Most issues with the teeth are not easily self-treated, and as such, they should not be.
When there is no dentist, e.g., in a survival situation, extraction of the problematic tooth will solve most dental emergencies; Diagnoses and Treatments – Head – Mouth and Teeth – Dental Extraction.
Crown: above the gum line.
Root: below the crown.
Alveolus: where the tooth sits.
Ligaments: what holds the tooth to the alveolar.
Enamel: the outside of the tooth, i.e., the white surface that you see.
Dentin: underneath the enamel and surrounding the pulp.
Pulp: all the blood vessels, nerves etc. that are in the middle of the tooth.
In any dental procedure:
Wear gloves, mask, eye protection etc.
Try to keep the area around the tooth as dry as possible.
Use cotton balls or rolled gauze around the tooth to help control bleeding.
The common toothache (pulpitis) is mainly caused by a bacterial infection which is a cause of tooth decay. It is an inflammation of the dental pulp tissue.
Increased sensitivity to hot/cold stimuli.
Throbbing pain, radiating to the eye or ear region.
Go to a dentist.
Clove oil applied topically will ease the pain.
If no dentist is available:
Be sure to identify the bad tooth correctly.
A dental mirror and pick will be useful.
Look for obvious cavities, abscess, trauma etc.
If nothing obvious is present, use hot/cold stimuli to further investigate.
Touch the teeth where there is the problem with something cold. A bad tooth is very sensitive to cold.
Touch this same tooth with something hot.
If there is pain there it may need to be extracted.
If there is no pain to heat, it can be repaired.
Remove decay and fill.
If there is no sensitivity to hot or cold but pain to the slightest touch, there is root nerve damage and extraction is needed; Diagnoses and Treatments – Head – Mouth and Teeth – Dental Extraction.
In a survival situation, treatment for a diseased tooth is extraction - the sooner the better.
Pharmaceuticals:
NSAIDs.
Extracting a tooth is extremely difficult, especially if untrained, and even more so in a survival situation where you may not have access to the proper tools. On the other hand, extraction will fix almost all otherwise non-treatable dental issues. This is good to know if you find yourself in a survival-type situation in which there isn’t a dentist.
The procedure will cause lots of pain, so analgesic is advised.
Tools Needed for Field Dental Extraction:
Analgesic.
Elevator (left picture).
Extraction Forceps (right picture).
Gauze.
Improvise if the correct tools are not available.
Procedure for Field Dental Extraction
Position yourself correctly:
Ø If you are right handed, stand to the right of the patient and if you are a left hander, stand to the left.
Ø If working on the upper teeth, the patient’s mouth is best at your elbow height; have the patient head down at a 60 degree angle to the floor.
Ø If working on the lower teeth, the patient’s mouth is best lower than your elbow and the patient sits upright.
Most people prefer to be in front of the patient except for lower molars where you might be better off behind.
Numb the tooth if possible. Clove oil contains eugenol which is well known for being a dental analgesic. Use a high concentration but be careful as it can burn the mouth, i.e., only apply it to the teeth.
Loosen the tooth. Using a dental elevator or similar (see picture above), apply light pressure between the tooth and gum on all sides to sever the ligaments and get to the root area. It will bleed.
Remove the tooth. If the tooth does not come out after severing the ligaments, use the extraction forceps (or similar) and grip the tooth as far down the root as possible.
Front teeth have one root. Pull them straight out, following the line of the tooth, i.e., directly down or up depending on if they are upper or lower teeth.
For other teeth, which have more than one root, use a rocking motion to help loosen it as you pull it out. Once loose, extract the tooth away from the tongue.
Commonly, the tooth will break. Use an elevator to push the remainder out.
Put gauze on the bleeding socket. The patient must bite down on it to keep it in place. Heavy bleeding may require stitches.
After-care of a tooth extraction:
Cold packs for first 48 hours to reduce swelling.
Warm compresses beyond 48 hours to reduce stiffness.
Do not smoke, spit, use straws or do anything that may affect the clot.
No blood thinners, e.g., aspirin, alcohol.
Only consume cool liquids and soft foods for 72 hours.
Monitor for dry socket; Diagnoses and Treatments – Head – Mouth and Teeth – Dry Socket.
Pharmaceuticals:
NSAIDs (ibuprofen, because aspirin thins the blood too much.)
Avulsion is when the tooth is completely knocked out by some kind of trauma.
If you can find and re-implant the tooth within 30 minutes, attempt to do so.
Avoid touching the roots, i.e., pick it up by the crown.
Irrigate with saline solution or milk (do not scrub).
Place in preservation solution if available; if unavailable, place in milk, saline or saliva rather than plain water.
