Dental Survival Kit

Most of us think of putting together a great medical kit for SHTF times. Few of us think of putting together a simple dental kit for hard times. I was a dental assistant for public health clinics, so I'd like to pass on some ideas for a dental kit that will see you and your family well through short term and long term disaster times. This is my opinion and does not constitute medical advice, use at your own risk, learn all you can ahead of time, etc. etc.

First, let's get one thing clear. Prevention of dental problems is much easier than having to deal with an infected or broken tooth. So this kit will emphasize prevention and secondarily cover dental treatment.

Your teeth are hard tissue, covered in an enamel that can easily stand heavy stresses. If you do a little preventative care. Everyone knows that you need to brush your teeth twice a day. Most know that you need to brush with a soft brush, with a gently "vibrating" motion by the gum line. It should take two minutes or more to brush your teeth properly.

For those with significant spaces between teeth or back tooth root exposure, use a proxabrush (available from any drugstore) to clean between teeth as well as floss elsewhere. Flossing should be done a minimum of twice weekly; Flossing motion is a "wipe/rub" on each side of the tooth; no snapping that bad boy floss in to teach the plaque germs a lesson.

Dealing with cavities post-TEOTWAWKI is relatively difficult and performing root canals will be out of the question. So head off problems today by using a prescription fluoride toothpaste a couple times a week. Brands include: Prevident, Ethedent, and Gelkam. All cost about $10 for a tube which will last for about 20 uses. Also, at least drink water after you have eaten candy or downed a soda. If your teeth are becoming sensitive to hot/cold or toothbrush pressure, one of these strong fluoride pastes could help. If the root of teeth start to become very abraded post-TEOTWAWKI, you can use the ART restoration listed in the references below or you could paint fluoride varnish on the abraded root surface (a very temporary solution).

Your teeth are held in place by a combination of gum tissue, ligaments, and bone, collectively, we'll call it the periodontal base. As we know from countless commercials, gum health is very important. Flossing is very helpful as is taking care of any tendencies to grind your teeth and not [tooth] brushing too hard. Using a good mouth wash, such as Listerine(r), a few times a week will help keep the germs knocked down. Remember to hold the mouthwash in your mouth for a little over thirty seconds. An alternative is to use hydrogen peroxide (1:1 with water) or collodial silver solution in the same manner.

Now to the treatment gear and supplies. The problems that you will need to deal with in a SHTF could be: crown pops off, filling drops out, tooth gets broken, brace bracket or wire comes off and has sharp edge remaining. In a TEOTWAWKI scenario, you might have to deal with: toothache or having to extract a tooth.

For a popped off crown or a lost filling, you could use one of the commercially available dental emergency kits that can be found at any drugstore. These usually include a little container of a zinc oxide-eugenol cement that can be used as a temporary cement or as a temporary filling material. Note that you must follow label directions carefully and you must not tempt fate: don't think that the patient can munch jerky or hard candy on these temporary fillings or on this crown recementing!

An alternative is to buy a product called Cavit-G and use it for replacing missing fillings. Cavit-G cost about $12 for a jar which would enable you to do several temporary fillings. Whatever agent you use to make temporary fillings, remember to do your best to make the filling "fit" by using a basic carver (see list of tools below) and using carbon paper to contour the filling so the patient is comfortable and the filling will be less likely to break.

If a tooth is broken, there will usually be associated facial injuries, and maybe neck/head injuries in the case of a bike wreck or fight injury. Use good first aid precautions in dealing with your patient. If a tooth is only chipped, a little chewing gum or orthodontic wax (available at drugstores) on the edge will help ward off cheek or lip injury.

If the tooth is fractured significantly, you need to decide if it is fractured into the dentin (most of the tooth is made of dentin) or if the fracture only affects the enamel. Take a sterile gauze and firmly wipe the fracture surface. If the tooth oozes blood and this step was painful, then the dentin is exposed. In this case, you would have the patient use the prescription toothpaste daily and avoid eating those great tasting but damaging to teeth foods such as soda, candy, and bananas. A coat of fluoride varnish would seal the dentin but won't stand up long on chewing surfaces.

If the tooth did not ooze blood, then caution the patient on diet, use orthodontic wax or gum on any rough edges and monitor the situation.

If a tooth is knocked out, common sense says to put it back where it came from. Handle the knocked out tooth only by the crown (the part we see in the mouth normally), rinse clean with sterile water, do not scrub the root or remove any tissue from it. Place the tooth gently back in its socket until it seats. The general rule is dentistry is: each minute the tooth is out of the socket is 1% less chance of successfully reimplanting it.

