By Gary F. Arnet, D.D.S

Enjoying lunch while lookingout over the gorgeous viewfrom your backcountryhome, you bite down hard

on a nut, hear a loud crack, andimmediately feel excruciating painfrom a broken tooth. Rare? No, itoccurs all the time.

Dental emergencies can occur athome or in the wilderness withoutwarning and can incapacitate a personin an instant. “No problem, I’ll getright over to the dentist,” you think.Hopefully, that is possible, but notalways. You may live some distancefrom a dentist, it may be a night orweekend when it is hard to find one,or there may not be any available.

One of the first things that stop dur-ing a disaster is dental care. Majornatural disasters, such as earthquakes,fires, or floods, and human disasters,such as terrorism or riots, close dentaloffices in a second. Electrical short-ages, as seen in California recently, orany disruption of the regional powergrids and there is no help since den-tists can’t operate without electricity.Hospitals rarely have any dental serv-ices, so you could be on your own forhours or days.

Since dental first aid is rarely taughtin first aid classes, information pre-sented here is intended to help you inan emergency situation when no pro-fessional dental help is available. It isnot intended to be a substitute forproper dental care.

PreventionLiving in a rural area, avid hunter,

fisherman, and dentist Dr. KennethLund has much experience with den-tal emergencies. “Nothing can ruin agood hunting trip like a toothache,”Dr. Lund says. “Anyone going on anextended trip, say over a week,should make sure they are currentwith their dental check-ups.” This is

good advice for everyone, whethertraveling or staying at home.

A routine visit to the dentist canprevent many painful dental prob-lems. Professional cleanings help pre-vent gum infections. Fillings that are

starting to fail can be fixed beforebreaking at an inconvenient time. Asmall cavity in a tooth that causes nopain can be easily repaired before itdoes.

Proper care of teeth is important.Brush and floss teeth regularly toavoid cavities and gum infections.This is especially important during atime of crisis, such as a disaster orevacuation. While brushing is the lastthing on your mind, gingivitis or guminfections are more frequent duringtimes of emotional and physicalstress, especially when coupled withpoor oral hygiene.

A toothbrush with toothpaste isalways the best way to clean yourteeth. If one is not available or youfind yourself in an emergency sur-vival situation, clean your teeth inother ways. A wash cloth or towel canbe used to remove the soft, sticky,bacteria-laden plaque that developson the surface of the teeth. The end ofa thin green twig from a non-poison-ous tree or bush can be used. Chew ituntil it is soft and fibery and use thisend as a brush to clean the teeth andgums. Even your finger will work ifnothing else is available.

Dental first aid kitThe first time I needed to treat a

broken tooth while backpacking, Iopened my first aid kit and there wasnothing that would help. I’ll bet yoursis the same. A few small, lightweightitems available at a drug store or mar-ket can be added to your first aid kitto treat dental emergencies. I recom-mend the following:

• Dental floss• Soft dental or orthodontic wax• Cotton pellets• Tempanol or Cavit temporary fill-

ing material• Oil of cloves (eugenol)• Small dental tweezersWhen working in the mouth,

remember to always wear protectivegloves from your first aid kit to pre-vent the spread of infectious diseases.

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No dentist?

A toothache is the last thing youneed when no dentist is available.Basic knowledge of dental first aidand a few things added to your firstaid kit will help you until you can

find professional help.

OH, NO!OH, NO!

ToothacheA toothache is caused by the

inflammation of the nerve inside atooth, called the dental pulp. Decayfrom a cavity that extends into thepulp can cause a toothache, as can afracture of the tooth. If infectionoccurs in the tooth, i t can causeexcruciating pain and can spreadthrough the root of the tooth into thejaw causing an abscess.

Symptoms of a toothache includepain in a certain tooth or over severalteeth. At first, the pain may be mild,intermittent, and made worse with hotor cold foods or drink, cold air, andthe pressure of biting. As it progress-es, the pain may become constant,excruciating, and incapacitating.

Sometimes, an abscessed tooth willslowly drain infection into a largecavity. After a meal, when food ispacked into the cavity, the drainagemay be blocked and the pressure willincrease in the tooth causing thetoothache to become worse until thefood is cleaned out.

