I 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