STUDY OBJECTIVE: To study crew referrals to out-patient port services from 3 passenger ships during 12 months (2004), with focus on dentist appointments. The median number of crew on Ship A was 561, on Ship B 534 and on Ship C 614. METHODS: Crew referrals were registered continuously and after each cruise segment recorded in the ship's doctor's medical cruise report, from which the data were retrieved and reviewed. RESULTS: During 2004 the doctors of the 3 sister ships had a total of 8888 crew consultations (Table 1). Mean number of doctor consultations for crew was 17.5 a day. On Ship A 50%, on B 59% and on C 70% of the port referrals were dentist appointments. A crew member was referred to a dentist every 7 (Ship C) to 10 days (Ships A + B). Among the specified dental referrals, 18% were extraction requests. CONCLUSIONS: The ship's doctors had a busy crew practice, but were neither trained nor equipped to do elective dentistry aboard. Crew referral rate to services ashore was low, but 50-70% of the referrals for out-patient port services concerned dentistry. Inadequate health insurance caused low-wage crew to request free extractions instead of expensive repair in high-cost ports. As dentistry in local ports is a poor substitute for the person's own dentist, doctors performing seafarer examinations should ensure that dental problems are solved before sign-on.