Nov 2014         BRITISH ANTARCTIC SURVEY MEDICAL UNIT
British Antarctic Survey Wintering staff Dental Assessment
BASMU 8 Form
Dear Colleague
The individual you are examining will shortly be deployed to the Antarctic for an extended period of time completely isolated from dental services. This could be for up to one year. Safeguarding the overall health and well-being of staff working in remote locations includes establishing thorough dental fitness prior to departing the UK. It is essential that all staff are dentally fit prior to travel to prevent avoidable emergencies in remote locations.
Please complete the attached form with appropriate radiographs for the patient. Your comments and the completed form will help us to determine the individual’s fitness for deployment. 
The individual will cover the reasonable cost of the examination, treatment and this report and will be responsible for returning the report and radiographs to BASMU (British Antarctic Survey Medical/Dental Unit). BAS fully understands and accepts it has no redress against you in the event of the individual encountering dental complications whilst in isolated areas but we would emphasise the importance of restoring carious lesions, removing teeth of poor prognosis or providing high quality root canal treatment where appropriate before signing the form.
We appreciate your support
Patient information for assessor (completed by patient)	
Name			Date of Birth									
Telephone		Email		
Antarctic Deployment Station		Winter deploy dates		to		

Information to be completed at assessment (completed by Dentist)	
Regular attender	   Yes		No		Irregular attender	Yes		No		
Year of last GDP dental appt.						

Reason for last attendance:	Pain		
	Perio.		
	Fillings		
	Endodontics		
	Oral surgery		
	Check-up 		
	Other		
Assessment report	

Soft tissue examination

BPE	
			
Active periodontal disease	 	

3rd molars	
Present	UR 8		UL8		
Potentially symptomatic	UR 8		UL 8		
		LR 8		LL 8			  LR 8		  LL8		

Please chart missing teeth, existing restorations, endodontically treated teeth and untreated disease if you have not been able to complete treatment you deem necessary to ensure the individual is dentally fit.

																	

8	7	6	5	4	3	2	1		1	2	3	4	5	6	7	8	
Right                                                                                                                                              Left	
8	7	6	5	4	3	2	1		1	2	3	4	5	6	7	8	

																

Radiographs attached 	
 B/W		
OPT 		
P/As		
Full mouth P/As		
Other		
Dates when taken											

Treatment identified at assessment visit and completed

	
	Treatment  not yet completed		

	

			
Potential areas of concern	

	

	

	

I have thoroughly dentally examined this individual before his/her travel to the Antarctic. All necessary treatment has been completed and I have identified what I believe could be potential areas of concern.

Summary	
This individual has good oral health and is not expected to need routine treatment within the next 12 months		
This individual has oral conditions as outlined above but these conditions are not expected to need urgent/emergency treatment within the next 12 months		
This individual has oral conditions as outlined above that may need urgent/emergency treatment within the next 12 months		

Additional comments (review of endodontically treated teeth, vitality tests of heavily restored or traumatised teeth, manifestations of systemic disease,  etc)

	

Signed	
	GDC 
Number			
Dentist Name		Performer’s List Number			
Date
		Practice telephone number			

Practice Stamp

	

Please remember to enclose radiographs as necessary. Thank you.