(This article first appeared in Gaye Levy’s Back Door Survival website)
Many of our readers are surprised that “The Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way” devotes a portion of its pages to dental issues. Indeed, few who are otherwise medically prepared seem to devote much time to dental health. Poor dental health can cause issues that affect the work efficiency of members of your group in survival settings. When your people are not at 100% effectiveness, your chances for survival decrease, and anyone who has experienced a toothache knows how it effects work performance.
A survival medic’s philosophy should be that an ounce of prevention is worth a pound of cure. This thinking is especially apt when it comes to your teeth. By enforcing a regimen of good dental hygiene, you will save your loved ones a lot of pain (and yourself a few headaches).
This article will discuss procedures that are best performed by someone with experience. Unfortunately, you’re probably not going to have a dentist in your party. The information here will give you a basis of knowledge that may help you deal with some basic issues
The prepared medic will have included dental supplies in their storage, but what exactly would make sense in austere settings? You would want the kit to be portable, so dentist chairs and other heavy equipment wouldn’t be practical.
We’ve mentioned that gloves for medical and dental purposes are one item that you should have in quantity. Don’t ever stick your bare hands in someone’s mouth! Buy hypoallergenic nitrile gloves instead of latex. For additional protection, masks should also be stored and worn by the medic.
Other items that are useful to the survival “dentist” are
- Dental floss, dental picks, toothbrushes, toothpaste or baking soda
- Dental or orthodontic wax as used for braces; even candle wax will do in a pinch. Use it to splint a loose tooth to its neighbors.
- A Rubber bite block to keep the mouth open. This provides good visualization and protection from getting bitten. A large-sized pink eraser would serve the purpose.
- Cotton pellets, Cotton rolls, Q tips, gauze sponges (cut into small squares)
- Commercial temporary filling material, such as Tempanol, Cavit, or Den-temp.
- Oil of cloves (eugenol), a natural anesthetic.It’s important to know that eugenol might burn the tongue, so be careful when touching anything but teeth with it. Often found in commercial preparations.
- Red Cross Toothache Medicine (85% eugenol)
- DenTemp Toothache Drops (benzocaine )
- Zinc oxide powder; when mixed with 2 drops of clove oil, it will harden into temporary filling cement.
- Spatula for mixing (a tongue depressor will do)
- Oil of oregano, a natural antibacterial.
- A bulb syringe to blow air and dry teeth for better visualization, and as a diagnostic tool to elicit discomfort in damaged teeth.
- A 12cc Curved irrigation syringe to clean areas upon which work is being done.
- Scalpels (#15 or #10) to incise and drain abscesses
- Dental probes, also called “explorers”.
- Dental tweezers
- Dental mirrors
- Dental scrapers/scalers to remove plaque and probe question- able areas
- Spoon excavators. These instruments have a flat circular tip that is used to “excavate” decayed material from a tooth. A powered dental drill would be a much better choice, but not likely to be an option off the grid.
- Elevators. These are thin but solid chisel-like instruments that help with extractions by separating ligaments that hold teeth in their sockets. #301 or #12B are good choices. In a pinch, some parts of a Swiss army knife might work.
- Extraction forceps. These are like pliers with curved ends. They come in versions specific to upper and lower teeth and, sometimes, left and right.
There are more types of dental extractors than there are teeth, you should at least have several. Although every dentist has their preferences, you should consider including the following in your dental kit:
-#151 or #79N for lower front teeth
-#150A or #150 for upper front teeth.
-#23, best for lower right or left molars
-#53R, best for upper right molars
-#53L, best for upper left molars
- Blood-clotting Agents: There are a number of products, such as Act-Cel, that help control bleeding in the mouth after extractions or other procedures. Act-Cel comes in a fabric square that can be cut to size and placed directly on the bleeding socket or gum.
- Sutures: A kit consisting of a needle holder, forceps, scissors, and suture material is helpful for the control of bleeding after extraction or to preserve the normal contour of gum tissue. We recommend 4/0 Chromic catgut as it is absorbable and delicate enough for the oral cavity but large enough for the non-surgeon to handle. Don’t forget a small scissors to cut the string. More information on suture materials can be found later in this book
- Pain medication and antibiotics. Medications in the Penicillin family are preferred if not allergic. For those allergic to Penicillin, Erythromycin can be used. For tooth abscesses, Clindamycin is a good choice. Antibiotics are discussed in detail in our book and in various sections of our website at doomandbloom.net
The Survival Dental Exam
Because your hands and your patient’s mouth are colonized with bacteria, every exam should begin with hand washing and the donning of gloves. All instruments should have been thoroughly cleaned or sterilized between exams. If an instrument has touched blood, consider using heat in the form of boiling water (or steam from a pressure cooker) as previously described in this book. Alcohol or bleach solution may be sufficient in cases where there was no blood involved.
Have your patient open their mouth so that you can investigate the area. A dental mirror and dental probe, also called an “explorer”, are good tools to start with. Does the patient have any problems opening and closing their mouth? Are there sores at the corner of their mouths (sometimes seen in vitamin B2 and other nutritional deficiencies)?
Evaluate the cheek linings, roof of the mouth, the tongue, tonsils, and the back of the throat. Are the gums pink, or are they red and swollen? Do they bleed easily when lightly touched by the probe?
Are there “canker” or “cold” sores? Contrary to popular opinion, these are not the same thing. Cold sore, or fever blisters, start off as small blisters and are caused by Herpes type I virus. They mostly affect the hard gums and the roof of your mouth. Canker sores are less certain in origin. They are shallow ulcers that affect soft parts like the inside of your lips and cheeks, the floor of the mouth, and the underside of the tongue.
Other soft tissues to check out include the tonsils. Are they enlarged? Are they or the back of the throat reddened and dotted with pus? These can be signs of tonsillitis or Strep throat.
Once you have checked the soft tissues inside the mouth, it’s time to examine the teeth. Using your dental explorer, carefully look around for any obvious cavities. A cavity will appear as a dark pit where bacteria has demineralized the enamel. Search for fractures, missing fillings, or other irregularities. Even if there is nothing visible, however, there may still be serious decay between teeth or below the gums. Patients with this issue may have pain, otherwise known as “toothache”. You’ll find information on how to deal with toothache, broken and “knocked-out” teeth, and other dental issues in The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way and in specialty books like “Where There is No Dentist”. We’ll discuss specific issues and how to treat them in future articles.
Once you’ve identified the problem area, you can do your best to deal with the problem. With the items above, you’ll be more prepared for survival dental 99.9% of the population. Our dental kit is designed to have the materials necessary to function in a survival setting and even comes with a free copy of “Where There is No Dentist”. That doesn’t mean that, in normal times, you shouldn’t seek out a qualified dentist; whenever and wherever modern dental care is available, take advantage of it.
Amy Alton, ARNP
Find out more about dental issues and 150 other topics in our 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.