Dealing With Dental Emergencies When There’s No Dentist

Savoring your lunch while gazing at the stunning scenery from your remote residence, you suddenly crunch into a nut, only to be met with a sharp crack and unbearable agony as a tooth shatters. Uncommon? Not at all, it happens frequently.

Dental emergencies

Unexpected dental emergencies can strike whether you’re at home or out in the wild, leaving you incapacitated in a flash. You might think, “No worries, I’ll just head straight to the dentist.” But that’s not always feasible. You could be far from the nearest dental clinic, it might be a late hour or weekend when finding a dentist is tough, or there simply may not be any available.

When disaster strikes, dental care is often one of the first services to go offline. Whether it’s a natural calamity like earthquakes, fires, or floods, or human-induced crises such as terrorism or civil unrest, dental offices shutter in an instant. Even temporary disruptions like power outages, render dentists unable to operate without electricity. And since hospitals typically lack dental services, you could be left to fend for yourself for hours or even days.

Given that dental first aid is seldom covered in standard first aid courses, the information provided here aims to assist you during dental emergencies when professional help isn’t an option. It’s crucial to note that this guidance is not a substitute for proper dental care.

Prevention

Dr. Amos Davison, a dentist who also happens to be an avid hunter and fisherman living in a rural area, has encountered his fair share of dental emergencies. According to Dr. Davison, “Nothing can spoil a great hunting expedition like a toothache.” He advises anyone embarking on an extended journey, lasting over a week, to ensure they’re up to date with their dental check-ups. This counsel holds true for everyone, whether they’re traveling or staying put at home.

Regular visits to the dentist can preempt many painful dental issues. Professional cleanings play a crucial role in warding off gum infections. Fillings showing signs of wear can be repaired before they unexpectedly give way, potentially ruining plans. Even small cavities, devoid of pain, can be swiftly addressed before they escalate.

Maintaining proper dental hygiene is paramount. Regular brushing and flossing help stave off cavities and gum infections. This is especially vital during times of crisis, such as disasters or evacuations. Although brushing might not be a top priority during such situations, instances of gingivitis or gum infections tend to rise during times of emotional and physical stress, particularly when coupled with inadequate oral care.

While a toothbrush and toothpaste are the optimal tools for cleaning teeth, alternatives can suffice in emergencies or survival scenarios. A washcloth or towel can effectively remove the soft, sticky plaque teeming with bacteria from the tooth surface. Additionally, the tip of a slender twig from a non-toxic tree or bush can be chewed until it turns soft and fibrous, serving as a makeshift brush for cleaning teeth and gums. In dire circumstances, even using your finger can suffice when nothing else is available.

Dental first aid kit

The first time I faced a broken tooth while backpacking, I reached into my first aid kit only to find it lacking any suitable remedies. Chances are, yours is in a similar state. Fortunately, a few lightweight and compact items, readily available at drugstores or markets, can be added to your kit to address dental emergencies. Here are my recommendations:

When tending to dental issues in the mouth, always remember to wear protective gloves from your first aid kit to minimize the risk of spreading infectious diseases.

Dental emergencies – Toothache

A toothache stems from the inflammation of the nerve within a tooth, known as the dental pulp. Decay from a cavity penetrating the pulp or a tooth fracture can trigger a toothache. When infection sets in, it can result in agonizing pain and may spread from the tooth’s root into the jaw, forming an abscess.

Signs of a toothache include pain localized in one tooth or across multiple teeth. Initially, the pain may be mild, sporadic, exacerbated by hot or cold foods/drinks, cold air, and biting pressure. With time, the discomfort may intensify, becoming constant, excruciating, and debilitating.

In some cases, an abscessed tooth may gradually release infection into a large cavity. After eating, when food lodges into the cavity, the drainage passage might be obstructed, causing increased pressure within the tooth and worsening the toothache until the debris is removed.

To address a toothache, first locate the painful tooth and inspect for any visible cavity or fracture. Clean out any food debris using a toothbrush, toothpick, or similar implement. Then, dampen a small cotton pellet or, if unavailable, a piece of cloth, with a topical anesthetic like eugenol or benzocaine solution, and place it into the cavity. Utilize small dental tweezers or a similar tool for precise placement, as accessing the mouth with fingers can be challenging. This topical anesthetic should provide swift relief.

The choice of topical anesthetic is crucial. Dentists typically employ pure eugenol for emergency toothache treatment due to its long-lasting effects, although it may be hard to obtain. Oil of cloves serves the same purpose and can be bought without a prescription at pharmacies or health food stores. Exercise caution, as pure oil of cloves can cause chemical burns if it comes into contact with the mouth or tongue.

Commercial toothache remedies include Red Cross Toothache Medicine with 85% eugenol, and Orajel with benzocaine. Some products come with dental tweezers and cotton pellets.

Once the medicated cotton is in place, cover it with a temporary filling material like Temparin or Cavit to prevent dislodgement. These materials are malleable and can be shaped to fit the cavity. In the absence of these, soft dental wax or softened candle wax can suffice. If using candle wax, melt it and let it cool until pliable before insertion.

For pain relief, consider taking pain medication such as 200mg Motrin, 3 tablets every 8 hours or prescription pain relievers like Vicodin, 1-2 every four to six hours if available. Avoid placing aspirin on the gum adjacent to the painful tooth, as it not only provides no relief but also causes painful burns to the gum tissue.

Seek immediate dental assistance. If locating a dentist takes time, consider replacing the cotton pellet with a freshly soaked one in topical anesthetic.

