Injured and Painful Teeth

Dental problems are common and provoke considerable anxiety. Most people don't even think to learn about dental problems and procedures beforehand. Teeth may be subject to trauma along with other parts of the body. This article talks about dental first aid and to help get a person back home where a dentist can take care of the dental problem.

Basic Dental Anatomy

Let’s start with basic anatomy. This will help you as you learn how to treat dental problems. Each tooth is made up of the same four components:

• Enamel

• Dentin

• Cementum

• Pulp

Enamel is the substance that covers the anatomic crown of the tooth. It is the hardest substance in the body. The enamel is the first line of protection for the tooth. It can withstand biting pressure but does not have the ability to regrow once fully formed. It chips easily. In fact, the entire enamel can be chipped off in a fall.

The dentin is the substance that lies beneath the enamel and the cementum. It is not as hard as enamel, and it makes up a significant portion of the tooth. The dentin is comprised of microscopic tubes. If the tubules become exposed, teeth become very sensitive to cold and air.

The cementum is the substance that covers the root of the tooth. It is also very thin and not as hard as the enamel but has a similar hardness as bone.

The pulp is the final component, and it is where all the nerves and blood vessels that supply the tooth are housed. If the pulp is exposed, you get a toothache. If a filling encroaches on the pulp, that can hurt also. The supporting tissue consists of the gingiva (gum), periodontal ligaments (PDL), and bone.

Tooth Ache (Pulpitis)

Inflammation of the pulp is the primary cause of most toothaches and is often the precursor for more serious dental and facial infections. The pain can range from mild to debilitating and can be steady or intermittent. Inflammation can arise from bacterial entry into the pulp from tooth decay, also called a cavity.

Sometimes a filling has been placed near the pulp, and this can cause pain. Trauma can cause inflammation of the pulp, which causes pain. Early on, the tooth will be sensitive to a stimulus such as heat or cold, or sweet or sugary food placed on the tooth. Sometimes the tooth will frequently remain achy or painful after the stimulus has been removed.

It will usually have sensitivity or pain to stimuli such as cold, hot, sweets, or tapping. In the early stages, it may be difficult to identify which tooth is causing the pain. In these cases, the tooth may look normal, or have a small cavitary lesion. In later stages, tooth decay may be obvious.

The treatment of pulpitis is first to remove any irritants or debris, usually by swishing the mouth with warm water. You can give Ibuprofen, which is great for reducing pain. All patients with pulpitis should see a dentist upon returning home.

When a Filling Falls Out

When fillings or crowns fall out, the tooth can hurt. To correct the situation until you can get to a dentist, you should first remove any debris in or around the tooth. You can rinse the mouth or try to pick debris out if necessary. Once this is done, you need to fill the hole in the tooth with some temporary filling material.

There really are two products that you can choose to put in your first aid kit.

• Cavit comes pre-mixed and will harden once placed in the mouth. Cavit can be thinned, if necessary, by mixing it with petrolatum jelly (Vaseline).

• IRM comes in a powder/liquid form that requires mixing. The advantage of IRM is that it can be mixed to any consistency.

Dental Trauma

Injuries to teeth are common during high-adventure activities, such as mountain biking, skiing, climbing, or rafting. Trauma can be isolated to the tooth, but it often involves the soft tissue and supporting tissue as well. Clean the region well to remove blood or debris.

Chipped Tooth

These are common in backcountry sports where almost anything can strike the mouth. When you look at it, you will see an obvious chip in the tooth. The pulp is usually not exposed, but it might still be sensitive to stimuli (hot, cold, sweets). The treatment is pain management. You can smooth sharp edges by placing temporary filling (IRM, Cavit, soft wax, or tape) over the tooth. Usually, you can wait until you get to the dentist.

Tooth Fracture

A fracture is where a very large part of the tooth is broken. When you examine the area, there will be a loose piece of tooth, and there will be pain or irritation on biting. The treatment is to remove any loose fragment(s), and then cover the tooth with a temporary filling. This will help with pain, but you will likely need to give Ibuprofen. A temporary filling will help with the pain, but a dentist needs to repair this.

When a Tooth is Knocked Loose

Trauma to the mouth may not fracture a tooth. Instead, it can be knocked loose. In time, the tooth can reattach and become secure again. Patients should eat soft foods and take Ibuprofen. If the tooth is very loose, it should be sprinted to the tooth to the next tooth using Cavit or tape until the patient goes to the dentist. The tooth will need to be realigned.

When a Tooth is Knocked Out

Having a tooth knocked out on a wilderness trip is not uncommon. Quick action is needed to increase the survival of the tooth. The longer the tooth is out of the mouth, the less the chance for survival of the tooth.

The best thing to do is to try to put the tooth back in its socket, so be careful of the tooth. A tooth can survive with a high rate of success if reimplanted in the first 20 minutes after the accident. This isn’t always practical when you consider the amount of time needed to assess the situation, secure the scene, survey the patient, find the tooth, prepare the tooth and socket, and get the tooth back into the socket. While not ideal, the prognosis is still good if this can all be done within the 1st hour.

When handling the tooth, do not scrub, scrape, disinfect, or let the root surface dry out. Rinse the tooth with water to remove debris. Remove clotted blood from the socket, using gentle irrigation and suction. Replace the tooth gently with steady pressure to displace any accumulated blood. This will hurt. The tooth will then need to be splinted in place. This may be difficult but necessary. Cavit or tape is good, or you might need to improvise with the material on hand.

Transport Solutions

If you cannot reimplant the tooth, take it to the dentist as quickly as possible. Here is a quick rundown of what is good to use and what you should avoid. Unfortunately, there is not a good medium that is also commonly taken into the outdoors.

Milk is everywhere and does an excellent job of maintaining a knocked-out tooth. Milk will help a tooth to last for about 6 hours. If you have a choice of milk products choose the one with the least amount of fat, in other words – skim milk.

Saltwater is great for irrigating but not good for tooth storage. It can be found in some First Aid Kits.

Saliva will do in a pinch, but it has some limitations. There are enzymes and bacteria in our saliva that over time will damage a tooth. This will protect a tooth for about 30 minutes.

Water destroys the cells in the tooth. It can be used to rinse the tooth but isn’t a good storage medium.

Sports drinks are not good and can damage a tooth.

Disclaimer: This article has been developed for educational purposes only. It is not a substitute for professional medical advice. Should you have questions or concerns about any topic described here, please consult your medical professional.