Dental Emergencies in the Wild

Dental Emergencies
in the Wild
Presented by: Dr. Natali Schindler, DDS
bite Family Dentistry
Banff, AB
Common Dental
Emergencies
•
Toothache from a cavity or
lost/broken filling (especially
important when travelling in
high altitudes or scuba diving)
•
Dental or periodontal abscess
•
Pericoronitis (wisdom tooth)
•
Loose crown/bridge
•
Avulsed or dislodged (tooth
(knocked out)
•
Fractured tooth
•
Fractured jaw
Prevention
and
Preparation
• Mouth guard
• Helmet with a jaw guard
• Having regular dental
exams or an exam prior to
going on an expedition
• Packing a dental
emergency kit and
preventive supplies
The Dental Emergency Kit
Including: Dental examining gloves, dental mirror, dental tweezers or
cotton pliers, dental spatula, dental wax, dental floss, temporary filling
material-zinc oxide powder and eugenol or Cavit, temporary crown &
bridge cement, topical analgesics (Orajel), cotton tip applicators, cotton
rolls, sterile cotton gauze pads, oral analgesics/anti-inflammatories,
antibiotics, toothbrush with toothpaste, sugarless gum
Emergency Medications
Analgesics/Anti-inflammatories
Antibiotics
Ibuprofen 200-400mg, 6-8 hours, prn
pain, do not exceed 1.2g/day.
Rx:
Acetaminophen 325-650mg, 4-6 hours
or 1000mg 3-4 times a day, do not
exceed 4g/day
Ibuprofen and Acetaminophen taken
together are more effective than when
taken individually.
Penicillin V (600mg or 300mg), qid for
7 days.
If allergic to Penicillin:
Clindamycin (300mg or 150 mg), qid
for 7 days
Toothache from decay,
broken or leaking fillings
 A toothache is a common dental emergency that is often caused
by a cavity in the tooth. Bacteria inside the mouth use food
particles left on the teeth to produce an acid, which destroys the
enamel and dentin resulting in a hole in the tooth. The pulp tissue
often becomes inflamed eliciting a pain response.
 Broken fillings can occur from an active process of decay under
an existing restoration or trauma. Broken fillings are often sharp to
the tongue and cheeks and may or may not be sensitive,
depending on whether the dentin is exposed. Exposed dentin may
cause the tooth to be sensitive to pressure, air or temperature of
foods.
 Signs and Symptoms - Pain from the tooth which is intermittent
and often hot or cold sensitive. Hot or cold sensitivity often lasts
for a few seconds and goes away. Sharp tooth surfaces can
cause pain to the soft tissues such as the tongue and cheek.
• Locate the offending tooth and moisten a piece of cotton or cotton
pellet with eugenol. Apply the cotton to the tooth or soft tissue to ease
pain.
• Fill the cavity with temporary filling material such as Cavit, zinc oxide
and eugenol cement, or dental wax.
• Smooth the temporary filling material with your finger or a wet cotton
roll. Bite down on the material when it is soft to ensure a comfortable
occlusion once set.
• Use pain medication as needed.
• Temporary fillings set after exposure to saliva and usually have to be
replaced every few days.
Follow-Up
See a dentist after your trip and have the tooth filled with a permanent
filling.
Treatment
Cavit requires no premixing and is applied directly over the tooth.
Intermediate restorative material is prepared by adding a few drops of
eugenol to powdered zinc oxide to make as dry a mix as possible. (Zinc
oxide and eugenol combination cements are advantageous in that they
have an anesthetic effect and can be mixed to different consistencies,
depending upon whether they are to be used as filling material or
adhesives. However, the liquid can leak from its container, and the
cement is sticky and more difficult to work with than Cavit).
Dental Abscesses
 A dental abscess can cause unbearable pain, swelling
and discomfort. Dental abscesses are a complication of
tooth decay or gum disease. It may also result from
trauma to the tooth, such as when a tooth is broken or
chipped. Infections may spread out from the root of the
tooth and to the bones and soft tissue surrounding the
tooth.
 If not treated, the infection can spread from the tooth to
the floor of the mouth, the face and neck resulting in
severe illness.
Dental Abscess cont’d
Signs and Symptoms
 Toothache -Severe and continuous pain, sharp and shooting pain, throbbing
pain, pain when biting and chewing. The pain may keep the person up at
night
 Redness and swelling around the gums and at the root of the tooth
 Presence of a gum boil near the root of the tooth that may or may not drain
 General malaise and discomfort
 Bad breathe and foul taste in the mouth
 Lymphadenopathy
 Trismus

