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Dental Care in an Emergency

In the film “Cast Away,” Tom Hanks’ character is stranded on an island after his airplane crashes. On top of all the problems he has - learning to make a fire, finding food, water, shelter - he has  a toothache!

This scared me half-to-death when I saw the film. I wondered, in an emergency, would I be able to take care of a simple toothache?

With the help of the Special Operations Forces Medical Handbook, we have highlighted some things that you can do to treat cavities, fractures, extracted teeth and more, in an emergency. These techniques should only be used in an emergency and are not a replacement for a qualified dental professional.

The handbook recommends that you have cotton balls, anesthetic, an explorer, a spoon excavator and a mixing tools. You will need some of these in order to take care of the problems we have listed below.

Anatomy of a toothAnatomy of a tooth
The first thing you’ll need to know about emergency dentistry is the anatomy of a tooth.

A tooth has two major parts - the crown and roots. The crown is the (hopefully) white part that is visible. The roots are embedded in your gums.

The crown has five surfaces: the occlusal (biting) surface, the lingual (tongue side) surface, the facial (cheek side) surface and two contact surfaces that touch the adjacent teeth.

Symptoms. If you have a cavity, you’ll feel dull pain in the area. Heat, cold, sweet, or salty foods may enhance the pain. You’ll want to determine on which surface the cavity is located.

Treatment. Cavities can be very tricky to treat because of anesthesia.

The first thing you’ll do is apply an anesthetic agent. Be sure that you are trained on where the injection should be placed - which is near the top of the tooth’s root - in a mucobuccal fold. Do not inject into a blood vessel.

The Medical Handbook recommends the following anesthesia:

  • 2% lidocaine with 1/100,000 epinephrine (Xylocaine)
  • 0.5% bupivacaine with 1/200,000 epinephrine (Marcaine)
  • 3% mepivacaine without epinephrine (Polocaine or Carbocaine)

After the anesthesia has been injected properly, begin to remove the soft decayed area with a spoon-shaped instrument. If they are properly anesthetized, they shouldn’t feel any pain.

After you remove the decayed content, wash out the cavity with warm water. Combine zinc oxide (IRM) powder with two or three drops of water - mix until it’s a putty texture. Then place the putty in the hole. If the cavity was on the occlusal surface, have the patient bite a few times to form the putty.

If IRM is not available, you can fill the hole with a cotton pellet impregnated with eugenol.

This is a temporary procedure. Only a dentist can provide definitive care.

Crown fractures
Your front teeth are more susceptible to fractures than your back teeth. A crown fracture will be a break in your tooth.

Symptoms. Usually someone with a crown fracture will have sensitivity to heat and cold. They might find tooth fragments in their mouth or feel jagged tooth edges.

Treatment. If the fracture is small, you can smooth the rough edges with an emery board or small flat file.

If the fracture is extensive wash the tooth with warm saline. Then, isolate the tooth with cotton gauze. After you’ve isolated the area, cover the fracture with Zinc Oxide-Eugenol paste (IRM). This will hold for about 6 weeks.

Dislocated tooth
Symptoms. You’ll probably notice that your tooth has moved or is wiggling.

Treatment. You can place local anesthetic on the tooth to relieve pain. After you’ve applied the anesthetic, manually reposition the tooth to its normal position. You can then use wire or heavy fishing line to bind the tooth the teeth next to it. Splint the tooth in place.

Tooth out of its socket
Symptoms. You may have your tooth in your hand.

Treatment. If the tooth has been saved, do not let it dry out. Do not try and scrape anything off the tooth. Instead, place the tooth in a clean liquid like saline or milk.

Next, administer some local anesthetic to the socket. If there are blood clots in the socket, clean it out with saline solution. Replace the tooth in the socket. Then splint the tooth to the surrounding teeth with wire or heavy fishing line. Be sure to administer some type of pain reliever after replacing the tooth.

Tooth extraction
If you end up having to extract a tooth, after the extraction, compress the sides of the empty socket and place a folded sponge over the socket. Apply light pressure for 60 minutes. Do not rinse your mouth for 12 hours since this may disturb the clot.

