Reasonable Rascal
11-04-01, 11:36
Here are some additional notes and references that I had sent to RR some time ago. I'm not going to go into techniques discussed, but rather cover equipment, supplies, and plants. If you are going to put together a dental kit, I highly recommend that you track down the references. You can get journal articles via Inter Library Loan (ILL) easily.
Equipment and supplies:
From [1]:
Dental mirror and probe
Pair of tweezers
Excavators and filling instruments
Hypodermic syringe
Extracting forceps
Zinc oxide powder
Oil of cloves
2% procaine or lignocaine
1/1,000 adrenaline hydrochloride
Absorbable homeostatic gauze
Codeine tablets
From [2]:
Universal type tooth extraction forceps
Needle holder instrument
Cotton or dressing pliers (tweezers)
Surgical sutures - silk or catgut, w/ needle size 4/0 x12
Soft ligature wire, stainless, .020" x50' (wiring jaws together/splinting teeth)
Dental floss x200 yd.
Zinc oxide powder x1 lb.
Oil of Cloves (Eugenol) x4 oz - 1 lb.
Dental cement, "IRM" brand
Toothbrushes x144
Oral pain tablets
Note: source for dental supplies, mail order:
Henry Schein, Inc.
Dept. SV
5 Harbor Park Drive
Post Washington, NY 11050
(Keep in mind that address is from 1984!)
Here is another supplier w/ a current address and great prices. I've ordered from them and have been very happy with their service:
http://www.dentalfuntoys.com/index.html
Dental Fun Toys
1040 E. 33rd Street
Hialeah, Florida, 33013
800-437-6455
Med tech Iowa is also carrying some dental supplies, write RR and ask about this.
http://medtech.syrene.net/
From [5]:
Some items not mentioned in other sources:
Orabase w/ Benzocaine
Sensodyne toothpaste
Hydrogen Peroxide
Salt
From [6]:
Cavit:
+ no mixing, easy to use
Tx provider squeezes small amount of material from the tube and places on tooth. Dental packing instrument (or cotton tip applicator or toothpick) is wetted to prevent sticking. Pack well and remove excess. Bites down to displace excess. Filling sets a few min after contact w/ saliva.
Zinc oxide/eugenol cements:
+ soothing effect of eugenol on teeth w/ pulpitis, significantly stronger than Cavit, can be mixed to a doughy stage for filling or less thickly for use as a cement.
- liquid tends to leak from its container leaving a pervasive odor on backpack and tent, difficult to mix, sticky mess to insert into tooth. Mixing begins w/ addition of a powder to a few drops of liquid, keep adding powder to make a dough that is as dry as possible, more powder is used on the instruments to
prevent sticking. Material is inserted and shaped as described for Cavit.
Barbed broaches are tiny instruments used to remove vital pulp tissue. Profound anesthesia is necessary. Anesthesia may be injected directly into the pulp as a last resort. A broach is inserted into the canal walls. The broach is turned clockwise 10 turns and then removed with the attached pulpal tissue.
More complete kit would include:
151 universal extraction forceps
Straight elevator (both for extracting teeth)
Bite registration putty (Express, 3M Co.) can be used to fabricate temp crowns and semirigid splints. With clean, dry hands (not letting powder from latex gloves contaminate the putty) kneed together equal amounts of components A and B. The material is molded into the desired shape, and any excess is trimmed with a sharp knife or scissors after 4 minutes setting time.
Mouth mirror
Syringe
30 gauge needles
Anesthetic carpules
A custom dental first aid kit is preferred over commercial dental "travel kits" which contain unnecessary items and lack essentials.
In an outdoor situation, techniques must often be adapted or improvised depending on the items available. For example, Fig. 13-19 shows how a suture can be used to splint and avulsed or extruded tooth. (txt from that illustration: …lacking adequate materials … use ingenuity and improvisation in splinting teeth. Suture can be used. A crude arch bar can be cut from a SAM splint and dead-soft wire obtained from copper wiring or twist ties). A temporary filling can be fashioned from soft candle wax, a hickory twig can be chewed to form a makeshift toothbrush and a Swiss army knife can be used to perform a drainage procedure. (Note that the coverage of drainage and applying drains is very good).
Additional coverage is given to anesthesia, w/ lidocaine recommended, all sorts of trauma treatment and selection and use of antibiotics, with penicillin and erythromycin recommended as the most commonly used in dental Tx, but noting that the broad spectrum antibiotics commonly carried on expeditions are acceptable.
Plants - from [5]:
Hercules Club (Xanthoxylum clava-herculis), a.k.a. Tickle tongue, toothache tree or Novocain tree. The white inner bark, when placed against the tongue, gum or inner cheek has a numbing effect. Boiling down larger quantities and applying directly to the problem tooth or gum can make stronger potions. Easily identified by its rough thorny bark. Found growing along fence rows and under power lines.