Treatment of a toothache consists oflocating the painful tooth and check-ing for any obvious cavity or fracture.Clean out any food with a toothbrush,toothpick, or similar tool. Then soaka small cotton pellet or, if not avail-able, a small piece of cloth, in a topi-cal anesthetic, such as a eugenol orbenzocaine solution. This should thenbe placed in the cavity. A small pairof dental tweezers, like the type pro-vided in commercial toothache kits,tick removing tweezers, or a smallinstrument like a toothpick is helpfulin placing the cotton as it is oftenhard to get your fingers into themouth. This topical anesthetic shouldgive quick relief.

The type of topical anesthetic usedis important. Dentists use pureeugenol for emergency treatment oftoothaches since it is long-lasting, butthis can be difficult to find. Oil ofcloves is the same thing and is avail-able without prescription at pharma-

cies and some health food stores. Becareful, however, as pure oil of clovescan cause chemical burns to themouth and tongue if it gets off thetooth.

Commercial toothache medicationsthat are available include Red CrossToothache Medicine containing 85%eugenol, Dent’s Toothache Dropscontaining benzocaine and eugenol,and Orajel containing benzocaine.Some products include the small den-tal tweezers and cotton pellets thatyou will need.

Once the medicated cotton is inplace, cover it with a temporary fill-ing material, such as Tempanol orCavit to prevent it from falling out.These are all soft, putty-like materialsthat can be molded into the cavity. Ifthey are not available, soft dental waxor softened wax from a candle can beused. If a candle is used, melt somewax and let it cool until it is pliablebefore placing in the mouth.

A pain medication, such as 800mgMotrin every 8 hours, or prescriptionpain medicines, such as Vicodin, 1-2every four to six hours, can be used if

available. Do not place aspirin on thegum next to a painful tooth. Not onlydoesn’t it help, it causes a large,painful burn to the gum tissue.

Seek help from a dentist immedi-ately. If it takes some time to findone, it may be necessary to replacethe cotton pellet with another freshlysoaked in topical anesthetic.

GingivitisGingivitis is an inflammation of the

gums (gingiva) most commonly dueto inadequate tooth brushing. Gumsbecome red, swollen, and may bleedwhile brushing the teeth. It is largelypreventable by good oral hygiene andregular dental check-ups. When gin-givitis causes pain and bleeding in thefield, improve oral hygiene by brush-ing three times per day, followed bywarm salt-water rinses. Over-the-counter anti-bacterial mouthwashesmay also help.

Dental abscessAn infected tooth or gum infection

(gingival infection) can cause a dentalabscess, also known as a pus pocket.

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Dental items to add to your first aid kit: Cavit or Tempanol temporary filling material, eugenol or benzocaine-based toothache medicine,

cotton pellets, small tweezers, small tool for placing filling material, soft dental wax, and dental floss.

Food lodged between the teeth canalso do so if not removed with dentalfloss.

Abscesses are normally locatednext to the offending tooth and causepain and swelling. They can spreadbeyond the tooth to the face, floor ofthe mouth, or neck and it may be dif-ficult to open the mouth or swallow.On rare occasions, dental abscessescan become life-threatening by get-ting so large that they block breathingor by causing fever or generalizedinfection throughout the body. Dealwith any abscess immediately.

Antibiotics are required to treatabscesses. Go to a dentist immediate-ly. If one is not available or if there issevere swelling go to a physician orhospital emergency room. When den-tal or medical help is not availableand the situation is an emergency,oral antibiotics, such as penicillin 500mg every six hours, can be given,after making sure the person is notallergic to the medication.

Warm salt-water rinses of themouth every four hours may help theabscess to spontaneously drain, giv-

ing some relief of the pain. Do notplace hot packs to the outside of theface unless directed to by your dentistor physician, as heat can spread theinfection outward. Pain medicationsmay be used as described above.

In the rare situation where no pro-fessional help is expected to be avail-able for some time and no antibioticsare available, an abscess that is local-ized next to a tooth can be drained toremove the pus. A sterile scalpel, nee-dle, or a fishhook (with the barbremoved and disinfected by heatingwith a match) may be used to punc-ture the abscess. It will be painful todo, but there should be immediaterelief from the abscess.

Broken filling or lost crown

Biting down on candy, nuts, icecubes, and other hard or sticky foodsare common ways to break a tooth orfilling. If the tooth is not painful, becareful not to break it further duringeating and see a dentist as soon aspossible.

