Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
When You Break or Lose A Tooth
Sometimes when a person falls or is struck in the mouth, a tooth is broken or knocked out. If a tooth is cracked (with the root still present and in place), there is little for the victim to do other than keep his mouth clean and avoid contact with extremes of temperature. If air, saliva, the tongue, or temperature change coming into contact with an exposed nerve causes intolerable pain, a temporary cap (shield) can be created by mixing melted paraffin (candle wax) with a few strands of cotton. When the mixture begins to harden but can still be easily molded, press a wad onto the tooth, using the teeth on either side as anchors. If you are carrying emergency dental supplies, a cap can be fashioned from Cavit™ or IRM®.
If a tooth is broken or a crown falls off, apply a little eugenol to the tooth for immediate pain control. For a displaced crown, press it back onto the tooth and see if the crown will hold without cement. If not, apply a dab of Cavit™ and use it as a fastener, scraping away the excess. If all else fails, cover the tooth with paraffin or dental wax.
If a tooth is shifted out of its normal position, but is still embedded in the gum, it may need to be repositioned. If the tooth appears to be longer or off to one side, use a gloved hand, firmly grasp the tooth, and move it into proper alignment. If the tooth has been pushed into the gum and appears to be too short, do not move the tooth.
If a tooth is knocked cleanly out of the socket, it can sometimes be replaced successfully if the victim can reach a dentist within the first hour. After two hours, there is little hope for salvage of that particular tooth. The best treatment for a tooth that has been out of the socket for 15 minutes or less is to gently rinse it clean (do not scrub the root of the tooth, because that will injure the periodontal ligament) and reinsert it with firm pressure into the socket to the level of the adjacent tooth. Try to splint the tooth in place with a paraffin bridge or a cap to the adjacent tooth. A better material for this purpose is Express Putty, which hardens within four minutes after equal amounts of the putty base and catalyst are mixed.
The best storage solution for a tooth that will be carried to a dentist is pH (acid–base) balanced (Hank’s balanced salt solution) and accompanied by a cushion to prevent injury to the microscopic ligament cells that hold the tooth in place and must reattach for the tooth to “take.” The Save-A-Tooth® or EMT Toothsaver™ storage device is recommended.
Alternately, the tooth can be placed in a container and covered with a small amount of cool, pasteurized whole milk (not yogurt, low-fat milk, or powdered milk) for transport. Do not carry the tooth on a dry cloth or paper. Do not soak the tooth in tap water. A tooth can also be rinsed and carried by the victim in the space between his lower lip and lower gum (taking care not to swallow the tooth), although saliva is not particularly good for the periodontal ligament. Do not place a tooth back into the socket unless an antibiotic (e.g., penicillin 500 mg four times a day for two weeks) can be administered to avoid an infection, and tetanus toxoid given if necessary.
Once the tooth is replaced, it can be splinted to an adjacent tooth or teeth by cutting a small piece of plastic and using something like tissue glue (Dermabond), if you have it in the first aid kit, to anchor the splint to the front of the teeth (Ann Emerg Med 2011;57:375-377). If it will be a few days until you are back to civilization, have the victim follow a soft diet, brush the teeth gently after eating, and use mouthwash twice a day.
If the socket of a broken or lost tooth continues to bleed, apply direct pressure by having the victim bite on a gauze pack for 30 minutes. If there is a large blood clot, remove it, then apply pressure. Keep the head elevated. Avoid rinsing, spitting, tooth brushing, and tobacco use for 24 hours. Gentle rinses with warm salt water can be started after that time period. If the bleeding does not stop after several hours, biting on a dry tea bag (tannic acid) may help. “Dry socket” may occur two to four days after a tooth is lost. This is characterized by pain, foul odor, and a bad taste. Inspection of the tooth socket may show exposed bone. Treatment is gentle saltwater rinses followed by packing with a strip of eugenol-soaked gauze. The pack should be changed every one to two days until the symptoms are relieved, which may take up to 10 days. During this period, do not ingest alcohol or carbonated beverages.
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