Swollen face and neck indicating a very serious condition

Fever may be present
 Administer oral antibiotics. (PenV or
Clindamycin)
 If there is a soft, pointing abscess
adjacent to the offending tooth, apply
orajel and then puncture the boil with a
sharp sterile scalpel if available. This
will help relieve the pressure and the
pain.
 Reduce pain and fever with oral
analgesics (Ibuprofen,
Acetominophen).
Treatment
 Rinse with warm salt water (1teaspoon
of salt in 1 cup of warm water) a few
times a day.
 Loss of tooth
 Spread of infection to the jaw bone (osteomyelitis of
the mandible or maxilla).
 Spread of infection to other areas of the body
resulting in cerebral abscess, endocarditis,
pneumonia, or other disorders.
If the swelling is localized to the soft tissues of the cheek
or the submandibular area, begin oral antibiotics and
monitor. If the infection spreads to the infra-orbital
space or is starting to affect the airway, the patient has a
persistent fever or are lethargic management in the
hospital setting will be necessary – GO TO THE
NEAREST HOSPITAL.
Follow Up
Visit a dentist for definitive diagnosis and treatment.
Complications
 Spread of infection to soft tissue (facial cellulitis,
Ludwig's angina).
Pericoronitis
Pericoronitis is an infection of the gum tissue that overlaps a
partially erupted tooth. It is most common around lower erupting
or impacted wisdom teeth. Bacteria and food debris get trapped
under the tissue and cause swelling, pain and infection.
Pericoronitis cont’d
Signs and Symptoms
Treatment
 Bad taste or bad breathe.
 Oral antibiotics
 Pain - may be mild but is
usually quite intense and my
radiate to the external neck,
the throat, the ear, or the oral
floor.
 Irrigate with salt water
 Trismus
 Cervical lymphadenopathy,
fever, and malaise
 Swelling localized around the
impacted or erupting tooth.
 Oral anti-inflammatories and
analgesics
 Soft diet
If the infection spreads and
affects the airway, there is
continued malaise and fever or
the symptoms worsen – GO THE
NEAREST HOSPITAL
Follow up: Visit a dentist - the
tooth may need extraction
Loose Crowns or Bridges
Loose crowns or bridges can pose a problem while in the back country. A loose
crown is dangerous as it can be aspirated or even swallowed if not careful. A
loose crown should be re-cemented to prevent sensitivity and further bacterial
contamination. The tooth may feel sensitive to temperatures or the bite might feel
different and the crown is loose or comes off.
Remove the crown/bridge from the mouth.

Wash away any debris and food particles around the tooth
by rinsing with water or with a cotton tip applicator or
toothbrush.

Remove the remainder of cement in the crown.

Check to see that the crown goes back on and the bite is
comfortable (if the bite is off – this can lead to pain in the
tooth and jaw pain)

Mix zinc oxide and eugenol into a temporary cement
consistency (runny) and place into the crown. Alternatively,
prepared dental cements, such as Temp Bond can be used.

Place the crown back on the tooth in the correct position
and bite down until the cement is set.

