2013, March/April Adirondac Adirondoc
Dental care gets short shrift in the backcountry. I am not sure why this is. In well over a thousand nights in the wilderness, the only personal health problem I have encountered is a lost filling during a three-week Alaskan trek. Fortunately, it was not painful, but it could well have ruined the trip for me.
As with any wilderness health issue, prevention is the first step in ensuring that a dental emergency will not come up in the woods. Although it is rarely mentioned in wilderness medical writings, I believe that any trek of a week or more should be preceded by a visit to one’s dentist. A careful check for loose fillings or other potential dental catastrophes is probably more useful than one of those “complete physicals” that are often recommended. This is particularly important for those who, like me, grew up in the pre-fluoride era and have the mouthful of metal to show for it.
Another aspect of prevention deals with stocking the first aid kit. Backcountry kits should include some sort of dental “patch” such as Dentemp®. This can provide a temporary replacement for a lost filling and even a temporary adhesive to reset a loose crown. Unfortunately, the instructions on the package are not very complete. However, the company website has a very useful graphic for the non-dentist: paste after brushing. www.majesticdrug.com/v/vspfiles/assets/images/PDFs/Dentemp_OS_lnstructions.pdf (updated link: cdn.shopify.com/s/files/1/1003/0106/files/Dentemp_Instructions_655742f0-dfe9-4418-a43a-44b2b78c211b.pdf).
One of my other favorite first aid items, which rarely makes it into published lists of kit contents, is a bottle of contact lens saline solution. In addition to its advertised use, I find the squeeze bottle of a sterile saline solution useful in a variety of other ways. Flushing out a cavity prior to applying Dentemp ® is recommended; the contact lens solution in a squirt bottle is perfect for this purpose.
This is also a good time to consider personal dental hygiene on trips. A few days in the woods are not the time to cut back on regular care, and not only for the benefit of your tent mates. Flossing and brushing should continue on backcountry treks in the same way they do at home. The environmental impact of this is nil. A small plastic zip bag can hold those used lengths of floss. While spitting toothpaste on the ground has trivial environmental impact, it can be sort of gross. For that reason, I just swallow my tooth.
No doubt some readers will be horrified about fluoride ingestion. Rather than debating, I will simply recommend a non-fluoride paste for them. (For another useful bit of dental advice in the backcountry, see the letter to the editor in this issue from Dr. Fass.)
Finally, a word about injuries to teeth. Superficial chips or cracks to teeth are those which do not expose deeper layers of tooth and consequently are not painful. They can also be covered with Dentemp until a dentist can see them. Deeper cracks are referred to as dental fractures and require a dentist’s intervention if the tooth is to be saved. These are also portals of entry for infections of the dental pulp. Again, Dentemp can be used for first aid, but evacuation should be considered. “Avulsions” are injuries in which the entire tooth-root and all-is dislodged from the jaw. Such teeth actually can be saved if they are implanted into the socket immediately. Rinse the root and the socket with saline and gently insert the tooth into place. While one can also wrap the tooth in wet gauze and bring it to a dentist, the most successful reinsertions are done within less than an hour from injury, which generally means in the field.
~Tom Welch, MD, is professor and chair of pediatrics at Upstate Medical University in Syracuse and an active member of the Wilderness Medical Society. More information is available at his website and blog: www.adirondoc.com.Head & Neck