Toothache in TEOTWAWKI

While most people have teeth made of bone and covered with enamel, my dear husband’s teeth are made of chalk.  His dentists love him.  That flaw could have perhaps been forgiven had he passed on the genes for perfectly straight teeth to his children.  (It’s totally true—he and all seven of his siblings have perfectly straight teeth.)  Unfortunately, not only did he not pass the straight teeth genes on to any of our children, he also passed the chalk teeth gene to King of the Picky Eaters.  KOTPE had a root canal before he was out of high school.  It was supposedly some kind of weird thing where the tooth had no cavity but just decided to decay from within, but I’m pretty sure KOTPE passed a dead president to the dentist just to say that.

Anyway, due to their history, I figure it’s important to understand what supplies we’ll need to have on hand to deal with some common dental issues.  And the first time most people will realize they have a problem with their teeth will occur when they get a toothache.

It’s called pulpitis, or inflammation of the dental pulp.  The first step is to identify the problem tooth, and that, unfortunately, can be difficult.  A dental pick and mirror will help.  Begin by looking for any obvious cavities or lost fillings, perhaps a crack or fracture.  Without x-rays, you won’t be able to find problems between the teeth or below the gums.

If you can’t visually identify any issues, move on to the next test:  Touch the teeth in the area of the pain with something cold.  A bad tooth touched with something cold will cause pain.[1]

Now touch that same tooth with something hot.  If the tooth doesn’t hurt, it can be salvaged.  If it does hurt, it will continue to hurt for 10-15 seconds after the heat source is removed.  And the tooth likely cannot be saved.  When there is no dentist, that tooth will have to be removed.  Delaying extraction risks spreading the infection to other teeth and/or sepsis.[2]

It can be difficult for the patient to determine the exact tooth causing the pain.  The afflicted tooth is usually not sensitive to tapping, but it may be sensitive to heat, cold, or sugar.[3]  There may be an obvious cause, like a large cavity.  To manage symptoms and control pain, OTC pain relievers, cold packs, saline gargles, and a soft diet are commonly recommended.[4] 

The following information comes from The Ship’s Medicine Chest and Medical Aid at Sea:

Toothache Without Swelling

This condition usually is caused by irritation or infection of the dental pulp from a cavity, lost filling, or a recurrent problem in a tooth that has a filling in place.

Treatment

The patient who has a toothache without swelling of the gums or face should be advised to chew on the opposite side of his mouth.  Foods should not be too hot or too cold.  Pain may be relieved with aspirin 600 mg by mouth or with codeine sulfate 30 mg if the pain is severe.  If the patient does not tolerate aspirin, acetaminophen at the same dosage and frequency should be given.  The patient with a toothache should be told to swallow the aspirin and never to hold the tablets in the mouth as this will burn the soft tissues.  If the aching tooth has a large cavity, the instructions for placing a sedative cotton dressing, described under Lost Filling [yesterday’s article, 26 April 2022], should be followed.

Toothache With Swelling

Toothache with swollen gums or facial tissues often results from infection by tooth decay that involves the dental pulp and spreads into the tissues of the jaws through the root canals.  The condition also is common as a result of infections associated with diseases of the gums, periodontal membrane, and the bone that supports the teeth.  In all cases, frequently there is pain, swelling, and the development of an abscess with pus formation. 

Treatment

The patient with mouth-facial swelling should be observed closely and the following findings noted:  (1) the exact area of the swelling, initially and during the illness; (2) the type of swelling, whether soft, firm, or fluctuant (movable tissue containing a pus-filled cavity); (3) difficulty in opening and closing the mouth; and (4) the oral temperature, morning and night.  These findings are important for following the patient’s progress and evaluating the effectiveness of the medication used.  The pain should be controlled with analgesics as described under Toothache Without Swelling.

For infection, an initial dose of penicillin V potassium 500 mg should be given by mouth followed by 250 mg every six hours.  If the patient is allergic to or suspected of being allergic to penicillin, oral erythromycin should be used in the same dosage and frequency.  The patient should be kept on the antibiotic for at least four days after he becomes afebrile (without fever).  Instructions should be given to see a dentist at the earliest opportunity.

The patient should be advised to rinse the mouth with warm saline solution (a quarter teaspoonful of table salt in 8 ounces of warm water) for five minutes of each waking hour.  This will cleanse the mouth and help to localize the infection in the mouth.  Also, saline solution may produce earlier drainage and relief from pain.  After the pain and swelling subside, the oral rinsing should be continued until the patient is seen by a dentist.[5]

This concludes the information from The Ship’s Medicine Chest.

Like many of our modern medical problems, most dental problems are largely avoidable with good dental hygiene that includes frequent brushing and flossing at least daily.  When failures occur, it’s good to be prepared with basic supplies to reduce pain and suffering.

Links to related posts:

Master Dental Shopping List

Lost Fillings

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[1] Joseph Alton, Survival Medicine Handbook, 2013, 131.

[2] Joseph Alton, Survival Medicine Handbook, 2013, 131.

[3] Survival and Austere Medicine, 3^rd Edition, 2017, 304.

[4] Survival and Austere Medicine, 3^rd Edition, 2017, 304.

[5] The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 152-53.