Introduction
Scouting is a global youth movement that aims to foster friendships, experiences, and active citizenship. Today, there are organizations in 174 countries with 57 million young people and dedicated volunteers [1]. The World Scout Jamboree (WSJ) is the world’s largest youth international event organized by the World Scout Movement every four years through a wide range of programs and outdoor camps that contribute to the development of young people [2].
The 25th WSJ was held in Saemangeum, Buan-gun, South Korea, with more than 43,000 young Scouts from 159 countries [3]. During the Jamboree period from August 1st to 8th in Buan-gun, the average relative humidity was 76.48%, the average temperature was 29.03ºC, and the average daily maximum temperature was 34.5ºC, representative of a hot and humid climate [4].
In this large-scale outdoor event, medical care is crucial for the participants to safely and comfortably enjoy camping and outdoor activities. Reports from long-term camps have emphasized the importance of first aid in preventing and treating trauma and infectious diseases [5,6]. In fact, the organization of healthcare at Jamborees has been an important issue since the earliest events, and several studies have been conducted on the implementation of camp-wide healthcare at scout camps and previous Jamborees [7-11].
However, most studies have focused on systemic diseases such as heat stroke and skin diseases, with limited information on dental care [8,11]. Even though Sir Baden Powell, the founder of the Scouts movement, emphasized the importance of good oral hygiene as a crucial element of civilized behavior in his book “Scouting for Boys”, there are no previous studies that have exclusively examined dental care at Jamborees[9]. Moreover, while dental research has been conducted at other international events, only a few studies have examined dental records in hot and humid summer camps with large numbers of adolescents [12-14].
This lack of research makes it difficult for future camp directors to plan and predict healthcare needs for a particular camp size, despite the fact that prevention as well as treatment of medical problems is a major task of health services when planning camps [15,16]. This is due to the fact that dental records have not been recorded in any standardized form, making analysis of dental emergencies impossible. Therefore, this study analyzed dental care at the 25th WSJ using a predesigned standardized dental chart to provide a reference for the operation of dental emergency clinics in future Jamborees and other large-scale youth events. The study was approved by the Institutional Review Board of Jeonbuk National University Hospital (IRB File No. CUH 2024-03-019).
Materials and Methods
1. Subjects
The dental charts of all patients treated at the Jamboree Emergency Dental Clinic during the 25th WSJ were examined. Dental care was provided at a dental bus located next to the entrance of Jamboree Hospital.
The dental team consisted of Korean and foreign medical volunteers (Table 1). The Korean dental team was composed of one local clinic dentist, one public health center dentist, and eight dentists from Jeonbuk National University Hospital. The international volunteer dentists included Taiwanese, Norwegian, and American dentists. Therefore, the dental clinic was able to provide treatment in Korean, English, and Chinese. If there were any problems with interpretation due to the rotation of the dentists, the Jamboree Central Hospital was able to provide interpretation services.
The dental bus was equipped with two unit chairs and basic treatment materials, including portable X-rays. Unavailable materials were procured from Jeonbuk National University Hospital. The patients were prescribed medications from the central hospital pharmacy. Patients who could not be treated at the clinic were referred to Wonkwang University Hospital.
2. Research methods
1) Dental charts
The dental chart for the Jamboree Dental Clinic was designed based on the emergency chart from Jeonbuk National University Dental Hospital, which was modified after discussions with the Jamboree Dental team to finalize the format. The chart was divided into two forms: a patient questionnaire form to be completed by the patient and a dental record to be completed by the dentist. The patient questionnaire included information such as gender, age, language used for consultation, nationality, medical and dental history, allergies, current medications, and injury descriptions in cases of trauma (Fig. 1). The dental records were categorized into trauma and non-trauma charts based on the patient’s chief complaint (Fig. 2A, 2B). Dental records included the date of visit, chief complaint, diagnosis, and treatment.
Charting was performed by the Jamboree dental team, with the patient’s questionnaire completed with the assistance of the dental team, and the dental records made by the dentist. The Jamboree dental team was trained in the charting method before the clinic opened.