Thoroughly empty and irrigate the socket.
Put the tooth back into the socket with slow, steady pressure.
Cover it with gauze and have the patient bite down to keep it in place.
Splint it with soft wax to the neighboring teeth. Candle wax will work if there’s nothing else.
Put the patient on a liquid diet.
Monitor for dry socket; Diagnoses and Treatments – Head – Mouth and Teeth – Dry Socket.
Note: do not replace children’s primary (non-adult) teeth.
Dry socket (alveolar osteitis) occurs in the socket bed after a tooth has been removed. It is due to the absence of a blood clot. It usually results in increased pain and a longer healing time after tooth avulsion or extraction; Diagnoses and Treatments – Head – Mouth and Teeth.
Clot is gone.
Foul odor in breath.
Bad taste in mouth.
Pain in socket.
Irrigate and redress.
Medicated dressing until pain subsides.
After an avulsion or extraction:
Avoiding hot fluids for 48 hours.
Don’t smoke.
Don’t drink through a straw.
Don’t spit forcefully.
Take recommended medications.
Aphthous ulcers are non-infectious sores that appear in the mouth. They are usually painful.
The cause is unknown but they are more common in women than in men. Some medications may trigger them, e.g., nicotine gum.
Patients usually have a history of similar ulcerations.
Burning in the mouth a day or so before an ulcer appears.
Lesion(s) (painful with a red halo).
The lesions usually dissipate within 10 to 14 days, but some things can be done to speed up the process and/or reduce pain:
Avoid spicy, salty and acidic foods and drinks.
Brush with a soft toothbrush.
Drink through a straw (not hot liquids).
Pharmaceuticals:
Chlorhexidine mouthwash.
Steroid lozenges.
A broken or chipped tooth occurs when a fragment of the tooth breaks off. It may be due to biting down on something hard, trauma etc.
The sooner it is treated, the more likely the tooth can be fixed.
Symptoms of a Broken or Chipped Tooth
Pain when exposed to saliva, air, or hot or cold stimuli (food or beverages).
Visible missing fragments of the tooth.
Treatment for a Broken or Chipped Tooth
Save the pieces of the broken tooth.
Rinse pieces and wrap in moist fabric.
Rinse mouth with warm saltwater.
Apply gauze to stop any bleeding; cold water will help also.
Cover sharp edges with wax or sugarless gum.
Ice area.
Get to a dentist ASAP.
If no dentist is available, extraction may be needed; Diagnoses and Treatments – Head – Mouth and Teeth – Dental Extraction.
Cold sores (herpes labialis, fever blisters) are the result of an infection that manifests on the lip. It may be caused by dehydration, local skin trauma, menstruation, stress etc.
It is infectious, so avoid touching the sores, wash hands frequently and don’t share oral items, e.g., water bottles.
Early symptom of tingling on the lip.
Small blisters or sores on or around the mouth.
Fever.
Sore Throat.
Sores usually dissipate within 2 to 3 weeks but are reoccurring.
Pharmaceuticals:
Famciclovir and other similar medications are available to speed up healing.
Alternative/Natural Remedies:
Garlic: cut a garlic clove in half and place it directly on the cold sore for 10 minutes, several times a day. It may be uncomfortable and/or sting.
Condensing osteitis is the inflammation at the root of a tooth, as a result of a reaction to an infection.
Symptoms of Condensing Osteitis
Localized pain.
No obvious swelling.
Sensitive to tapping.
Throbbing.
Treatment for Condensing Osteitis
Condensing osteitis is usually self-resolving.
Soft diet.
Extract as last resort.
Pharmaceuticals:
NSAIDs.
A dental abscess is a collection of pus around a tooth. It is commonly caused by a bacterial infection which may stem from tooth decay, broken teeth etc. If untreated, the infection will probably spread to other areas of the body.
In a normal setting you should go to the dentist. In a survival situation, extraction may be needed.
Discomfort or pain.
Possible fever.
Sensitive/Painful to touch.
Swelling.
Treatment for a Dental Abscess
Drainage.
Extraction; Diagnoses and Treatments – Head – Mouth and Teeth – Dental Extraction.
Pharmaceuticals:
Antibiotics alone will not cure a dental infection but can be helpful to reduce symptoms. Use with other treatment, e.g., drainage.
Antibiotic: amoxicillin/clavulanate 875 mg two times a day for 7 to 10 days.
Antibiotic: amoxicillin.
A fractured tooth is basically a cracked tooth.
May have no symptoms at the start.
Pain as damage increases to the nerve.
Pain when chewing.
Severe fractures may cause bleeding.