24 thoughts on “Dental Care in an Emergency”

  • Melissa H

    The advice given for the dislocated, out of socket tooth, as well as extracted tooth are good, but I wanted to add to the previous entries regarding what was described as zinc oxide (IRM) powder. I've worked with both zinc oxide powder and 'intermediate restorative material', they are different (I am a dental assistant, and make homemade soap). IRM is a cement that will form a putty that can be inserted into the the void in the tooth until it can be properly/permanently restored. This will harden in time, making the tooth functional again. Zinc oxide powder when mixed with water as suggested in this article will not form a putty but rather a paste, when it drys it is crumbly, unlike the IRM. Also you mentioned soaking the cotton pellet (that can be put in before the IRM) in eugenol, but didn't mention that Clove Oil naturally contains high amounts of eugenol, an anesthetic and antiseptic. Clove oil is a great item to have on hand in an emergency kit to sooth tooth aches.

  • Scott

    The question everyone is wondering about is "where do you get the numbing medications?"

  • Matt Stutterheim
    Matt Stutterheim April 23, 2012 at 1:50 am

    Numbing medications like Ambesol can be purchased at any drugstore, or in the lore of Holywood cowboy movies, swishing around whisky in your mouth might work.

    I have always kept a yachtsmen's emergency dental kit at home for emergencies and yet I find few websites promoting them as emergency essentials. Ideally I'd buy 3 at about $35 each, one for myself and two to barter with for things or services I might need in a true emergency.

    Even more obvious is the eventual need for something as simple as baby's diaper rash cream; I'd buy a dozen of those at the 99-cent store as it may become handy to have for burns, rashes, and stomach distress side effects.

    The dental kit I have allows me to even fill cavities if necessary; not a pretty sight, but functional. For instructions on how to self-treat dental problems I recommend you view "Mr. Bean's Visit to the Dentist" which can be found on YouTube.

  • Sharon

    thank you for this information. I have ordered the updated publication from the government and am adding it to our emergency preparedness "stash". I hope to never have to use the information in the publication, but grateful to have the information to fall back on if needed.

  • jody

    This is an EXCELLENT article. So many hate their DDS to begin with and many suffer needlessly waaay to long before going to see them. This is a much needed Topic & I applaud you for pushing it out front. We all know how painful dental issues can be... and many dont realize you can get very ill & even die from a nasty abscess if ignored.
    I dont have a full Dentanurse kit and need to get a few. However I carry a mini kit of Temparin with me everywhere. Having a full crown in top front makes it a necessity. Its called a Princess Crown, and should be since it caost me a grant and Ive had re-fix it twice after chomping into something I shouldnt have. Needless to say, I learned the first time, at a wedding, that Ill never go w/o a kit again! Lol
    Im not sure if I should mention the Book "Where There Is No Dentist" by Murray Dickson is a good resource but kinda dated.
    Thanks again... Ill be pasting this in my local Preppers FB.

  • Melissa H

    @scott: The "numbing medication" mentioned in this article is not a topical gel "ambesol" as suggested by Matt, but rather carpules of liquid anesthetic that would have to be injected into the mucosa by needle and syringe. The only place you would find this is through hospital or dental supply companies.

  • Sue

    I am a dental hygienist who uses local anesthetic almost every day, and am not sure how an untrained person would be expected to administer local anesthetic even if they had the medications.
    One of the best things you can do is to keep your dental health at a very good baseline by having excellent home care, and visiting your dentist regularly. Have annual x rays taken to catch decay while it is still small, and deal with gum disease by increasing the frequency of your cleanings. Quite smoking and reduce your sugar consumption.
    If you have dental phobia, find a dentist who uses oral conscious sedation to help you get through your appointments.
    Yes, dental care is expensive, but letting your mouth fall apart makes things get even more expensive, and can put your health at risk.
    I recently saw a patient who had an abscessed tooth removed after letting it go a long time. She then had a stroke caused by a brain abscess from the tooth infection: 1 month in the hospital near death, left side paralyzed, heavy meds for many months, etc.
    One thing I am seeing on the emergency dental van where i work is folks who once had dental insurance but have been laid off for several years and have not been to the dentist.
    If you don't have dental insurance, move dental care up in your priorities and pay cash.
    Make friends with your dental professionals and get your mouth tuned up just like you would your car and your food storage!

