Dental Pain

Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book.

If your potential time off the grid may be substantial, then planning for dental emergencies is critical. Keep preventative dental care up to date. Then when off the grid, brush twice daily. If you run out of toothpaste, use baking soda or salt as a substitute. Flossing and brushing can prevent needless pain and suffering.

GUM PAIN OR SWELLING

Pain with swelling high on the gum at the base of the tooth usually indicates an infection and a tooth that may require extraction, or root canal therapy, if a dentist can be consulted who has brought a lot more than just his fly rod with him on the trip. Attempting to treat without either option, have the patient use warm-water mouth rinses. Start the victim on antibiotics as indicated in the previous section. If a bulging area can be identified in the mouth, an incision into the swollen gum made with a sharp blade may promote drainage. If the pain is severe and not relieved with any pain medication that you have, the tooth may have to be pulled.

Swelling at the gum line, rather than at the base of the tooth, may indicate a periodontal abscess. The gingiva (or gum) is red, swollen, foul smelling, and oozing. Frequently this represents food particle entrapment and abscess formation along the surface of the tooth and the gums, the so-called gingival cuff. Considerable relief can often be obtained by probing directly into the abscess area through the gingival cuff using any thin, blunt instrument. Probe along the length of the tooth to break up and drain the abscess. Have the patient use frequent hot-water mouth rinses to continue the drainage process. If a foreign object, such as a piece of food, is causing the swelling, irrigate with a warm salt solution or warm water, using sufficient force to dislodge the particle. Probe it loose if necessary. Dental floss may be very helpful. Acute pain and swelling of the tissue behind the third molar usually is caused by an erupting wisdom tooth; technically this is called pericoronitis. A little flap of tissue called the operculum lies over the erupting wisdom tooth, and biting on this causes it to swell, and it becomes much easier to bite on it again and again. The result is considerable pain. This can be relieved by surgically removing the operculum. If local anesthetic is available, such as lidocaine, inject it directly into the operculum, and then cut it out with a sharp blade using the outline of the erupting tooth as a guideline. The bleed.ing can soon be stopped by biting down on a gauze or other cloth after the procedure is over. Stitching this wound is not required. If no lidocaine is available, swab the area with alcohol, as this helps provide some slight anesthesia. Application of powder from a crushed diphenhydramine tablet from the Non-Rx Oral Medication Module might provide some anesthesia.

Swelling of the entire side of the face will occur with dental infections that spread.This condition should ideally be treated in a hospital with intravenous antibiotics. In the bush apply warm compresses to the face. Do not lance the infection from the skin side, but a peaked, bulging area on the inside of the mouth may be lanced to promote drainage. Abscess extension into surrounding facial tissues generally means that lancing will do little good. This patient is very ill and rest is mandatory. Provide antibiotic coverage from the Rx Oral/Topical Medication Module, with levofloxacin, 500 mg once daily, Zithromax as indicated on page 285, or, from the Rx Injectable Medication Module, Rocephin, giving 500 mg by intramuscular injection every 12 hours. Urgent evacuation is mandatory.

MOUTH LACERATIONS

Any significant trauma to the mouth causes considerable bleeding and concern. The bleeding initially always seems worse than it is. Rinse the mouth with warm water to clear away the clots so that you can identify the source of the bleeding.

Laceration of the piece of tissue that seems to join the bottom lip or upper lip to the gum line, called the labial frenum, is a common result of trauma to the mouth and need not be repaired, even though it initially looks horrible and may bleed considerably. Simply stuff some gauze into the area until the bleeding stops.

A laceration of the tongue will not require stitching (suturing) unless an edge is deeply involved. Fairly deep cuts along the top surface and the bottom can be ignored when off the grid. If suturing is to be accomplished and you have injectable lidocaine from the Rx Injectable Medication Module, inject into the lower gum behind the teeth on the side of the gum facing the tongue. Technically this area is called the median raphe distal to the posterior teeth. This will block the side of the tongue and be much less painful than directly injecting into the tongue. Use the 3-0 gut sutures. These sutures will dissolve within a few days. Sutures in the tongue frequently come out within a few hours, even when they are well tied, much to the victim’s and surgeon’s annoyance. If this happens and the tongue is not bleeding badly, just leave it alone. Minor cuts along the edge of the tongue can also be ignored.

