Dental care in an Emergency
Dental Care in an Emergency
Written by The Ready Store

In the film “Cast Away,” Tom Hanks’ character is stranded on an island after his
airplane crashes. On top of all the problems he has – learning to make a fire, finding
food, water, shelter – he has  a toothache!

This scared me half-to-death when I saw the film. I wondered, in an emergency, would
I be able to take care of a simple toothache?

With the help of the Special Operations Forces Medical Handbook, we have
highlighted some things that you can do to treat cavities, fractures, extracted teeth
and more, in an emergency. These techniques should only be used in an emergency
and are not a replacement for a qualified dental professional.

The handbook recommends that you have cotton balls, anesthetic, an explorer, a
spoon excavator and a mixing tools. You will need some of these in order to take
care of the problems we have listed below.

Anatomy of a tooth
The first thing you’ll need to know about emergency dentistry is the anatomy of a

A tooth has two major parts – the crown and roots. The crown is the (hopefully) white
part that is visible. The roots are embedded in your gums.

The crown has five surfaces: the occlusal (biting) surface, the lingual (tongue side)
surface, the facial (cheek side) surface and two contact surfaces that touch the
adjacent teeth.

Symptoms. If you have a cavity, you’ll feel dull pain in the area. Heat, cold, sweet, or
salty foods may enhance the pain. You’ll want to determine on which surface the
cavity is located.

Treatment. Cavities can be very tricky to treat because of anesthesia.

The first thing you’ll do is apply an anesthetic agent. Be sure that you are trained on
where the injection should be placed – which is near the top of the tooth’s root – in a
mucobuccal fold. Do not inject into a blood vessel.

The Medical Handbook recommends the following anesthesia:
2% lidocaine with 1/100,000 epinephrine (Xylocaine)
0.5% bupivacaine with 1/200,000 epinephrine (Marcaine)
3% mepivacaine without epinephrine (Polocaine or Carbocaine)

After the anesthesia has been injected properly, begin to remove the soft decayed
area with a spoon-shaped instrument. If they are properly anesthetized, they shouldn’
t feel any pain.

After you remove the decayed content, wash out the cavity with warm water. Combine
zinc oxide (IRM) powder with two or three drops of water – mix until it’s a putty
texture. Then place the putty in the hole. If the cavity was on the occlusal surface,
have the patient bite a few times to form the putty.

If IRM is not available, you can fill the hole with a cotton pellet impregnated with

This is a temporary procedure. Only a dentist can provide definitive care.

Crown fractures
Your front teeth are more susceptible to fractures than your back teeth. A crown
fracture will be a break in your tooth.

Symptoms. Usually someone with a crown fracture will have sensitivity to heat and
cold. They might find tooth fragments in their mouth or feel jagged tooth edges.

Treatment. If the fracture is small, you can smooth the rough edges with an emery
board or small flat file.

If the fracture is extensive wash the tooth with warm saline. Then, isolate the tooth
with cotton gauze. After you’ve isolated the area, cover the fracture with Zinc Oxide-
Eugenol paste (IRM). This will hold for about 6 weeks.

Dislocated tooth
Symptoms. You’ll probably notice that your tooth has moved or is wiggling.

Treatment. You can place local anesthetic on the tooth to relieve pain. After you’ve
applied the anesthetic, manually reposition the tooth to its normal position. You can
then use wire or heavy fishing line to bind the tooth the the teeth next to it. Splint
the tooth in place.

Tooth out of its socket
Symptoms. You may have your tooth in your hand.

Treatment. If the tooth has been saved, do not let it dry out. Do not try and scrape
anything off the tooth. Instead, place the tooth in a clean liquid like saline or milk.

Next, administer some local anesthetic to the socket. If there are blood clots in the
socket, clean it out with saline solution. Replace the tooth in the socket. Then splint
the tooth to the surrounding teeth with wire or heavy fishing line. Be sure to
administer some type of pain reliever after replacing the tooth.

Tooth extraction
If you end up having to extract a tooth, after the extraction, compress the sides of
the empty socket and place a folded sponge over the socket. Apply light pressure for
60 minutes. Do not rinse your mouth for 12 hours since this may disturb the clot.

Updated April 21, 2012