                       Dental Emergencies

                 By Douglas W. Stephens, D.D.S.  


  TOM  and Sylvia Moore and their two boys, Tom Jr.,  age  twelve 
and  Jed,  age ten, hiked all day and near dusk made  camp  on  a 
lovely  grassy  knoll overlooking a high mountain  stream  loaded 
with trout, apparently begging to be tossed in their frying pan.  

    At  daybreak, Tom and Sylvia were awakened by Tom  Jr.    and 
Jed  jumping up and down outside their tent yelling for  them  to 
get  up  and take them down to the stream.   The boys  had  their 
four  rods  rigged by the time their parents had  dressed.    Tom 
understood their excitement knowing how much the whole family had 
been looking forward to this vacation.  

     As they started out, the two grownups found the kids'  feel
ings  contagious.     Halfway down the trail, Jed, who  had  been 
running ahead, suddenly let out a cry of pain.   When the  family 
rushed  up,  they found the boy lying on the ground  holding  his 
jaw.    Tom  picked him up and sat him on a  flat  rock.    Blood 
gushed out of his mouth.   Pulling the boy's hand away, Tom saw a 
gapping hole where Jed's front tooth should have been.   The  boy 
held  up  a bloody tooth.   Tom saw where the boy  fell  and  the 
bloody  rock where he must have hit his jaw and realized  he  had 
knocked the front tooth cleanly out of its socket.  

  Luckily Sylvia had once worked in a dental office.   She gently 
took  the  tooth  from the boy being careful to hold  it  by  the 
crown.    Leading  the boy back to camp, she sat him  in  a  camp 
chair while she got out her emergency first aid kit.   Laying the 
tooth  on a clean piece of gauze, she washed the blood  from  the 
boy's mouth and inspected the tooth's socket.   A small amount of 
blood  was still oozing out.   She had the boy rinse  with  plain 
water  cautioning  him not to suck or use any force.    She  then 
rinsed  what dirt she could from the surface of the  root,  being 
careful  not to touch the root with her fingers.   Still  holding 
the  tooth  by the crown, she tenderly inserted it in  the  tooth 
socket,  holding  it firmly in place while her husband,  using  a 
piece  of heavy monofilament fishing line splinted the  tooth  to 
the  two adjoining teeth.   She made a cold pack with water  from 
the  icy stream which she had the boy hold against his face  next 
to the injured area to minimize swelling.  

 Leaving Tom Jr.   and Sylvia at camp,  Tom took the boy down the 
mountain  to  a hospital emergency room where they got  in  touch 
with  a dentist who gave the boy more permanent  treatment.    He 
told  Tom  due to their quick action in replacing the  tooth  and 
bringing  him  in for professional help, they  had  an  excellent 
chance  the tooth would be permanently attached though  he  would 
have to check the tooth's pulp from time to time to make sure  it 
was  alive.    If it died, he would fill the canal  and  the  boy 
could still retain his tooth for many years.

  Often  when taking a vacation away from home, we  are  prepared 
for general health problems but do not know what to do when faced 
with a dental emergency.   Whether the trouble faced is a  simple 
toothache,  pain  from tooth eruption or something  more  serious 
like a broken jaw or a abscessed tooth, it may threaten to  spoil 
a vacation.  

  Before leaving on a trip, it is good insurance to see a dentist 
in order to make sure there will be no dental problems which  may 
give  trouble  in the near term.   It is smart to  add  a  dental 
first aid emergency kit to your luggage.  

  This should include:
  1.   Medications such as, salt, hydrogen peroxide (3%), aspirin 
or acetaminaphen (Tylenol), oil of cloves and orabase with benzo
caine,  (like  Orabase Oral Protective Paste with  Benzocaine  on 
sale at your local pharmacy).  
  2.    Supplies  should include: cotton   balls,  cotton  swabs, 
gauze  pads,  tea bags, a toothbrush, dental  floss,  toothpicks, 
tweezers,  some paraffin or candle wax and an ice pack or  a  wet 
frozen wash cloth.  

   TOOTHACHE: The most common dental emergency.   This  generally  
means  a badly decayed tooth.   As the pain affects  the  tooth's 
nerve,  treatment involves gently removing any debris  lodged  in 
the  cavity  being careful not to poke deep as  this  will  cause  
severe pain if the nerve is touched.   Next rinse vigorously with 
warm water.    Then soak a small piece of cotton in oil of cloves 
and  insert it in the cavity.   This will give  temporary  relief 
until a dentist can be reached.  

