Dental Emergencies in the Wild

Presented by: Dr. Natali Schindler, DDS bite Family Dentistry Banff, AB Common Dental Emergencies

• from a cavity or lost/broken filling (especially important when travelling in high altitudes or scuba diving) • Dental or periodontal abscess • Pericoronitis () • 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 or Cavit, temporary crown & bridge cement, topical (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 Rx: pain, do not exceed 1.2g/day. Penicillin V (600mg or 300mg), qid for Acetaminophen 325-650mg, 4-6 hours 7 days. or 1000mg 3-4 times a day, do not exceed 4g/day If allergic to Penicillin:

Ibuprofen and Acetaminophen taken Clindamycin (300mg or 150 mg), qid together are more effective than when for 7 days taken individually. 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. Treatment zinc oxide zinc oxide wet cotton wet , Cavit as possible. (Zinc Cavit). tooth or soft tissue to ease wax. and have and have the tooth filled with a permanent . trip after exposure to saliva and usually have to to be have and usually saliva exposure after combination cements are in advantageous that they . Apply . Apply the cotton to the cement, or dental medication as needed. powdered zinc oxide oxide tozinc as make dry mix a powdered eugenol eugenol to Up - dentist after your requires no premixing and is applied directly over the tooth.over and is directly no premixing applied requires Fill Fill the cavity with filling such material temporary as Smooth the temporary filling with the material Smooth temporary your finger or a Locate the Locate tooth and offending moisten a piece of cotton or cotton Use pain Use Temporary fillings set Temporary • oxide and oxide have an anesthetic effect and can be mixed to different consistencies, consistencies, and canto be mixed different effect an anesthetic have they are touponwhether be used as fillingor materialdepending and the theits liquid can leak container, from However, adhesives. cement is sticky and more difficult to work with with than towork difficult more and is sticky cement • Cavit ismaterial by restorative a prepared adding few Intermediate drops of eugenol • with pellet pain. eugenol and roll. Bite down on the when material it is softto a ensure comfortable occlusion once set. • See a filling. • replaced every replaced every few days Follow Dental Abscesses

 A dental abscess can cause unbearable pain, swelling and discomfort. Dental abscesses are a complication of 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

 Swollen face and neck indicating a very serious condition

 Fever may be present Treatment a the few apply a , ) and PenV or . ( available. This This available. if fever with oral warm water warm ). of and the tooth offending . oral antibiotics oral then puncture the boil with a soft, pointinga soft, abscess to is and a day help relieve the pressure salt 1 in cup there Reduce pain times If adjacent Rinse with warm salt water (1teaspoon of Clindamycin) analgesics (Ibuprofen, Acetominophen sharp sterile sharp scalpel orajel will pain. Administer Administer     Complications . , GO TO THEGO TO – Ludwig's angina). Ludwig's of jaw (osteomyelitis the bone to of infection Spread mandible or the maxilla). body of the other areas to of infection Spread endocarditis, abscess, in cerebral resulting disorders. other or pneumonia, Spread of infection to soft tissue (facial (facial soft tissue cellulitis to infection of Spread Loss of tooth of Loss NEAREST HOSPITAL. HOSPITAL. NEAREST Follow Up treatment and definitive dentist diagnosis for a Visit space or is starting to affect the airway, a patient has the airway, the to affect is starting or space the in management lethargic or are fever persistent necessary setting will be hospital monitor. If the infection spreads to the infra-orbital infra-orbital the to spreads infection the If monitor.   cheek of the tissues soft to the is localized swelling the If antibiotics and begin oral area, submandibular the or   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  Irrigate with salt water usually quite intense and my radiate to the external neck,  Oral anti-inflammatories and the throat, the ear, or the oral analgesics floor.  Soft diet  Trismus If the infection spreads and  Cervical lymphadenopathy, affects the airway, there is fever, and malaise continued malaise and fever or the symptoms worsen – GO THE  Swelling localized around the NEAREST HOSPITAL impacted or erupting tooth. 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. Treatment . toothpick, toothbrush isover for definitive this can lead to in the pain – . place into the Alternatively, crown. with with cottona tip applicator or eugenol into a temporary cement (runny) and (runny) cemented permanent with cement and adjusted crown crown back on the tooth in the correct position - off any a excess cementwith any off zinc oxide and your your dentist as soon as your trip tooth and pain) jaw Mix consistency prepared dental cements, such as Temp Bond can be used. prepared dental cements, Temp such as Place the and bite down until the cement is set by rinsing with water water with or rinsing by toothbrush. Remove the remainder of cement in the crown. to Check see that the crown goes backon and the biteis comfortable (if the bite is off Remove the crown/bridge crown/bridge the from mouth. the Remove away any debris and particlesfood around Wash the tooth and floss between the teeth flossbetween and Clean        Follow-Up Visit or simply new may tooth The crown may a require treatment. to be re need into occlusion. 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 Treatment

 Broken tooth  Place temporary restorative filling material into the fractured area of the  Pain and sensitivity when breathing in tooth (if it will hold). air.  Avoid hard foods and maintain a soft  Hot and cold sensitivity when eating. diet.   Bleeding around the gums at the Avoid very hot and very cold drinks. injured site.  Check other areas of the mouth for  Tooth mobility may or may not be lacerations or broken teeth fragments. present. 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. Treatment cont’d a teeth break. A break. A jaws. jaws. Make may may be to needed repair to a hospital emergency room. emergency to a hospital jaw. Surgery Surgery jaw. blood in blood the tomouth dribble out or have not attempt to align the any any but do by coldby compresses. applying touching the roots, gently remove any broken or lost Medical Help Immediately, go Help Medical Immediately, bandage out of a handkerchief, scarf,or necktie,outand tieof ita handkerchief, around bandage jaw the topand over tothe of thethe head jaw keepfrom moving. should be bandage The in easily removable case the person starts to vomit. swelling Control the patient spit into a handkerchief Prevent choking,Prevent allow from the from mouth and place them in cold milk, saliva, or sterile water. the broken teeth to the care health provider. Take theImmobilize jaw Without Get Follow Up Follow of the on and severity the locationdepends treatment Medical  wires may althoughmay be surgery able tothe setwithout bone surgeon need to need be toplaced stabilize the will The surgeon theplace break. plates or to screws hold the broken pieces of bone together while they heal.     Thank-you, I hope you have a safe journey into the wild! Dr. Natali Schindler, DDS bite Family Dentistry Banff, AB