Dental injuries are not usually life- or limb-threatening but they can be very painful as well as causing cosmetic concerns. Fortunately, the treatment of traumatic dental injuries in the field is relatively simple both in terms of techniques and equipment.
Purposes of Dental First Aid
Increase the probability that the tooth can be restored to its original appearance and function.
Decrease further complications to the patient's medical condition.
Relieve pain.
Supplies
Orajel® Mouth-Aid® is a topical anaesthetic ointment that is more effective than clove oil. It can be used anywhere on the skin which makes it a good general purpose item. In any dental procedure anaesthetic can be applied before or after treatment as required bearing in mind that tooth replacement should be done as quickly as possible. Some people carry oil of cloves as an anaesthetic. The oil may prevent dental wax from sticking properly.
Dental (Orthodontic) wax is available at drug stores or from an orthodontist. It is used to create temporary fillings for broken teeth or when an existing filling has come loose. It can also be used to splint loose teeth. It is warmed to soften it and then pressed into place.
Acetaminophen (Tylenol®) or Ibuprofen (Advil®) to reduce pain and swelling. Never use ASA (Aspirin®) because it promotes bleeding and is acidic enough to cause tooth and soft tissue damage.
Missing Tooth
A tooth that has been knocked out may reattach itself without further intervention if it is replaced quickly enough. Teeth have a "golden half hour" during which there is a good chance of reattachment and after that the probability goes down rapidly. If the injury site has formed a firm clot then replacement should not be attempted in the field because of the chance of increasing the injury. In this case package it in a sealed, moist environment (wet dressing and a Ziploc®) for transport with the patient. Normal saline solution or Alberta drinking water are best for wetting the dressing. If all else fails and the patient is fully conscious the tooth can be stored in the patient's own mouth.
If the tooth can be found wash it and the injury site to remove debris. Handle the tooth by the crown, not the root, to prevent further damage. Wash it with clean water or the patient's own saliva: Do not scrub it. Infection is usually not a large problem and can be treated later with antibiotics. Place the tooth in the correct position and orientation and press it slowing and gently into place. If possible get the patient to do this himself. You will probably have to aid him in locating and orienting the tooth.
Chipped or Cracked Tooth
Clean and dry the injury site. Heat the wax to soften it and gently press it into the affected area. The wax insulates the tooth's nerve from temperature or pressure changes that would cause pain and is easily removed for later treatment. The wax is not very strong so the patient must be careful while eating or drinking.
If the missing piece can be found package it in a sealed, moist environment (wet dressing and a Ziploc®) for transport with the patient. Normal saline solution or Alberta drinking water are best for wetting the dressing. A dentist can either cement the fragment back in place or use the piece as a template for a crown. If all else fails and the patient is fully conscious the tooth can be stored in the patient's own mouth.
Missing Filling
Try to get the filling area clean and dry by gently dabbing it with a sterile dressing. Heat the wax to soften it and gently press it in place of the missing filling. Remember that the wax is not as strong as a real filling and may melt if the patient drinks hot beverages. There is no medical reason to look for or keep a displaced filling.
Crowns, Bridges and Braces
A loose crown or bridge can be temporarily cemented back into place with dental wax, Vaseline® or a dental adhesive such as Fixodent®. Protecting the actual tooth is vital.
Braces can and should be be removed if loose, otherwise leave them in place. Broken wire ends can be padded with dental wax or gauze. Wires embedded in the soft tissues should be treated as an impalement and left in place.
Displaced tooth
If a tooth is displaced but still attached then either the root is fractured or the bone is. It is actually better if the bone has been fractured because bones heal more easily than teeth. Try to move the tooth gently back into approximately the correct alignment so that the patient can close his mouth relatively normally without hitting the injured tooth. If you can't move it relatively easily then leave it alone. You can protect it by padding the patient's bite with sterile dressings.
Bleeding
Dental trauma is frequently accompanied by bleeding. Usually this is not serious although some people will vomit when swallowing blood and this may complicate other injuries.
One of the reasons for replacing a missing tooth is to control the bleeding from the injury. If the tooth cannot be found or is unusable then a wadded sterile gauze pad can be used to apply direct pressure. The pressure may come from clamping the teeth together or placing the dressing between the cheek and gum and holding it from the outside. Leave the dressings in place for at least 30 minutes. If bleeding continues add another dressing. If it becomes necessary to change the dressing remove only the second dressing. Leave the first one in place.
Be careful to monitor the patient's condition. A dressing can be inhaled if the patient starts coughing, gagging or loses consciousness. For patients at high risk leave a tail of dressing material hanging out of the mouth and pinned to clothing so that the dressing can be retrieved easily.
Abscesses
An abscess is a pocket of infection. When in soft tissue such as the cheek it is usually not life-threatening although, like all infections, it should be monitored. In any case it is unlikely that a delay of a day or two in getting to a doctor will cause major problems. An abscessed tooth may be life-threatening because the infection can easily spread throughout the mouth and into the brain. This requires massive antibiotics and surgical intervention. There is no effective field treatment. Orajel will relieve much of the pain but the patient needs to get to a dentist as soon as possible.
Heat and Cold
Applying warmth to the outside of the face next to the injury may help relieve pain and promote blood circulation. This could be hot water in a bag, a heated rock or a hot pack. In all cases place cloth between the check and the heat source to prevent burns.
If the tooth is infected then cold may be more effective in controlling pain and reducing swelling. Try water from a stream in a bag (doesn't have to be drinkable), ice or a cold pack. Don't let the patient become frostbitten and be careful if the patient's other injuries involved heat or cold.
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