Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section VI: Backcountry Medicine

is directed at ensuring that critical body system problems are considered and stabilized. Beyond that, broken teeth do not represent a medical emergency.

place with toothpaste, but this is not ideal. The patient should eat only soft foods and cool liquids.

Anticipate: • Infection • Pain Treatment: • Pain medication • Clean and cover with dental wax . • See dentist ASAP Fractured Teeth

General Principles

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Dental Trauma

General Principles

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Anticipate: • Airway obstruction • Infection • Pain Treatment: • Recover tooth • Replace and splint • Pain medication • See dentist ASAP

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©2018WMA

Referral of trauma or lost fillings to dental fol- low-up may be non-emergent if infection does not develop. In significant trauma where teeth have been avulsed or fractured, prophylactic antibiot- ics are indicated. Pain medication and a soft diet

©2018WMA

Treatment of Dental Trauma Position the patient to allow drainage of blood and debris out of the mouth, rather than down the throat. Instruct the patient to rinse the mouth with cool water. This cleans out blood clots and loose teeth and helps stop bleeding. Examine the mouth with a good light. Look for teeth that are loose or fractured but still in the socket. Look for empty sockets that could match any avulsed teeth you have found. Teeth that have been cleanly avulsed have a fair chance of reattaching if returned to their socket within a few hours. Handle the tooth only by the enamel, not by its root. Rinse the tooth in clean water and push it gently all the way into its socket. You can splint the tooth to a healthy one adjacent to it by tying it with dental floss or fishing line, or by constructing a bridge from dental wax or Cavit. Any teeth that are loose, but still in the socket, may be splinted in this manner as well. Fractured teeth that are still in place may be extremely sensitive on exposure to air if the nerve is still alive. The fracture site can be anesthetized with topical oral pain relievers (e.g., oil of cloves or viscous lidocaine) and covered with temporary filling material or dental wax. The loss of a filling can be treated the same way, using wax or filling material to protect the sensitive nerve tissue that is exposed when the filling falls out. Loose fillings or crowns can also be temporarily glued back in

may also be required. Dental Infection

Infection and swelling within the confined space at the base of a tooth or in the gum can be excru- ciatingly painful. Eating and drinking will be dif- ficult or impossible. If the infection penetrates the soft tissues of the head and neck, it can become dangerous. Both the infection and the pain it causes will be difficult to manage in the field. Bacteria usually enter through a break in the enamel caused by trauma, or through a cavity, and form an abscess with the typical swelling, pressure, and pain. Swelling of the gum on the affected side may be evident, as well as the tenderness of one or more teeth when tapped with a finger or stick. A patient with a more serious infection will show facial swelling and fever. Treatment of Dental Infection Urgent evacuation to dental care is indicated if swelling, fever, or severe pain is present. The ideal treatment includes drainage, antibiotics, and pain relief. The usual method is drilling and cleaning the inside of the tooth and installing a filling.