He has many years of experience in Expedition/Wilderness and Remote Access Dentistry, having first become interested in this specialism while running dental camps in remote parts of India (where he did his Masters in Oral Surgery), and later when working in the Sultanate of Oman.
Burjor deepened and broadened his expedition medical experience through spending four seasons in the Antarctic; working as a VSO dentist in Malawi and working with Mobile Surgical Services in New Zealand.
The contributing author and editor for the dental chapter in the new Oxford Handbook of Expedition and Wilderness Medicine, Burjor has written numerous articles about his specialism, which have been published in AdventureMedic and in the dental section of competency guides for remote health care practitioners and expedition medicine. He has also lectured extensively on his subject and provides phone and email support for event medics.
His main passion these days is to train medics in the dark art of Expedition Dentistry, through running intensive yet interesting hands-on workshops.
Read more about WED here.