2) Data collection
Data were collected using dental charts. From the patient questionnaire, data on gender, age, language used for consultation, and nationality were collected. From the dental records, the date of the visit, chief complaint, diagnosis, and treatment were collected. Patients were categorized according to age, with 14 - 17-year-olds classified as youth scouts and 18-year-olds and older classified as adult leaders. The official 25th WSJ period was from August 1st to 12th . However, there was an early exit on August 8th due to the threat of typhoons. Therefore, the visits were divided into the first half (July 30th - August 3rd) and the second half (August 4th - August 8th) of the event, including the preparation period for the Jamboree. Regions of origin were divided into Africa, Arab, Asia-Pacific, Eurasia, Europe, and Interamerica, as in the Scout Regions of the World Scout Organization [17].
3. Statistical analysis
Fisher’s exact tests were used to analyze the differences between youth scouts and adult leaders by gender, visit time (first half vs. second half), and region of origin. Because this study concerns the operation of the dental clinic, patients who were referred and were not treated on the dental bus were excluded. All statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA).
Results
1. Visit frequencies
Eighty visits of 71 patients were included in the study. There were 38 adult leader visits, corresponding to 2.9 per 1000 adult participants. The number of youth scouts was 33, which was 1.1 per 1000 youth scout participants (Table 2).
Before the opening, there were four adult leader visits. There was an increasing trend in visits towards the middle of the event, peaking around August 5th, followed by a decline. Finally, the clinic shut down on August 8th due to the threat of a typhoon (Fig. 3).
2. Regional distribution and consultation language
The largest number of patients was from the Asia-Pacific region (49.3%), followed by patients from Europe (40.8%). When compared by the number of patients per 1000 participants from that region, the visit rates for the Asia-Pacific and Europe regions were 2.6 and 1.4 per 1000 participants, respectively (Table 2). In terms of the number of visits by continent, Taiwan had the most visits in the Asia-Pacific region with 14 patients, and Germany had the most visits in Europe with 7 patients (Table 3).
English was the most spoken language among the patients, with 47 patients. Chinese was the second most common language used, followed by Korean with 15 and 9 patients, respectively (Table 2).
3. Chief complaints
Among the youth scouts, lesions of the lips (13 cases), orthodontic discomfort (8 cases), and oral ulcers (6 cases) were the most prevalent. In adult leaders, oral ulcers (8 cases), restoration loss (5 cases), and periodontitis (5 cases) were the most prevalent. Overall, oral ulcers (14 cases) and lesions of the lips (13 cases) were predominant (Fig. 4).
4. Comparison of adult leaders and youth scouts
The analysis showed a significant difference (p= 0.0023) in the distribution of patients between the first and second halves of the event. Among adult leaders, there were almost twice as many visits in the first half (63.2%) than in the second half (36.8%). In contrast, in the youth scout group, there were four times more patients in the second half (80%) of the event (Table 4).
Although there appeared to be a trend indicating a difference in the gender distribution between adult leaders and youth scouts, this difference was not statistically significant. There were also no statistically significant differences according to the region of origin.
Discussion
This study analyzed 80 dental emergencies of 71 patients from the 25th WSJ. In a study of the 2011 Sweden Jamboree by Jammer et al. [8], only 10 cases were reported. In another study at the 2015 Japan Jamboree, 60 cases were reported, which were only broken down by gender and whether they were youth or adults [11]. Hence, in previous studies, only the number of cases or brief demographic information of dental cases was available as part of the medical research. However, in our study, we were able to exclusively analyze dental patients by demographic information and chief complaints using standardized charts. With the increasing trend in dental cases in Jamborees, our study may help with patient prediction and preparation for future events.
When analyzing the daily visit frequency, the incidence of adult leader visits before the opening of the Jamboree was similar to the situation in the Japan Jamboree in terms of medical trends[11]. This implies that there is a possibility of the adult leaders being injured during the preparation process suggesting the need to finalize the clinical setting before the opening. The increase in the number of initial patient visits after opening was likely due to the development of stressful conditions from camping in a hot and humid climate and increasing orthodontic discomforts among youth scouts over time.
Meanwhile, the sharp decline from August 5th was due to early departures from participants from several countries. The United Kingdom Scouts (4,465 participants), the largest of the countries that participated in the Jamboree, announced their early departure on August 4th and the following day, along with the United States (1,072 participants) and Singapore (66 participants), they had their early departures [18]. As such, patient volumes are closely tied to environmental conditions and Jamboree events. Therefore, it seems important to stay alert to fluctuating patient flows in response to changing circumstances.