If the nearest dentist is under 20 tons of rubble, you can stabilize the tooth by splinting it. The procedure is to cement a piece of arch wire (get from your dentist) across the affected tooth and to the teeth on either side of it. Cyanoacrylate glue is acceptable for this, just remember that all surfaces must be dry first. Ensure that neither end of the wire is sharp or rough before cementing it in place. As always, get to a dentist as soon as possible.

If a tooth is broken and the pulp is exposed, you have a dental emergency. The patient will be in severe pain, will be at high risk of infection, and the tooth cannot be taken care of well in the field. If your dental kit has a zinc oxide-eugenol (ZOE) agent, this can be used to seal the pulp temporarily and this will help cut the risk of infection and relieve some pain. Even better would be to have Dycal available as this is part of the definitive treatment for an exposed pulp. It basically "scars" the area and seals the pulp from the outside world. It comes as a two tube set and costs about $45 for the set. You would then proceed to place a temporary restoration. See the reference list at the end of the article for further information.

Toothache can be dealt with empirically. You can try a pledget of cotton, soaked in eugenol (oil of cloves) on the painful tooth. It is a centuries old remedy for toothache. If a filling fell out or a crown came off and then the tooth ached, clean the area thoroughly and fix as per label directions for the commerical product. If the patient shows sensitivity to cold and tapping, not good. If patient is also sensitive to hot and/or there is fever and swelling, you need to seek a root canal doctor. But what if the nearest endodontist floated away, facedown an hour ago? Common sense says to deal with potential infection and keep the patient comfortable. In a prolonged, over a week SHTF scenario, you might have to consider extracting the offending tooth if the basic care outlined in references cited below does not work.

I will not be going into tooth extraction or gum boil care here. Read the references cited below and talk to your dentist.

Here is a basic dental kit that should see you and your group through common SHTF scenarios. Remember, this does not constitute medical or dental advice. It is a suggested kit for use only when no dentist is reasonably available.

Prevention
Prescription fluoride toothpaste, toothbrush for each member, toothpaste for each member with floss and floss holder, fluoride varnish (ampules would be best), mouthwash.

Tools
(diagnostic) dental mirror, dental explorer, periodontal probe ( is a "dental ruler" that lets you measure pockets around teeth, size of cavities, etc.), cotton pliers (also sold as college pliers; used for manipulating cotton or small items), minnesota retractor (for retracting the cheek or tongue, useful especially for child patients).

(for doing fillings) woodson (little "golf club" paddle at one end, little compactor at the other), dental mixing spatula, discoid-cleoid (for carving restorations to fit), small and large spoon excavator (clearing out old cement, etc. where you are going to fill), dycal instrument (placing filling/sealing materials in small amounts, precisely), pieces of carbon paper (ca 2"x1"), bayonet forceps ( also sold as: articulating paper holder. useful for ENT basic procedures also), mixing pad/slab (if needed for material you choose to stock).

(for extractions) Note that this instrument set will run over $1800.
Left and right apical elevators (1/each); #7 perio elevator (1); #150 and #151 extraction forceps (1/each); consider addition of cow horn, hawks beak and other molar forceps (#s 87,93, 18R, and 18L); Cryers elevators, one each, right and left. Surgical instrument as needed from wound care unit.

Dental Materials
several small (2-3mm) cotton balls, several cotton rolls (get from your dentist).

A commercial dental [filling] emergency kit and or an IRM set (liquid and powder for fabricating filling and temporarily cementing crowns. Costs about $60), [consider] Dycal (make sure you that a mixing pad comes with the two tubes of material and a dycal instrument for mixing/placing), orthodontic wax, two small pieces of arch wire (get from your dentist, preferrably from an orthodontist), bottle of oil of cloves (be careful, very irritating to eyes and skin!), Oragel or other dental [soft tissue] pain reliever.


Good luck with making your dental kit. Post-SHTF; may all your teeth stay cavity free, may your gums not bleed, and may trench mouth never develop amongst your group (hints: control stress reaction and quit smoking)!

References
http://www.noah-health.org/en/dentistry/procedures/emergency.html Good page of links for caring for dental emergencies.
http://www.hesperian.org/publications_download.php The site for the publisher of Where There is no Dentist and ...No Doctor, etc. The books are available as free PDFs online as well as for sale. ...Dentist is very useful for survivalists!
http://www.whocollab.od.mah.se/expl/art2.html Introduction to Autraumatic Restoration Technique (ART), a very useful method of doing semi-permanent restorations after SHTF.