Treatment for a Fractured Tooth
Stop the bleeding with direct pressure. A moistened teabag works well.
Cap the exposed area, e.g., candle wax, cavit.
Reposition the tooth as precisely as possible.
Splinting is recommended. If no access to specialist equipment, candle wax is better than nothing.
If the crack extends below the gum line, extract the tooth; Diagnoses and Treatments – Head – Mouth and Teeth – Dental Extraction.
Gingivitis is a bacterial infection of the gums. The exact cause is unknown, but poor oral hygiene is the general cause. If left untreated, gingivitis can progress to periodontitis (gum disease).
Bad breath or bad taste in the mouth.
Bleeding gums, during and after brushing.
Loose or shifting teeth.
Pockets forming between teeth and gums.
Receding gums.
Red, swollen, or tender gums.
Prevention and treatment are the same:
Brush.
Floss.
Mouthwash.
Regular dental check-up and clean.
Pharmaceuticals:
Antibiotics for serious cases only: doxycycline 100 mg every 12 hours for 3 days.
Others antibiotics: amoxicillin, metronidazole.
A lost filling is when a previous filling falls out.
Same treatment as a broken/chipped tooth; Diagnoses and Treatments – Head – Mouth and Teeth – Broken/Chipped Tooth.
Luxation in dentistry is basically when a tooth has been pushed out of place, usually from some type of trauma.
There are 5 types of luxation:
Concussion: there is no abnormal displacement or loosening but has reaction to being tapped (percussion).
Subluxation (loosening): a tooth that is knocked loose but not out of its alveolar socket.
Extrusive Luxation: partial displacement of the tooth out of its socket, the tooth is usually mobile.
Intrusive Luxation: displacement of the tooth deeper into the alveolar bone, fracture of the alveolar socket is also usually present.
Lateral Luxation: eccentric (off-center) displacement of the tooth and usually accompanied with fracture of the alveolar socket. The tooth is usually not mobile and there is a metallic tone when tapped.
Avoid use of affected teeth.
Splint if severe loosening, e.g., wax if nothing better.
Soft diet for 2 weeks.
Extrusive and lateral luxation: gently and slowly push back in place before splinting.
Intrusive luxation: spontaneous re-eruption (self-resolves) or orthodontic extrusion (manually pull it back into position).
The mandible is the lower part of the jaw bone. A dislocation will probably render the patient incapable of closing his/her mouth.
A dislocation of the mandible can be brought on by something as simple as yawning, but if it is caused due to trauma, expect a fracture.
Symptoms of Mandibular Dislocation
Unable to fully open or close the mouth.
Pain.
Treatment for Mandibular Dislocation
Rest your thumbs on the patient’s lower molars.
Move the lower jaw down, then push in, and finally up so it ‘click’ back into place.
Once fixed, the patient should avoid opening the mouth to extent.
This is immobility or pain in the chewing muscles of the jaw, which is usually caused by the grinding of teeth and/or excessive chewing, e.g., eating chewy and/or dried foods.
Symptoms of Myofascial Dysfunction
Clicking of jaw.
Deviation of the chin to one side on opening.
Headache or earache; Diagnoses and Treatments – Head.
Inability to open the mouth widely.
Limited jaw movement.
Pain in the muscles used for chewing.
Tenderness of jaw muscles.
Treatment for Myofascial Dysfunction
Avoid grinding teeth.
Moist heat to jaw.
Soft diet.
Thrush is an oral yeast infection and is usually found in the mouth of infants; it sometimes spreads to the nipple tissue of breastfeeding mothers.
Irritation.
White patches in the mouth which may bleed if wiped off.
Pharmaceuticals:
Antifungal: fluconazole once a day for a week.
Antifungal: nystatin
Baking soda solution: 1 teaspoon to 8 ounces of water, apply to nipples.
White Vinegar (distilled): apply to nipples.
Yogurt: apply inside mouth.
Tonsillitis is when the tonsils, located at the back of your throat, become infected. It is more common in children.
The main symptom is the inflammation of the tonsils. Sometimes the swelling can result in difficulty of breathing. Other symptoms include:
Abdominal pain (children)
Bad breath.
Blisters or ulcers on the throat.
Difficulty swallowing.
Discoloration of tonsils (white or yellow).
Ear pain.
Fever.
Headache.
Hoarseness.
Nausea (mainly in children).
Pain.
Voice loss.
Vomiting (mainly in children).
Eat soft foods.
Gargle with warm salt water.
Lozenges.
Rest.
Warm or very cold fluids to ease throat pain.
Pharmaceuticals:
Antibiotics if a bacterial infection: amoxicillin, azithromycin.
If viral, it should self-resolve (antibiotics won’t work).