In terms of regional distribution, most patients were from Asia-Pacific (49.3%) and Europe (40.8%). This trend is likely due to the presence of Korean, Taiwanese, and European dentists in the dental team, which increased accessibility to the clinic. When comparing the ratio based on the population of each continent, Asia-Pacific had twice as many patients per 1,000 participants as the other regions. The high rate of Asians was mainly attributed to the presence of 13 Taiwanese patients with lesions of the lips.
The main consultation languages were English, Chinese, and Korean. The Jamboree dental team had a multinational dental staff that allowed for treatment in English, Chinese, and Korean. Previous studies have shown that providing care in a language other than the patient’ s native tongue can lead to miscommunication, resulting in lower patient satisfaction and poorer adherence to prescriptions [19-21]. In Jamborees, a multinational dental team or volunteer interpreters may effectively address language barriers.
In terms of chief complaints, our study reported that oral ulcers (19.7%), lesions of the lips (18.3%), and orthodontic discomfort (15.5%) were the most prevalent chief complaints, which were quite different from typical dental emergency rooms.
Studies of dental emergency rooms in South Korea have reported trauma as the chief complaint in 60 - 66% of cases [22,23]. Internationally, a study conducted on dental emergencies in Taiwanese hospitals found that pulp-related problems were the most common (36.7%), followed by periodontal problems (22.9%) and trauma (22.2%) [24]. In an Australian study, dental infections (35.8%) were the most common, followed by toothaches (30.3%) [25]. This unexpected difference may be due to the special environmental settings where most of the patients were camping in a hot and humid climate, resulting in limited activities.
The chief complaints in our study were mostly related to the hot and humid conditions. The etiology of oral ulcers is diverse, including stressful environments, extreme weather, dehydration, and mental health [26]. In addition, certain microbial agents or systemic diseases can result in ulcers [27]. As dentists are closer observers of oral ulcers than physicians, they can facilitate early detection and screening for systemic diseases or infections [28]. Moreover, lesions of the lips were reported to result from sunburn and dehydration in the collected Jamboree medical records. It is reported that exposure of the lips to various harmful agents, including adverse weather conditions, can cause inflammation [29]. The Taiwanese scouts had a close relationship with the Taiwanese dentist and were therefore exclusively treated in the dental clinic. However, patients from other countries presumably had lesions of the lips and would have been seen at the Jamboree medical clinic immediately. The lesions of the lips in some of these patients were severe, some even requiring referral to a university hospital. As a result, the patients were referred to a pediatrician to determine if the condition was an emergency and to determine the appropriate treatment. Most lip conditions are relatively easy to treat if the abnormalities are detected early [30]. Dentists should be aware of the causes of ulcers and lesions of the lips to enable accurate screening and facilitate effective cooperation with the medical teams.
In the 25th WSJ dental clinic, eight out of ten of the Korean dentists and dental students who assisted were sent from the local national university. In addition, instruments for unexpected procedures, such as orthodontic complaints were also obtained from the same local university hospital within one day of the patient’s visit, allowing all patients with dental problems to be treated without referral to the local hospital. In this special setting, where patients’ chief complaints are different from a typical emergency dental clinic, unexpected problems can arise despite adequate preparation, and therefore, operations should be conducted in community-based dental hospitals to allow for immediate and efficient responses in international camps.
Previous studies have provided limited information about emergency dental clinics in Jamborees while this study was able to analyze Jamboree dental charts and categorize their characteristics according to the patients’ chief complaints. This study may help plan dental clinic operations for future Jamborees and international youth summer events.
However, because this study included only data from the 25th WSJ, it is difficult to generalize the results to all Jamborees, and an in-depth analysis of the causes of the chief complaint was limited. Continuous data collection from this international quadrennial event will allow specific patient screening and guidelines that may lead to more effective treatments in the future.
Conclusion
We found a higher incidence of dental conditions associated with hot and humid environments, which differ from typical dental emergencies. Moreover, our findings suggest the need to prepare for characteristic dental discomfort in adolescents and dental problems in adults accompanying adolescent participants. Therefore, despite adequate preparation, unexpected dental visits may occur, and it is recommended that operations be based in community-based dental hospitals to allow for immediate and efficient responses in large-scale international youth camps.
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