Western red cedar - chew buds to relieve toothache. Found in NW part of US
Arizona Cypress - chew leaves to relieve toothache. Found in SW part of US.
Dogwood as expedient toothbrush, peel bark, chew, brush. Somewhat bitter, but is supposed to have an anti-bacterial effect.
Wild mint or sassafras root may be chewed raw or boiled into a tea and used as a breath freshener or antiseptic.
Other plants w/ dental applications: wild asparagus, sweetgum, birch and yellow dock. (No additional information provided - anyone know more about these?).
Misc. notes and questions:
Analgesics: I do remember that aspirin and eugenol applied to vital pulp will cause necrosis (tooth death).
Drill speed: slow HURTS!, fast is good!. The old foot powered ones are slow… [10]
Antibiotics: seem to remember that some types of antibiotics are bad for the teeth, esp. for kids - anyone know which ones and why?
Abscesses: sewing needle applied between tooth and gum is one way to relieve them. Sterilize first.
Oral rectumessment: any dentists or dental techs out there that can give a summary of this? (hot/cold/sweet) sensitivity? I asked my dentist about this and got a rundown, but can't find my notes. Do remember that palpating a tooth that was going south will cause the pt to levitate… just like palpating certain abd conditions.
Refs:
[1] Emergencies in General Practice; Dentistry for the Ship Surgeon, by E. Joseph, F.D.S., British Medical Journal, p679-681, March 1956. This is one of the best articles available. Things have not changed much since it was written, and the info is still good.
[2] Expedient Dentistry; Experts Outline Emergency Procedures, by Dr. Devore E. Killip and Dr. John F. Nelson, p34-37 and p64-68, Survive, January 1984. This is a suprisingly good article for a mass-market publication, highly recommended.
[3] SF 31-91, SF Medical Hbk, ch. 19. This book should already be on your shelf, go fetch and re-read that chapter while your waiting for your ILL requests to come in. I like to xerox related chapters and put them in a file folder w/ articles. You don't overlook things later, that way, and it makes putting references and information together easier.
[4] Where there is no Dentist - a MUST HAVE book, if it's not on your shelf, go get a copy. Tells you how to make some of your own equipment. (Ditto the companion volume "Where there is no Doctor").
[5] Field Dentistry, Teeth, by David M. Knots, p8-11 and 68, Survival Guide, March 1984. This article focuses on use of the commercial temporary filling kits, however it does discuss other problems and the discussion of plant use is excellent. I have summarized the plant info above.
[6] Wilderness Medicine; Management of Wilderness and Environmental Emergencies, 3rd edition, 1995, by Paul S. Auerbach, editor. This is a large book - about the size of a phone directory, but well worth borrowing from your local library. P343-354 covers dental emergencies and the coverage is outstanding! Those who have not had medical vocabulary will want to keep a medical dictionary handy, but the
language is not so highbrow as to discourage the lay reader. The book is 1506 pgs long and heavy - not something you want in your BOB…
NOTE: I have not seen refs {7-9] yet, they were listed in the refs from [6], but look very promising. The core info from these refs looks to be summarized in [6], as it seems to cover the "meat" of the topics in a very hands on, loaded w/ info, fat free way. You still might want to see the primary source articles for a bit more depth.
[7] Dental Emergency: incision and draining technique for non-dental personnel, by DD Antrium, US Navy Med 75(1):20, 1984.
[8] Treatment of traumatic dental injuries by non-dental personnel, by DD Antrium, US Navy Med. 74(3):18, 1983
[9] Kit for temporary treatment of dental emergencies by laymen found useful, by Christiansen, G., Clin Res rectumoc Newsletter, 11(2):4 1987
[10] Personal correspondence w/ RR
Q) lidocaine vs. other anesthetics - any comments on pros/cons?
Q) Does anyone have any experience or tips on enalgum(sp?) or silver for permanent fillings?
Another ref. And I'm sorry to say, I don't have a good reference for this. Here's what I have: It's an
Article by Nick Williams, D. O., dated March 1993, that was published in the proceedings of NASAR
(National rectumociation for Search and Rescue). It's 18 8 ˝ x 11 pages and the best article on putting together a disaster, SAR or relief org medical kit that I've ever seen. I don't have a publication date on the proceedings or even a title. This was later expanded and went through 2 editions as:
The Wilderness Medical Kit; Selection and Use of Field Medical Supplies, by Nick Williams, D.O., Second Ed. 1998, 5x7, wirebound, soft cover, ~120pgs. Published and available through NASAR. OK, "available" is a misnomer. They sold out and even their library copy disappeared, so they can't even reprint the second edition. They have been after Nick for a couple of years to finish his revisions and get the third
edition out the door, but to no avail. Nick is supposedly living in NM or AZ - if anyone can track him down, please kidnap him and FORCE him to finish this - it's too good to not have available! At the minimum, please call NASAR (703-222-6277, bookstore@nasar.org) and bug them about the book so they will put more pressure on him. Ask for a catalog while you are at it. They have many books of interest.