  • Shawn

    Anyone know where any of those meds. can be found? Last time i knew, you could only get that done by the dentist at his office.

  • julie a neary

    over in the uk
    we are normally limited to
    nurophen or paracetamol
    a kind gp or dentist who leaves you with a course of antibiotic that can treat an abcess and leave a tooth intact
    oil of clove which quite honestly i think the smell detracts the brain from the pain only
    and the odd temporary filling pack available from pharmacy
    NOT suitable if you have an abcess under without treating
    salt water mouth rinses and dental washes for hygene if they are tolerated
    dentylPH for those with issues around alcohol

    and then prey for a dental appointment from someone who has power generator and a water supply on and some basic hygene principals back in place
    after any catastrophe

    Thats from a basic patient point of view

    an allum compound i beleive available from pharmacy or apothacory in advance apparently treats a loose tooth
    but i only know that from a child perspective and losing milk teeth

  • Dawn

    This past summer I grew an herb called "toothache plant". If you chew on the leaves or make a tea or police out of the leaves or flowers it numbs up the mouth for a short period of time. It does taste a bit funny at first, but i have used it several times and it works better than the gel OTC brands. It was easy to grow and the dried flowers are still somewhat effective.

  • Dave

    Everyone's asking where you can get the medications. Try a farm store or feed & grain. Veterinary meds are made to the same standards as human ones - they're the same drugs. In many places you'll be able to buy what you need off the shelf.

  • Nakiel

    For temporary relieve of the acute pain caused by cavities or inflamed nerves, I found applying Natreen artificial sweetener to the area does the trick. (better than painkillers)

    I guess any sweetener with saccharin will do.

  • Lora

    "Where there is no Dentist" by Murray Dickson. This book covers allot of information about dental care where access to a Dentist doesn't exist. Very detailed and easy to understand format.

  • Jan

    I see that clove seems to be overlooked in the talk here. Being an herbalist I know how important this herb is for a dental emergency, so I would suggest reading the information on the following web link. I am not connected with this sight in any way, but I feel the information here could make a difference in a real emergancy. I hope it is helpful. http://herbs.lovetoknow.com/Cloves_for_Toothache

  • K

    The toothache plant that I know of is Yarrow- the root has a numbing agent in it. It grows around here in the northwest.

  • Gregory Clifton
    Gregory Clifton May 20, 2013 at 5:16 am

    where does one get the Special Operations Forces Medical Handbook ?

  • Ann

    So what do you use if you have a serious allergic reaction (anaphylaxis) to "caine" anesthetics, as I do? It's rare, but real. Do be careful administering anesthetics to people -- one killed my father, and another nearly killed me.

  • Irish-7

    Good information! Truthfully, the average person could not make most dental repairs, even with the right dental supplies. The dental wax works very well for cavities or broken teeth. No mixing required, like with Temparin. Just form it and put it in place.

  • Ben from Texas

    White Rum makes a excellent numbing aid and antiseptic for a bad tooth,or infection..Used it many times in the past,now I don't need it now,got dentures,ha

  • Hal

    Just the thought of trying to inject an anasthetic into the proper place is terrifying. And how would you do that to yourself?

  • Irish-7

    I am reminded of the account of Len McDougall in The Self Reliance Manifesto, of extracting both tooth and broken root in the field (without any painkillers). It will make you cringe to read it. Anyway, he gained my respect forever. I am going to float some personal advice. Take it or leave it. DO NOT DISCARD the leftover narcotic pain pills after previous dental work, surgery, broken bones, back injury, etc. I guarantee you will wish you kept them. Put them with your survival/Bug Out or camping supplies. At some point, you will have a dental emergency, twist your ankle, break your thumb or other painful mishap, and medical help will NOT be readily accessible. Ignore the expiration date. Just keep them dry and away from light, they'll be good for years.

