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WARNING: This article is meant to be a quick overview and not a detailed guide on how to deal with dental care in an emergency situation. Professional medical treatment should always be sought first before attempting any of these methods.
Do you remember the movie Cast Away? In this film, protagonist Chuck Noland (played by Tom Hanks) survives four years on a deserted island after his plane goes down in the ocean. At one point in the movie, Mr. Noland develops a bad tooth. Since a professional dentist isn’t available to extract the tooth, he’s forced to improvise and gruesomely knocks the tooth out with an ice skate blade and a rock. Isn’t there a better way? Could he have prevented the situation from getting that bad?
While this may have been played up for dramatic effect, think about that scenario for a second. If you develop severe dental problems, such as an infected or cracked tooth, lacerated gums, an oral fungal infection, or one of many other nasty issues in that opening you’re using to eat food and drink water, what can you do? If no medical help is available, you may be in a world of hurt.
Anyone who has experienced even a mild toothache or onset of a cavity knows that it’s a level of discomfort you wish to rid yourself of as quickly as possible, lest it become unbearably painful. Without proper treatment, an abscess or infected tooth could even be life-threatening. First, let’s talk preventive measures. Don’t assume that if you’re without floss or a toothbrush you’ll just have to hope for the best. There are items out there you can either fashion yourself or that can be found in nature. An ounce of prevention is worth a pound of cure.
Answers to those questions can be found in Murray Dickson’s book, Where There Is No Dentist. First released in November 1983, it’s an excellent, easy-to-understand resource to manage various dental issues in remote third-world countries or a long-term survival situation. Like Mr. Dickson, we value preparedness.
As part of a preventive strategy, you can rinse your mouth with a mixture of ½ teaspoon of table salt dissolved in a cup of warm water every day to keep harmful bacteria to a minimum. This works by gently altering the pH balance in your mouth to create an alkaline environment that impedes the growth of specific tooth-decay-causing bacteria. Fortunately, the saltwater solution won’t irritate the mucous membranes that line your mouth and help maintain its equilibrium.
In a survival situation, you can boil ocean water down to procure sea salt crystals, but rinsing with untreated seawater should always be avoided (more on that shortly). If you aren’t near an ocean, you can boil hickory roots until the water evaporates. The crystals left in the pan are salt. You might even be lucky enough to find a salt block in a farmer’s field.
It’s important to note that while pure saltwater rinses can be beneficial for oral health, the use of saltwater — especially raw seawater — on open wounds elsewhere on the body poses some concerns. See our “Debunked” column elsewhere in this issue for more details on saltwater wound care.
If you don’t have a toothbrush, you can create one by using a small, soft tree branch (ash, willow, poplar, pine). Choose a small branch that’s about the thickness of a pencil. It should be sturdy enough that it won’t break when you brush your teeth. Chew the end of it to soften it, and use that end to brush with. Toothpaste is helpful, but not essential, as brushing with water alone is better than not brushing at all. As for floss, you can use the smaller cordage from paracord, palm leaves, fibers from a yucca plant, or similar nontoxic fibrous items.
In the second part of the book, Dickson discusses treatment of various dental problems. With poor dental and gum care, infection becomes a real possibility. The gums often get infected due to poor hygiene and a diet high in sugar. These can cause the gums to loosen around the teeth and allow bacteria to grow in this space. The gums can swell, get red, bleed, and be painful as some of the earliest signs of infection.
If the infection gets deeper near the root of the tooth, there’s a possibility it can spread to the adjacent bone. If the infection gets into the bloodstream, it can infect the heart valve (called endocarditis), and is a potentially life-threatening situation. This type of infection requires intravenous antibiotics, which would not be readily available in a survival setting. Thus, recognition of early signs of infection is your best bet to minimize more serious infections from occurring.
Starting oral antibiotics early is important, so hopefully you have stored some for these types of emergencies. Antibiotics that’d be useful are Penicillin, Amoxicillin/Clavulanate, or Clindamycin. You could also try herbal remedies like chamomile, Echinacea, garlic, onions, etc., to boost the immune system if nothing else is available, but these may not help if the infection is too far advanced.
If an abscess is present, you may need to drain it to relieve the pain and pressure. This would require a large sterile needle or sharp sterile knife to incise the area and allow the pus to drain. Remember that good hygiene is an important part of keeping your teeth and gums in good shape so you won’t have to attempt oral surgery on yourself or someone else. Those are dangerously desperate measures that may only exacerbate the problem if you have no experience in this area — they’re a last resort.
What happens when the tooth gets infected? One simple sign of infection is that the tooth can be sore with chewing. If the pain is fairly constant and severe, it may suggest a deeper infection, or abscess, in the tooth. Bacteria find safe harbor in a dental cavity, a lost filling or a loose crown. Cleaning the tooth and filling the breach is essential to prevent any further damage to the tooth. Dickson devotes specific chapters to cleaning, filling, and pulling a tooth.
Although there are dental kits that have everything you need to place a temporary filling in a cavity (including instructions), you may need to make your own tools. You can, however, purchase a small collection of dental tools for about $10 and still not take up much room in your bug-out bag.
These tools should include a probe, scaler, spoon, and a filling tool, at the very least. If you don’t have access to these tools, you’ll have to scavenge for items to make them. Coat hangers and heavy-gauge wire are easy to fashion into anything you may need to clean or remove a tooth. Keep in mind that when placing the filling, be sure there’s no infection deeper in the tooth. This may cause increased pain and an infection that spreads to the bone and bloodstream.
For sterilization purposes, boiling the improvised dental instruments in clean water would be the way to go.
What happens if you break a tooth or even knock it out completely? You’ll need to decide whether to fix the problem or pull the tooth. If the tooth has changed to a dark color or has broken off deep at the root, or if the nerve is exposed, then you should remove the tooth. If you carry lidocaine and a syringe, I’d suggest injecting into the gums at the root above the tooth (for the upper teeth).
For the lower teeth, you’ll need to inject inside the mouth above the angle of the jaw. This is where the main nerve enters the jawbone. If the tooth gets completely knocked out in one piece due to trauma, you have about 12 hours to replace it. Ideally, replace the tooth as soon as possible. Make sure to clean it first with saline or purified water. Hold the tooth in place for about five minutes. Try to protect it by covering it and the adjacent teeth with a roll of beeswax. Of course, if you find yourself with nothing but an ice skate and a rock, you’ll have to do the best you can.
As far as improvised gauze found in nature, you could use alfalfa leaves, cayenne, or calendula to stop bleeding and the inner part of the brown cattail fruit, cotton, or hemp flour as an absorbent. In lieu of those items, a piece of clothing or tampon could also serve as temporary absorbents.
Dickson’s book provides an excellent resource for prevention and treatment of different dental ailments when there’s no dentist and you find yourself suffering from oral health problems. Educating yourself prior to a dire situation will be paramount to returning home with all of your pearly whites. Speak to your dentist as well about tools and medical supplies you should carry with you that could come in handy during an emergency. Although you may not have thought to add something as simple as floss, toothbrush, and bottles of mouthwash to your bug-out bag, they’re an essential and often-overlooked part of your survival needs.
David Miller, DO, FACOI, is an internist in private practice. Diagnosed with Type 1 diabetes in 1990, he has a unique perspective on patient care and disease management. Experiences away from the office have included being a fight doctor for regional MMA bouts and a team physician for a Division I university in west central Illinois. Dr. Miller is an instructor for the Civilian Crisis Response Team (medical section) based out of Indianapolis.