Make sure that cuts on the inside of the mouth do not have foreign bodies, such as pieces of tooth, inside of them. These must be removed. Inject a small amount of lidocaine into the wound before probing if you have the Rx Injectable Medication Module, then irrigate thoroughly with water. Even without the lidocaine, the inside of the mouth can be stitched with minimal pain. Use the 3-0 gut sutures, removing them in 4 days if they have not fallen out already. Refer to page 130 for discussion of suturing the face and the outside portion of the lips.

DENTAL PAIN

Cavities may be identified by visual examination of the mouth in most cases. At times the pain is so severe that the patient cannot tell exactly which tooth is the offender. It helps to know that a painful tooth will not refer pain to the opposite side of the mouth and painful back teeth normally do not refer pain to front teeth and vice versa. With the painful area narrowed down, look for an obvious cavity. If none is found, tap each tooth in turn until the offending one is reached—a tap on it will elicit strong pain.

For years, oil of cloves, or eugenol, has been used to deaden dental pain. Avoid trying to apply an aspirin directly to a painful tooth; it will only make a worse mess of things. Many excellent dental kits that contain topical anesthetic agents and temporary fillings are now available without prescription. A daub of topical anesthetic will work. In your Topical Bandaging Module, you have triple antibiotic with pramoxine that you can use. It’s the pramoxine component that pro.vides the pain relief. Before applying the anesthetic, dry the tooth and try to clean out any cavity you may find. From the Non-Rx Oral Medication Module, give Percogesic, 2 tablets every 4 hours, or ibuprofen, 200 mg, 2 to 4 tablets every 6 hours, for pain. When off the grid and a toothache begins, I would also start treating with an anti.biotic if the Rx Oral/Topical Medication Module is available. While not the first choice usually in civilization, use Levaquin, 500 mg once daily, until swelling or pain resolves, which indicates the infection is under control.

LOST FILLING

This could turn into a real disaster. An old-fashioned remedy uses powdered zinc oxide (not the ointment) and eugenol. Start with the two in equal parts and mix until a putty is formed by adding more zinc oxide powder as necessary. This always takes considerably more of the zinc oxide than at first would seem necessary. Pack this putty into the cavity and allow it to set over the next 24 hours.

The Cavit dental filling paste in the Rx Oral/Topical Medication Module provides a strong temporary filling. Dry the cavity bed thoroughly with a gauze square. Place several drops of anesthetic, such as oil of cloves (eugenol), to deaden the nerve endings and kill bacteria.

The triple antibiotic with pramoxine ointment from the Non-Rx Oral Medication Module can also be used for this purpose (plain triple antibiotic ointment will not work). You will have to pack the ointment into the cavity area and allow it to melt. Dry the cavity carefully once again. The Cavit paste should be applied to the dry cavity and packed firmly into place. Obviously avoid biting on the side of the filling, regardless of the materials used to make your temporary filling. The loss of a filling may indicate extension of decay in the underlying tooth and an underlying cavity.

CAVITY

In the event a tooth becomes painful, you may note the formation of a cavity. While in normal dental practice the cavity area would be drilled out, in your situation off the grid, you may be able to handle this problem quite well without drilling. Using a dental spoon, you can scrape the edges of the decay area clean. Be careful not to go too deep as you will hit the nerve in the pulp at the core of the tooth. As long as you seal the area with your filling, you should prevent further decay. Of course, if an abscess has formed, it is too late to fill the tooth and it should be extracted. Fill with a temporary filling as mentioned above under lost filling. A more permanent filling can be achieved with a glass ionomer compound (an Rx item in the US that requires mixing just before using, it hardens to an appropriate stiffness) or something like Prevest DenPro’s Fusion Flo nano hybrid composite, which is available without a prescription but requires an ultraviolet light to cure or harden it; the UV source can be a blue cobalt penlight.