Clean off any excess cement with a toothpick, toothbrush
and floss between the teeth.
Follow-Up
Visit your dentist as soon as your trip is over for definitive
treatment. The tooth may require a new crown or may simply
need to be re-cemented with permanent cement and adjusted
into occlusion.
Treatment

Dislodged or Avulsed Tooth
When a tooth is dislodged or knocked out, timing is everything. The tooth
has a better chance of surviving the sooner it is placed back into the
socket. When possible, gently rinse the root and socket with water and
remove any debris (do not scrub the root) and place back in the socket
immediately. Pack with temporary material to splint in place. Eat a soft
diet. See a dentist as soon as you can.
Delayed Treatment
For delayed treatment of an avulsed tooth (5 minutes – 60 minutes), the tooth
should be stored in a physiologic medium such as chilled milk, saliva, tissue
culture medium). Usually ankylosis will be the outcome. Over 60 minutes of
time out of the mouth will predictably result in ankylosis.
The decision to replant a tooth is reversible: it allows for more time to assess
other available options and plan for eventual loss of the replanted tooth.
The tooth will require endodontic therapy and a more rigid splint for 7-14 days.
Seeing a dentist as soon as possible will provide the most favorable outcomes.
Implants or dental bridges are long term treatment options if tooth must be
extracted or is not replanted.
Traumatic Dental Injuries
A fractured tooth, for the most part, can be saved depending on where
the fracture occurs and if the nerve is exposed. Most dental fractures
occur in the front teeth, however some fractures occur on posterior teeth
such as the molars.
Fractured Teeth
Signs and Symptoms

Broken tooth

Pain and sensitivity when breathing in
air.

Hot and cold sensitivity when eating.

Bleeding around the gums at the
injured site.

Tooth mobility may or may not be
present.
Treatment

Place temporary restorative filling
material into the fractured area of the
tooth (if it will hold).

Avoid hard foods and maintain a soft
diet.

Avoid very hot and very cold drinks.

Check other areas of the mouth for
lacerations or broken teeth fragments.
Follow-up
See a dentist for a permanent restoration
and possible endodontic therapy as
needed.
Fractured Jaw
In the majority of patients, the
signs and symptoms of a jawbone
fracture begin to develop
immediately after some trauma to
the jaw.
Symptoms:
•
jaw pain
•
the teeth do not fit together
•
unable to open the jaw all the way,
have problems speaking or
chewing food, or notice swelling or
displacement of the jaw
•
the chin or lower lip may be numb
•
bleeding or bruising at the site of
the fracture or under the tongue
•
Drooling and the inability to close
the mouth may occur
Treatment
A broken jaw is best evaluated at a hospital. Therefore,
most doctors will advise the person to go to an
emergency department, preferably at a large hospital
that would be more likely to have specialists (oral
surgeons) on call to help evaluate and treat the
individual if needed. A potential but serious
consequence of jaw fractures is a problem breathing
due to loss of support to the tongue. Therefore, any
signs of breathing problems or shock need to be
addressed immediately by calling 911.
Get Medical Help Immediately, go to a hospital emergency room.

Prevent choking, allow any blood in the mouth to dribble out or have
the patient spit into a handkerchief

Without touching the roots, gently remove any broken or lost teeth
from the mouth and place them in cold milk, saliva, or sterile water.
Take the broken teeth to the health care provider.

Immobilize the jaw but do not attempt to align the jaws. Make a
bandage out of a handkerchief, scarf, or necktie, and tie it around
the jaw and over the top of the head to keep the jaw from moving.
The bandage should be easily removable in case the person starts
to vomit.

Control swelling by applying cold compresses.
Follow Up
Medical treatment depends on the location and severity of the break. A
surgeon may be able to set the bone without surgery although wires may
need to be placed to stabilize the jaw. Surgery may be needed to repair
the break. The surgeon will place plates or screws to hold the broken
pieces of bone together while they heal.
Treatment
cont’d

Thank-you,
I hope you have a safe journey
into the wild!
Dr. Natali Schindler, DDS
bite Family Dentistry
Banff, AB