Wilderness Dentistry

shutterstock_101677420I recently returned from a wilderness medicine conference in Whistler, British Columbia.  Eric Johnson, MD gave a great talk on dentistry in the wilderness so I give him credit for much of the information presented here.

On wilderness backpacking adventures there are many possible dental problems.  Many patients have dental crowns or veneers that get broken.  Dental cavities or broken teeth can often be spotted before leaving for a three week journey, so it’s important to get a dental pre-trip exam to look for problems before departure.

Some of the most commonly encountered dental problems in the wilderness are:

1)  Cracked or dislodged fillings

2)  Inflammation of the gums around the tooth (the piece of popcorn stuck between the tooth and gum)

3)  A cracked tooth or crown

4)  A chipped tooth

5)  Trauma causing a completely knocked out tooth (exodontia)

6)  Dental abscess

Treatment:  Treatment of dental problems should always be attempted by someone trained in dental surgery, however in an emergency situation in the wilderness a dentist may not be available.  Adequate lighting is essential when treating dental problems in the backcountry.  I like to carry a headlamp so that my hands are free to work with the patient.

Cavit is a temporary filling material that is self curing that you can bring with you and is very helpful to treat problems such as dental crown or filling that has broken or come off.  It comes in small tubes or containers and is similar in consistency to silly puddy but hardens and can be very helpful to reduce dental pain from exposed pulp/nerve.

If a tooth needs to come out, it can be removed in the back country but it should only be attempted by someone with experience in this procedure.

Exodontia:  The extraction of a tooth.  If the tooth is not extracted in its entirety or there is a root that does not come out they can get infected.  Extracting a tooth is not as simple as simply pulling it, there are many possible complications of tooth extraction such as:

1)  Accidentally removing the wrong tooth  – it’s easy to do because pain from one tooth can feel like it’s coming from somewhere else in the mouth

2)  Breaking a tooth while pulling it – can cause severe abscess

3)  Excessive bleeding

4)  Dry socket – extreme pain after the extraction

Extrusion:  Dental trauma causing the tooth to get knocked out completely.

If a tooth gets knocked out, it’s important to protect the tooth and try to get it re-implanted as soon as possible.  If re-implantation is done within 20 minutes there is usually a very good chance that there will be a good outcome.  If it’s longer than 1 hour, there is less chance that the tooth will live.  Some tips on what to do if a tooth gets knocked out:

1)  Keep the tooth moist with saliva (keep it in your mouth)

2)  If there is not a dentist in the back country with you, a medical provider may be able to anchor the tooth into the socket using a figure of eight stitch (suture).  I have also heard that dental floss can be used to tie one tooth to another.

3)  Do not chew

Dental Blocks:  Sometimes it can be very helpful to provide local anesthesia using a dental block to help alleviate pain.  On the upper teeth, injecting on either side of the tooth (around the tooth) with lidocaine may provide adequate analgesia rather than having to do full dental block.  Anesthesia for teeth on the lower jaw (mandible) is more difficult and may require a block.

20% Benzocaine gel can decrease the discomfort at the injection site and is a good item to have in your dental kit.  It can also be used on tongue or lip ulcers or canker sores.

Equipment:  1” 27 gauge needle, 3ml syringe, 2% lidocaine with epi (or similar agent)

Back Country Dental Kit:  Here are some items that you might consider taking with you into the back country if you are the medical officer on an expedition with a group of hikers:

1)  Number 150 or 151 universal extraction forceps

2)  Straight elevator

3)  Mouth mirror

4)  Orabase with benzocaine

5)  Orthodontic wax

6)  Dental floss

7)  Dental syringe

8)  27 gauge needles with anesthetic

9)  Cavit or IRM for temporarily filling/sealing a tooth

10)  #11 blade scalpel

11)  20% benzocaine gel

If you’re in the Seattle area and are looking for an excellent dentist, I highly recommend Robert Odegard, DDS.  He has been my dentist for more than 20 years and has excellent skills and his staff are great.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Dental Pain – What to do about an abscessed tooth

Even though I’m not a dentist or oral surgeon, I have patients who come in to get treatment for their dental infections.  A tooth infection is a result of bacteria that can extend into the gums, cheeks, throat, behind the tongue or even into the jaw or facial bones.  These infections are known as dental abscesses and can become very painful.

Patients with a weakened immune system, autoimmune disorder or who experience trauma to the mouth or gums can also be more susceptible to have dental infections. Pus from the infection can collect at the site of the infection and may become more painful until the abscess either ruptures and drains on it’s own or is drained surgically.  If the infection progresses, it can become so severe that it may block the patient’s airway and cause difficulty breathing.  This is rare, but is a medical emergency requiring immediate surgical attention.

Symptoms:  Patients with dental infections often complain of pain, swelling and redness of the mouth or face.  It can feel like a sinus infection if the involved tooth is on the upper jaw.  There is always tenderness with pushing over the area of infection.  Late signs of a dental infection might be fever, chills, nausea, or vomiting.

Diagnosis:  Usually a doctor or dentist can determine if you have an abscess or dental infection by physically examining the affected area.  Sometimes x-rays of the mouth may be necessary if the infection is located in the deepest part of the tooth.

Treatment:  Pain relievers may be helpful such as ibuprofen or Aleve.  For more severe infections, narcotic-type medications such as Vicodin may be prescribed.  Antibiotics are helpful to treat the infection, but usually are not the cure.  Dental abscesses are infections that involve the teeth, gums, jaw and sometimes the cheek or throat so they need surgical attention by a dentist or oral surgeon.  Your local family physician, urgent care doctor or emergency physician is generally not trained in how to perform dental surgery so it is important to be seen by the dentist.  A dentist can also perform a dental block that numbs the nerve causing the pain.  Generally this is far more helpful that oral pain relievers.  They may also cut open the abscess if it’s along the gum line to allow the pus to drain. They may also pull the tooth or perform a root canal.  An abscess that has extended to the floor of the mouth or to the neck may need to be drained in the operating room under anesthesia.

Prevention:  A major role is maintaining excellent dental health is prevention with brushing, flossing and regular dental checkups.  If tooth decay is discovered it should be treated early so that cavities do not develop into abscesses.  Avoiding tobacco (chewing and smoking) is also helpful for prevention of decay.

To find a dentist in your area, the American Dental Association has a useful Dentist locator:  http://www.ada.org/ada/findadentist/advancedsearch.aspx

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com