Dental emergencies – Gingivitis

Gingivitis refers to the inflammation of the gums (gingiva), often stemming from insufficient tooth brushing. This condition manifests with red, swollen gums that may bleed during brushing. Fortunately, it is largely preventable through proper oral hygiene practices and routine dental examinations. If experiencing pain and bleeding due to gingivitis in outdoor settings, enhance oral hygiene by brushing teeth three times daily, coupled with warm salt-water rinses. Additionally, over-the-counter antibacterial mouthwashes may offer relief.

Dental emergencies – Dental abscess

An infected tooth or gum infection, also known as gingival infection, can lead to a dental abscess, often referred to as a pus pocket. Likewise, food trapped between teeth, if not removed with dental floss, can also contribute to this condition.

Abscesses typically develop near the affected tooth, causing pain and swelling. In severe cases, they can extend to the face, floor of the mouth, or neck, resulting in difficulty opening the mouth or swallowing. In rare instances, dental abscesses can pose life-threatening risks, either by obstructing breathing due to their size or by triggering fever or widespread infection in the body. It’s imperative to address any abscess promptly.

Treatment for abscesses necessitates antibiotics. Seek immediate dental attention. If unavailable or if experiencing severe swelling, consult a physician or visit a hospital emergency room. In emergency situations where professional help isn’t accessible and there’s severe swelling, oral antibiotics like penicillin (500 mg every six hours) can be administered, provided the individual isn’t allergic to the medication.

Regular warm salt-water rinses of the mouth every four hours may aid in the spontaneous drainage of the abscess, alleviating some of the pain. Refrain from applying hot packs to the outer face without dentist or physician guidance, as heat can exacerbate the infection. Pain relievers may be used as previously described.

In exceptionally rare scenarios where professional assistance is delayed, and antibiotics are unavailable, a localized abscess adjacent to a tooth can be drained to expel the pus. A sterile scalpel, needle, or disinfected fishhook (with the barb removed and heated with a match) may be employed to puncture the abscess. While this procedure will be painful, immediate relief from the abscess should ensue.

Dental emergencies – Broken filling or lost crown

Chewing on hard or sticky foods like candy, nuts, or ice cubes is a common way to break a tooth or filling. If the affected tooth isn’t causing pain, take care not to exacerbate the damage while eating, and seek dental attention promptly.

To alleviate sensitivity to hot or cold and prevent food from getting stuck in the gap left by the filling, a temporary filling can be applied. Use a dental instrument or a flat tool like a knife blade or popsicle stick to place a small amount of temporary filling material, such as Temparin or Cavit, into the cavity. Have the individual bite down on the material to mold it to their bite, then remove any excess. These materials will harden over time and stay in place. Soft wax can also serve the same purpose as described for filling a cavity.

Crowns, or caps, can be dislodged by sticky foods like caramel or salt-water taffy. If the tooth isn’t sensitive to temperature changes, save the crown and schedule a dentist appointment at your earliest convenience.

If the tooth sensitivity is severe enough to impede eating, temporary replacement might be necessary. However, this should only be done as a last resort, as it’s a temporary fix with the risk of the crown coming off and being swallowed. Remove any residual cement or material from inside the crown using a dental instrument or knife. Apply a thin layer of temporary filling material, denture adhesive, or a thick paste made from water and flour inside the crown. Ensure proper alignment of the crown on the tooth, then have the individual gently bite down to secure the crown in place. Seek dental care as soon as possible.

Injuries to teeth

Falls or impacts to the mouth can result in tooth injuries, commonly affecting the upper front teeth. Teeth may remain in their normal position but feel loose when touched, be partially dislodged or pushed back, or be completely knocked out. If the tooth is not fully knocked out, your first step should be to seek dental attention.

When immediate dental care isn’t available, a displaced tooth can sometimes be repositioned by applying steady, gentle pressure to guide it back into place. If it’s very loose, biting down on a piece of gauze can help stabilize it temporarily. However, it’s crucial to see a dentist as soon as possible, as the tooth may require splinting to hold it in position during the healing process.

For a completely knocked-out tooth (avulsed), acting swiftly within the first 30 minutes is crucial for potential preservation. When a tooth is knocked out, the ligaments, nerve, and blood vessels holding it in place are torn, essentially rendering it a “dead tooth.” Re-implanting the tooth within 30 minutes allows the body to accept it, with the ligaments reattaching. Although a root canal will be needed to remove the dead nerve and blood vessels, the tooth can still function.

After 30 minutes, the body starts treating the tooth as foreign material, leading to gradual dissolution of the root over weeks to months. In such cases, extraction of the tooth is often necessary.

To treat a knocked-out tooth, locate the tooth and if the socket is bleeding, have the person bite down on gauze pads placed over it. A moistened non-herbal tea bag can also be used. Handle the tooth by the crown only, gently rinse off any dirt or debris with sterile saline, disinfected water, or milk. Avoid touching the soft tissue covering the root. Replace the tooth into the socket with gentle, steady pressure and have the person lightly bite down on gauze to keep it in place. Seek immediate dental attention to stabilize the tooth.

If immediate reimplantation isn’t possible, wrap the tooth in gauze and soak it in sterile saline solution, milk, or the person’s saliva while they are taken to a dentist. Some suggest keeping the tooth moist by placing it in the person’s mouth, but there’s a risk of accidental swallowing.

Concluding

Dental emergencies occur more frequently than many people think. While you’ll usually have access to a dentist for assistance, there may be occasions when you’re left to manage the situation on your own. Being proactive with prevention, equipping yourself with knowledge, and ensuring you have essential items in a dental first aid kit can make a significant difference in safeguarding you and your family during such instances.

This article has been written by James H. Redford MD for Prepper’s Will.

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