Seafarers and good oral health: An essential but challenging combination

By Nina Garlo-Melkas

Päivi Miilunpalo, a Seafarers’ doctor, has worked for more than ten years as an occupational physician at the Turku Maritime Health Centre

Day of the Seafarer is celebrated on 25 June annually. It is a day to pay tribute to 2 million seafarers —who help transport 90% of the world’s total global trade — keeping the wheels of the global economy turning.

Seafarers enables the maritime industry to operate. Maritime work can be physically and mentally challenging, threatening seafarers’ general and oral health.

Päivi Miilunpalo, a seafarers’ doctor, has worked for more than ten years as an occupational physician at the Turku Maritime Health Centre, where she is responsible for Finnish seafarers’ health care. She is also a senior medical doctor at the Institute of Occupational Health (TTL), caring for seafarers’ health issues nationwide.

Miilunpalo said that the oral health of seafarers is a problem in the shipping industry. Seafarers live on ships for months, with limited access to medical treatment.

If a tooth infection or a severe toothache strikes in the middle of the ocean during a long voyage, seafarers must be moved off ships. Hence, good oral health and preventive dental care are crucial for maritime workers.

Seafarers are at risk of oral disease

Research shows seafarers are at risk of oral health problems. The main risk factors for oral diseases are related to seafarers’ oral hygiene and eating habits, as well as the frequent use of tobacco products and alcohol.

The eating habits of seafarers during long sea voyages can threaten oral health. Extended working hours and lack of physical activity often lead to high consumption of coffee and sugary drinks, frequent snacking and a high carbohydrate diet. These factors increase the risk of tooth decay and the risk of developing severe gum diseases, such as periodontitis, if oral hygiene routines are not ideal.

Studies showed tooth decay poses a greater risk for seafarers than the general population. A toothache can be difficult to treat with the medicines found in the medical kits on board. Severe pain can adversely affect their performance, disturb their concentration and pose a safety risk on board.

Dental care systems and the quality of care in foreign ports can also vary from what seafarers are used to at home. Hence seafarers must take care of their oral health and have regular dental check-ups, especially before embarking.

Anticipation in the maritime sector

Proactive health care and disease prevention are essential for workers in the maritime sector. As working at sea results in delayed access to treatment. These delays can be critical to a person’s life, added Miilunpalo.

According to her, seafarers’ occupational health checks include assessing their fitness to work on ships. In Finland, a licensed seafarer’s doctor carries out the initial examination of a seafarer and a valid medical certificate is required before entering the profession or commencing its related studies. A seafarer’s doctor can also renew one’s certificate outside the marine health centre.

Greater awareness on oral hygiene education is needed as life at sea, under challenging circumstances, is stressful. Seafarers need to be given thorough information about correct oral hygiene protocols, dental hygiene and the advantages of keeping a healthy mouth. Poor oral hygiene has also been linked to other health issues, such as cardiovascular disease, respiratory disease, and rheumatoid arthritis.  

Regular oral health checks needed

In Finland, Helsinki city maintains health services for seafarers. These services include oral health care and approved seafarers’ doctors are increasingly checking patients’ mouths during regular health examinations. But an oral examination done by an occupational health physician is not the equivalent to an assessment conducted by a dentist, and seafarers do not have an invitation system for regular dental check-ups yet, according to Miilunpalo.

It is therefore vital for a seafarer’s doctors to refer their patients to dental treatments immediately when oral problems arise, such as a chronic inflammation in the mouth. Further, regular dental visits are encouraged because they help identify symptoms of oral problems early.

Timely intervention is key

Miilunpalo also added that the aim of statutory health checks of seafarers is to ensure that risk factors can be addressed in a timely manner. She said, “We aim to emphasise the importance of preventive health care. If a person already has an illness, we want to keep it under control so that it does not prevent them from continuing to work on board.”

Further, the increased use of drugs among the young is common in Finnish maritime sector. She said that substance abuse is also reflected in oral health. According to a population survey conducted by the National Institute for Health and Welfare (THL) in 2018, 24% of Finns aged 15-69 have tried cannabis at some point in their lives. Drug experimentation and use has become common among young adults aged 25-34, which is also reflected in the oral health of young people. Drugs such as cannabis, amphetamines and opioids dry out the mouth, making people prone to oral diseases such as tooth decay, gingivitis and periodontitis.