Dr. Bob's Blog

Posts for tag: Treating Dental emergencies

By drmalenius
May 16, 2010
Category: Uncategorized

 

UP THE CREEK WITHOUT A DENTIST!!!

 

 

 

You're sitting on the bank of a slow moving river at sunset, enjoying a delightful shore side dinner when you suddenly bite down hard on an unsuspected piece of bone, hear a loud crack, and immediately feel excruciating pain from a broken tooth. Surprisingly, this occurs quite often in the backcountry.
Dental emergencies can occur at home or in the wilderness without warning and can incapacitate you instanly. Around the house you may be able to get a hold of a dentist immediately, but on the weekend, or in new area, or especially in the wilderness you may be on your own for the a while.

Natural disasters such as the earthquakes in Haiti, foods, fires, human disasters caused by terrorism and riots, or just plain everyday problems in remote areas cause problems due to the lack of electricity which needed for a dental office to operate.. Hospitals rarely have any dental services, so you could be on your own for hours or days.

Very rarely is dental first aid taught so here is some information intended to help you in an emergency situation when no professional dental help is available. It is not intended to be a substitute for proper dental care.

 

Prevention:


All my life, I've spent as much time as possible outdoors, either photographing nature, fishing, camping, hunting, or playing sports. From experience I can tell you nothing ruins an extended trip, outdoor adventure, or pleasant day away than dental pain. The best insurance against such disaster is simple home care, regular dental checkups, and treatment if necessary. This advice is sound for everyone, whether traveling or staying at home. Regular cleanings help prevent gum infections, fillings that are starting to fail can be replaced before suddenly breaking at the wrong time and small painless cavities in teeth can be repaired before they become deep and painful.
Proper home care of your teeth is very important. Brush and floss your teeth regularly to avoid cavities and gum infections. In times of crisis, brushing and flossing are the last things on your mind, and the result is gingivitis ( gum infections) are more frequent during times of emotional and physical stress.
Brushing with a toothbrush with toothpaste is the simplest way to clean your teeth. In an emergency survival situation you have to find a temporary way to clean your teeth. A wash cloth or towel can be used to remove the soft, sticky, bacteria-laden plaque that develops on the surface of your teeth. The end of a thin green twig from a tree or bush can be chewed until it is soft and fibrous and this end can be used to clean the teeth and gums. You can even use your finger if nothing else is available.


Dental first aid kit
:


It's easy to add a few items to your first aid kit to use when traveling or in the outdoors. I recommend the following:
- Dental floss
- Soft dental or orthodontic wax
- Cotton pellets
- Tempanol or Cavit temporary filling material
- Oil of cloves (eugenol)
- OralJel (benzocaine)
- Dent's Toothache Drops (Eugenol and Benzocaine)
- Small dental tweezers
- Protective gloves
- Denture adhesive crème
Remember it's always a good idea to wear gloves when working in the mouth if available to help prevent the spread of germs.

 

Toothache:

A toothache is caused by the inflammation of the central nerve inside a tooth (called the dental pulp). Decay (bacterial infection) from a cavity that extends into the pulp can cause a toothache, as can a fracture of the tooth. If infection occurs in the pulp, it can cause excruciating pain and can spread through the root of the tooth into the jaw causing an abscess.
Symptoms of a toothache include pain in an isolated tooth or spread over several teeth. At first, the pain may be mild, intermittent, and made worse with hot or cold temperature changes caused by food or drink, cold air, orby the biting pressure. As it progresses, the pain may become constant, excruciating, and incapacitating.
Sometimes, an abscessed tooth will slowly drain infection into a large cavity. After a meal, when food is packed into the cavity, the drainage may be blocked and the pressure will increase in the tooth causing the toothache to become worse until the food is cleaned out.
Treatment of a toothache consists of locating the painful tooth and checking for any obvious cavity or fracture. Clean out any food or debris with a toothbrush, toothpick, or similar tool. Then soak a small cotton pellet or, if not available, a small piece of cloth, in a topical anesthetic, such as a eugenol o ra benzocaine solution. This should then be placed in the cavity. A small pair of dental tweezers, like the type provided in commercial toothache kits, tick removing tweezers, or a small instrument like a toothpick is helpful in placing the cotton. This topical anesthetic should give quick relief. Placing aspirin on the gums next to the tooth can cause even greater pain by causing a chemical burn of the tissue and is strongly advised against.
The type of topical anesthetic used is important. Dentists use pure eugenol (oil of clove) for emergency treatment of toothaches because it is long-lasting. Oil of cloves is available without prescription at pharmacies and some health food stores. Be careful, however, as pure oil of cloves can cause chemical burns to the mouth and tongue if it gets off the tooth just like aspirin.
Commercial toothache medications that are available include Red Cross Toothache Medicine containing 85% eugenol, Dent's Toothache Drops containing benzocaine and eugenol, and Orajel containing benzocaine. Some products include the small dental tweezers and cotton pellets that you will need.
Once the medicated cotton is in place, cover it with a temporary filling material, such as Tempanol or Cavit to prevent it from falling out. These are all soft, putty-like materials that can be molded into the cavity. If they are not available, soft dental wax or softened wax from a candle can be used. If a candle is used, melt some wax and let it cool until it is pliable before placing in the mouth.
A pain medication, such as 800mg Motrin every 8 hours, or prescription pain medicines, such as Vicodin, 1-2 every four to six hours, can be used if available. Once again, Do Not Place Aspirin On The Gum next to a painful tooth. Not only doesn't it help, it causes a large, painful burn to the gum tissue.
Seek help from a dentist immediately. If it takes some time to find one, it may be necessary to replace the cotton pellet with another freshly soaked in topical anesthetic.