A temporary filling can be placed toprevent the tooth from becoming sen-sitive to hot or cold and to avoid foodfrom packing into the hole left by thefilling. Place a small amount of atemporary filling material, such asTempanol or Cavit, into the hole inthe tooth using a dental instrument ora flat tool such as the blade of a knife,popsicle stick, or similar tools. Havethe person bite down on the tempo-rary material to form it to their biteand then have them open their mouthand remove any excess material.These materials will harden some andremain in place. Soft wax also can beused in the same manner as filling acavity described above.

Crowns (caps) can be pulled offteeth by sticky foods, such as carameland salt-water taffy. If the tooth is notsensitive to hot or cold, save thecrown and see a dentist as soon asconvenient.

If the tooth is so sensitive that itprevents the person from eating, itmay be necessary to replace it tem-porarily. Do this only if really neces-sary, as this is only a temporary solu-tion and there is a risk that the crowncould come off and be swallowed.Clean out any dry cement or materialfrom the inside of the crown with adental instrument or knife. Place athin layer of temporary filling materi-al, denture adhesive, or even a thickmixture of water and flour inside thecrown. Making sure the crown isaligned properly on the tooth, havethe person gently bite down to seatthe crown all the way and see a den-tist as soon as possible.

Injuries to teeth A fall or blow to the mouth can

injure teeth, most commonly theupper front teeth. Teeth may be in anormal position, but loose whentouched, may be partially out of thesocket or pushed back, or may becompletely knocked out. Unless it iscompletely knocked out, the firstthing you should do is see a dentist.

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Over-the-counter toothache medicines will help ease the pain from a toothacheor broken tooth. Many are available, including those containing eugenol (oil of

cloves), such as Red Cross Toothache Medicine, benzocaine, such as Orajel,and those containing both, such as Dent’s Toothache Drops.

When one is not available within areasonable time, a tooth that is out ofplace may be repositioned withsteady, gentle pressure to bring itback into proper position. If it is veryloose, gently biting on a piece ofgauze can help hold it in place. Adentist should be seen as soon as pos-sible, as the tooth may need to besplinted to hold it in place until heal-ing occurs.

When a tooth is completelyknocked out (avulsed), what you doin the first 30 minutes determineswhether the tooth can be saved. Theligaments that hold a tooth into thejaw are torn along with the nerve andblood vessels when it is knocked outof its socket and it is essentially a“dead tooth.” When re-implanted intothe tooth socket within 30 minutesthe body will usually accept it and theligaments will reattach. While it willrequire a root canal to remove thedead nerve and blood vessels, it willbe a functioning tooth.

Over 30 minutes before it is re-implanted and the body treats it likeforeign material and slowly dissolvesthe root over a period of weeks tomonths. Often the tooth needs to beextracted.

To treat an avulsed tooth, find thetooth on the ground or in the person’smouth. If the socket is bleeding, havethe person bite down on gauze padsplaced over the top of the socket. Amoistened non-herbal tea bag mayalso be used.

Check the tooth to make sure it iswhole and not broken. Handling thetooth only by the crown, the part thatnormally shows in the mouth, cleanoff any dirt or debris by gently rins-ing the tooth with sterile saline, disin-fected water, or milk. It is importantthat you do not touch the thin, whitishcolored layer of soft tissue coveringthe root. This is the important layer ofperiodontal ligament that will allowthe tooth to reattach. Replace thetooth into the tooth socket and withgentle, steady pressure push it into

place. Have the person bite downlightly on a piece of gauze to hold itin place and see a dentist immediatelyto have the tooth stabilized.

If a tooth cannot be immediately re-implanted, it should be wrapped ingauze and soaked in a container ofsterile saline solution, milk, or theinjured person’s saliva while they areimmediately taken to a dentist. Somerecommend keeping the tooth moistby placing it in the victim’s mouth.This does work, but the tooth can alsoaccidentally be swallowed.

Dental emergencies are more com-mon than most people realize. Whileyou most often will be able to obtainhelp from a dentist, there are timeswhen you may be on your own.Prevention, knowledge, and a fewimportant items in a dental first aidkit can save you and your family dur-ing these times. ∆

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