   At  times  the pain may have a more obscure location  such  as 
decay under an old filling.   As this can be only corrected by  a 
dentist  there  are  two  things you can do  to  help  the  pain.   
Administer  a pain pill (aspirin or some other analgesic)  inter
nally  or dissolve a tablet in a half glass (4 oz) of warm  water 
holding  it in the mouth for several minutes before  spitting  it 
out.     DO  NOT PLACE A WHOLE TABLET OR ANY PART OF  IT  IN  THE 
TOOTH OR AGAINST THE SOFT GUM TISSUE AS IT WILL RESULT IN A NASTY 
BURN.  

    SWOLLEN  JAW:  This may be caused by several  conditions  the 
most probable being an abscessed tooth.   In any case the  treat
ment should be to reduce pain and swelling.   An ice pack held on 
the outside of the jaw, (ten minutes on and ten minutes off) will 
take care of both.   If this does not control the pain, an  anal
gesic tablet can be given every four hours.  

   OTHER ORAL INJURIES: Broken teeth, cut lips, bitten tongue  or 
lips  if  severe means a trip to a dentist as soon  as  possible.   
In  the mean time rinse the mouth with warm water and place  cold 
compresses  on the face opposite the injury.   If there is a  lot 
of  bleeding,  apply direct pressure to the bleeding  area.    If 
bleeding  does  not stop get patient to the emergency room  of  a 
hospital as stitches may be necessary.  

 PROLONGED BLEEDING FOLLOWING AN EXTRACTION: Place a gauze pad or 
better  still  a moistened tea bag over the socket and  have  the 
patient bite down gently on it for 30to 45 minutes.   The  tannic 
acid  in the tea seeps into the tissues and often helps stop  the 
bleeding.    If  bleeding  continues after two  hours,  call  the 
dentist  or  take patient to the emergency room  of  the  nearest 
hospital.  

 BROKEN  JAW: If you suspect the patient's jaw is  broken,  bring 
the upper and lower teeth together.   Put a necktie, handkerchief 
or towel under the chin, tying it over the head to immobilize the 
jaw  until you can get the patient to a dentist or the  emergency 
room of a hospital.  

 PAINFUL ERUPTING TOOTH: In young children teething pain can come 
from  a  loose baby tooth or from an  erupting  permanent  tooth.   
Some relief can be given by crushing a little ice and wrapping it 
in gauze or a clean piece of cloth and putting it directly on the 
tooth  or gum tissue where it hurts.   The numbing effect of  the 
cold,along with an appropriate dose of aspirin, usually  provides 
temporary relief.  

 In young adults, an erupting 3rd molar (Wisdom tooth), especial
ly  if  it is impacted, can cause the jaw to swell and  be  quite 
painful.    Often  the gum around the tooth will  show  signs  of 
infection.    Temporary  relief can be had by giving  aspirin  or 
some  other  painkiller and by dissolving an aspirin  in  half  a 
glass  of warm water and holding this solution in the mouth  over 
the sore gum.   AGAIN DO NOT PLACE A TABLET DIRECTLY OVER THE GUM 
OR CHEEK OR USE THE ASPIRIN SOLUTION ANY STRONGER THAN RECOMMEND
ED  TO PREVENT BURNING THE TISSUE.   The swelling of the jaw  can 
be  reduced by using an ice pack on the outside of the  face  (At 
intervals of ten minutes on and ten minutes off.  

 COLD SORES, CANKER SORES AND FEVER BLISTERS: Sores in the mouth, 
lips  or  tongue can be caused by many reasons,  irritation,  in
juries which bruise or cut the lip or just a run-down  condition.   
The germs which cause most of these sores are always laying  just 
below  the  surface waiting for a chance to flare  up.    Usually 
these  lesions  last five days no matter what you  put  on  them.   
Such  preparations as Blistex, Carmex, Butyn Dental  Ointment  or 
Spirits  of Camphor will relieve pain but it is doubtful  whether 
they  cause  them to heal any sooner.  New studies  suggest  that 
high levels of another amino acid, arginine can give the body in
creased resistance to these painful mouth and lip sores.  

 Generally,  when confronted by a dental emergency, you can  only 
relieve  the pain and give temporary treatment until the  patient 
can  see their dentist.    Sometimes, as was the case in Tom  and 
Sylvia's  family, fast prompt emergency treatment can  spell  the 
difference between permanently losing a tooth and saving it.   

Reprinted from American Survival Guide July 1991