  • Charlie

    'Where There Is No Dentist' is a not-bad reference and how-to manual, but it is aimed at a somewhat-trained dental provider in a Third-World situation; the photographs and illustrations are mostly of Africa.
    It focusses mainly on education and prevention, but does also show how to administer anesthetic, fill cavities, and extract teeth.
    It also gives illustrated instructions on how to fabricate some of your own field expedient dental instruments and gives a list of extraction forceps and other dental instruments one should consider having on hand.
    It's well worth the money, and a good resource to have available.
    Very few people have dental instruments in their First-Aid supplies; it wouldn't be a bad idea to go online and order some extraction forceps, root tip picks, periosteal elevators, scalers, curettes, and exam mirrors while the Internet is still up and UPS still delivers to your door.
    Even if you aren't comfortable in using these instruments yourself, that's not to say that you won't run into someone who is. And it'd be a whole lot better to have the appropriate instruments on hand rather than trying to extract a tooth with a pair of vicegrips and a flat-bladed screwdriver.
    Some of the dental/medical supply sites have outrageous prices; others are more reasonable, so shop around.
    You can get a reasonably complete set-up of emergency dental treatment instruments and extraction forceps for around $150.00 US. Yeah, not cheap, but just need them once and they're priceless.

    And folks, strongly recommend that you get a dental checkup and have any dental issues resolved NOW. Just because it doesn't hurt or isn't bothering you very much doesn't mean there's nothing wrong or that it's okay to ignore it. The tooth fairy will not come and magic it all better, and it WILL get worse - trust me on this.

    Hope this was helpful.

  • Dave

    For Gregory Clifton and others:

    You can obtain the SOF Medical Specialist Handbook in several places, but beware of buying a pig in a poke.

    The best is the 2008 edition from the Government Printing Office (GPO) online. It is $59.00, which sounds way expensive, but in this case, you really get what you pay for with usage. It uses a three-ring binder set up so it can be laid out flat for usage without having to prop open the pages and occluding some information. Having been a Special Forces Medic using the original 1969 version of the SF Medical edition (back before SOF was created in the 80's), any other binding is a real pain to work with and won't last; the military issue 1969 version used very long staples for that reason; a pain, but it stayed together but my Junior Medic had to read sections while I treated patients when our patient load was low enough. Plus, the GPO version has water resistant paper (huge for durability) and color plates (critical value), especially for the lab work and circulatory review/training.

    Having said that, beware of the cheap and misleading knock offs you can find at Amazon and other places. They mislead by suggesting they are the "latest" edition; they still use the 2008 edition content, but they published their editions in 2012 and 2013. Totally black and white and is "perfect bound" (that means it has a glued binding and once you "break" the binding glue, pages will eventually start to fall out.

    (NOTE: The color plates are critical if doing lab tests with a microscope; see Edmund Scientific Equipment catalogs to get a microscope at a decent price that uses a mirror and a light source, either candle, bright sun, or other source for illumination like back in school in the 50's & 60's, instead of an electrical supply, unless you'll have AC power in survival situations and extra bulbs.)

    Finally, check and see if the GPO is still selling (or providing for free)the PDF version. I have it and it is the same and usable like the print version. Download it, but ensure you have a large pipe that doesn't suffer from timeout problems, because it's a big file. Then review it and determine all the color plates and print them to a color printer and print the rest to three-holed stock using B&W. Three ring binder and you're good to go.

    For use, I recommend read through it, especially areas where you have no skills or background experience. Find out what education and training classes are available and upgrade your knowledge set; without the proper equipment, supplies, and skills combined with the knowledge in the book, a lot of this info can be very dangerous. Also, look into recruiting surgical Physician Assistants (PA), medical PA's, certified Clinical Nurse Practitioners (CNP's), EMT's/Paramedics, doctors, dentists, and former military medical people, especially SOF/SF medics for your survival team. Good luck.

  • Eagle

    The best thing I know to have in an emergency kit is Cavit and Oil of clove.
    Cavit is made by 3M and is MUCH MUCH better than temprin had kills bad germs. It is solid and can stay in place till removed by a dentist. (Can be bought online)
    Oil of clove tastes like the devil but it works well.
    Saving unused antibiotics is a biggie too because most tooth pain can be relieved by getting rid of the infection.

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