Gingivitis:


Gingivitis is an inflammation of the gums (gingiva) most commonly due to inadequate tooth brushing and lack of flossing. Gums become red, swollen, and may bleed while brushing the teeth. It is largely preventable by good oral hygiene and regular dental check-ups. When gingivitis causes pain and bleeding in the field, improve oral hygiene by brushing three times per day, followed by warm salt-water rinses. Over-the-counter anti-bacterial mouthwashes may also help.


Dental abscess:


An infected tooth or gum infection (gingival infection) can cause a dental abscess. Food lodged between the teeth can also do so if not removed with dental floss.
Abscesses are normally located next to the offending tooth and cause pain and swelling. They can spread beyond the tooth to the face, floor of the mouth, or neck and it may be difficult to open the mouth or swallow. On rare occasions, dental abscesses can become life-threatening by getting so large that they block breathing or by causing fever or generalized infection throughout the body. Deal with any abscess immediately.
Antibiotics are required to treat abscesses. Go to a dentist immediately. If one is not available or if there is severe swelling go to a physician or hospital emergency room. When dental or medical help is not available and the situation is an emergency, oral antibiotics, such as amoxicillan 500 mg every six hours, can be given, after making sure the person is not allergic to the medication.
Warm salt-water rinses of the mouth every four hours may help the abscess to spontaneously drain, giving some relief of the pain. Do not place hot packs to the outside of the face unless directed to by your dentist or physician. Heat can spread the infection outward. Pain medications may be used as described above.
In the rare situation where no professional help is expected to be available for some time and no antibiotics are available, an abscess that is localized next to a tooth can be drained to remove the pus. A sterile scalpel, needle, or a debarbed fishhook ( disinfected by heating with a match) may be used to puncture the abscess. It will be painful to do, but there should be immediate relief from the abscess.


Broken filling or lost crown
:


Biting down on candy, nuts, ice cubes, and other hard or sticky foods are common ways to break a tooth or filling. If the tooth is not painful, be careful not to break it further and see a dentist as soon as possible.
A temporary filling can be placed to prevent the tooth from becoming sensitive to hot or cold and to avoid food from packing into the void. Place a small amount of a temporary filling material, such as Tempanol or Cavit, into the hole in the tooth using a dental instrument or a flat tool such as the blade of a knife, popsicle stick, or similar tools. Bite down on the temporary material to form it to your bite and then have them open your mouth and remove any excess material. These materials will harden some and remain in place. Soft wax also can be used in the same manner as filling a cavity described above.
Crowns (caps) can be pulled off teeth by sticky foods, such as caramel and salt-water taffy. If the tooth is not sensitive to hot or cold, save the crown and see a dentist as soon as convenient.
If the tooth is so sensitive that it prevents the person from eating, it may be necessary to replace it temporarily. Do this only if really necessary, as this is only a temporary solution and there is a risk that the crown could come off and be swallowed. Clean out any dry cement or material from the inside of the crown with a dental instrument or knife. Place a thin layer of temporary filling material, denture adhesive, or even a thick mixture of water and flour inside the crown. Making sure the crown is aligned properly on the tooth, have the person gently bite down to seat the crown all the way and see a dentist as soon as possible.


Injuries to teeth:


A fall or blow to the mouth can injure teeth, most commonly the upper front teeth. Teeth may be in a normal position, but loose when touched, may be partially out of the socket or pushed back, or may be completely knocked out. Unless it is completely knocked out, the first thing you should do is see a dentist.
When one is not available within a reasonable time, a tooth that is out of place may be repositioned with steady, gentle pressure to bring it back into proper position. If it is very loose, gently biting on a piece of gauze can help hold it in place. A dentist should be seen as soon as possible, as the tooth may need to be splinted to hold it in place until healing occurs.
When a tooth is completely knocked out (avulsed), what you do in the first 30 minutes determines whether the tooth can be saved. The ligaments that hold a tooth into the jaw are torn along with the nerve and blood vessels when it is knocked out of its socket and it is essentially a "dead tooth." When re-implanted into the tooth socket within 30 minutes the body will usually accept it and the ligaments will reattach. While it will require a root canal to remove the dead nerve and blood vessels, it will be a functioning tooth.
Over 30 minutes before it is re-implanted and the body treats it like foreign material and slowly dissolves the root over a period of weeks to months. Often the tooth needs to be extracted.
To treat an avulsed tooth, find the tooth on the ground or in the person's mouth. If the socket is bleeding, have the person bite down on gauze pads placed over the top of the socket. A moistened non-herbal tea bag may also be used.
Check the tooth to make sure it is whole and not broken. Handling the tooth only by the crown, the part that normally shows in the mouth, clean off any dirt or debris by gently rinsing the tooth with sterile saline, disinfected water, or milk. It is important that you do not touch the thin, whitish colored layer of soft tissue covering the root. This is the important layer of periodontal ligament that will allow the tooth to reattach. Replace the tooth into the tooth socket and with gentle, steady pressure push it into place. Have the person bite down lightly on a piece of gauze to hold it in place and see a dentist immediately to have the tooth stabilized.
If a tooth cannot be immediately re-implanted, it should be wrapped in gauze and soaked in a container of sterile saline solution, milk, or the injured person's saliva while they are immediately taken to a dentist. Some recommend keeping the tooth moist by placing it in the victim's mouth. This does work, but the tooth can also accidentally be swallowed.


Dental emergencies are more common than most people realize. While you most often will be able to obtain help from a dentist, there are times when you may be on your own. Prevention, knowledge, and a few important items in a dental first aid kit can save you and your family during these times.

 

 

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