When placing a permanent filling, you have to be particular about your technique. After scraping the decay out of the cavity, dry out the hole or the cement will not stick. Practice with the cement to achieve the right consistency prior to inserting it or in managing the UV light to harden the material when it is in place. If the cavity extends to the side of the tooth, protect the space between the teeth by placing something thin between them, such as a tooth from a comb. It is also critical to remove extra cement from around the tooth and from between the tooth, and to make sure that the filling does not extend so high that the tooth biting down on it comes into contact with the filling.

An excellent description of performing this procedure using the glass ionomer is found in Where There Is No Dentist by Murray Dickson (2018). You will find it much easier to use the UV-cured nano hybrid. You can purchase a simple dental tool kit online, in addition to any of the products previously mentioned in this section.

LOOSE OR DISLODGED TOOTH

When you examine a traumatized mouth and find a tooth that is rotated or dislocated in any direction, do not push the tooth back into place. Further movement may disrupt the tooth’s blood and nerve supply. If the tooth is at all secure, leave it alone. The musculature of the lips and tongue will generally gently push the tooth back into place and keep it there.

A fractured tooth with an exposed pink substance that is bleeding is showing the exposed nerve. This tooth will need protection with eugenol and temporary filling as indicated above. This is actually a dental emergency that should be treated by a dentist immediately.

If a tooth is knocked out, replace it into the socket immediately. If this cannot be done, have the victim hold the tooth under their tongue or in their lower lip until it can be implanted. In any case, speed is a matter of great importance. A tooth left out too long will be rejected by the body as a foreign substance.

All of the above problems mean a soft diet and avoidance of chewing with the affected tooth for many days will be necessary. Off the grid, start the patient on an antibiotic such as doxycycline, 100 mg daily, for any of the above problems.

Trauma that can cause any of the above may also result in fractures of the tooth below the gum line and of the alveolar ridge affect.ing several teeth. If this is suspected, start the patient on an antibiotic as mentioned in the paragraph above. Oral surgical help must be obtained as soon as possible. A soft diet is essential until healing takes place, possibly a matter of 6 to 8 weeks.

PULLING A TOOTH

It is best not to pull a tooth from an infected gum, as this might spread the infection. If an abscess is forming, place the patient on an antibiotic such as Levaquin, 500 mg daily, or doxycycline, 100 mg twice daily, and use warm-water mouth rinses to promote drainage. After the infection has subsided, it is safer to pull the tooth. Opening the abscess as described under Gum Pain or Swelling (page 109) will be helpful at times. If it appears necessary to pull an infected tooth, give the patient an antibiotic pill about 2 hours before pulling the tooth to provide some protection against spreading the infection.

Pull a tooth by obtaining a secure hold with either a dental forceps or, even better, a side-cutting bone rongeur. You will have to obtain one from a surgical supply house or a friendly orthopedic surgeon. Slowly apply pressure in a back-and-forth, side-to-side motion to rock the tooth free. This loosens the tooth in its socket and will permit its removal. Avoid jerking or pulling the tooth with a straight outward force; it can resist all of the strength that you have in this direction. Jerking may break off the root. The rongeur will grip the tooth surface by cutting into the enamel, holding better than even dental extraction forceps. The Murray Dickson book described above also indicates an alternative method of dental extraction using differ.ent equipment.

If the root breaks off, you may leave it alone rather than trying to dig it out. If the root section is obviously loose, then you can pick it out with a suitable instrument. Thin fragments of bone may fracture off during the extraction. These will work their way to the surface during healing. Do not attempt to replace them, but pick them free as they surface.

If you do not have the side-cutting dental rongeur or dental for.ceps, it is best not to attempt to pull the tooth with another instrument. Pliers may crush the tooth and the tooth can slip in your grasp. However, even a large, solid tooth can be removed by using your finger to rock it back and forth. This may take days to accomplish, but it will eventually loosen sufficiently to remove.