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by Paul Auerbach, M.D.
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
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
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.
reposted with permission from the Medicine for the Outdoors Blog
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