He's what he has to say about dental supplies in the 18-page version:
Dental Module:
1) Cavit or Eugenol/Zinc oxide for temporary dental repair or re-cementing of loose dental work. Cavit is easy to use but Eugenol/zinc oxide is stronger.
2) Bupivicaine (Marcaine or Sensorcaine 0.5%) can be applied topically to painful area, often with good, long lasting results.
3) Dental floss
4) Small, sharp bucks curette - for scraping out cavity material after anesthesia.
5) Consider a small dental burr mounted on a pin vice to further clean and slightly undercut cavity prior to filling with Cavit or Eugenol/zinc oxide. (My personal experience has been that any fillings that are not completely dry will be lost within hours and any that are not undercut will be lost within days).
6) Consider a small pulp removal tool if skilled in use.
7) A very complete and compact dental emergency kit is available commercially. (No source given, the commercial kits I've seen are not good).
Off topic, but while I'm looking at it, another resource given in this paper is: Margaret Cole specializes in miniaturized equipment for field laboratory work.
Margaret S. Coles, M.T.
R.R. 1 Box 43AA
Delhi, IA 52223
(319) 927-3152
(1993 address)
Equipment and supplies:
From [1]:
Dental mirror and probe
Pair of tweezers
Excavators and filling instruments
Hypodermic syringe
Extracting forceps
Zinc oxide powder
Oil of cloves
2% procaine or lignocaine
1/1,000 adrenaline hydrochloride
Absorbable homeostatic gauze
Codeine tablets
From [2]:
Universal type tooth extraction forceps
Needle holder instrument
Cotton or dressing pliers (tweezers)
Surgical sutures - silk or catgut, w/ needle size 4/0 x12
Soft ligature wire, stainless, .020" x50' (wiring jaws together/splinting teeth)
Dental floss x200 yd.
Zinc oxide powder x1 lb.
Oil of Cloves (Eugenol) x4 oz - 1 lb.
Dental cement, "IRM" brand
Toothbrushes x144
Oral pain tablets
Note: source for dental supplies, mail order:
Henry Schein, Inc.
Dept. SV
5 Harbor Park Drive
Post Washington, NY 11050
(Keep in mind that address is from 1984!)
Here is another supplier w/ a current address and great prices. I've ordered from them and have been very happy with their service:
http://www.dentalfuntoys.com/index.html
Dental Fun Toys
1040 E. 33rd Street
Hialeah, Florida, 33013
800-437-6455
Med tech Iowa is also carrying some dental supplies, write RR and ask about this.
http://medtech.syrene.net/
From [5]:
Some items not mentioned in other sources:
Orabase w/ Benzocaine
Sensodyne toothpaste
Hydrogen Peroxide
Salt
From [6]:
Cavit:
+ no mixing, easy to use
Tx provider squeezes small amount of material from the tube and places on tooth. Dental packing instrument (or cotton tip applicator or toothpick) is wetted to prevent sticking. Pack well and remove excess. Bites down to displace excess. Filling sets a few min after contact w/ saliva.
Zinc oxide/eugenol cements:
+ soothing effect of eugenol on teeth w/ pulpitis, significantly stronger than Cavit, can be mixed to a doughy stage for filling or less thickly for use as a cement.
- liquid tends to leak from its container leaving a pervasive odor on backpack and tent, difficult to mix, sticky mess to insert into tooth. Mixing begins w/ addition of a powder to a few drops of liquid, keep adding powder to make a dough that is as dry as possible, more powder is used on the instruments to
prevent sticking. Material is inserted and shaped as described for Cavit.
Barbed broaches are tiny instruments used to remove vital pulp tissue. Profound anesthesia is necessary. Anesthesia may be injected directly into the pulp as a last resort. A broach is inserted into the canal walls. The broach is turned clockwise 10 turns and then removed with the attached pulpal tissue.
More complete kit would include:
151 universal extraction forceps
Straight elevator (both for extracting teeth)
Bite registration putty (Express, 3M Co.) can be used to fabricate temp crowns and semirigid splints. With clean, dry hands (not letting powder from latex gloves contaminate the putty) kneed together equal amounts of components A and B. The material is molded into the desired shape, and any excess is trimmed with a sharp knife or scissors after 4 minutes setting time.
Mouth mirror
Syringe
30 gauge needles
Anesthetic carpules
A custom dental first aid kit is preferred over commercial dental "travel kits" which contain unnecessary items and lack essentials.
In an outdoor situation, techniques must often be adapted or improvised depending on the items available. For example, Fig. 13-19 shows how a suture can be used to splint and avulsed or extruded tooth. (txt from that illustration: …lacking adequate materials … use ingenuity and improvisation in splinting teeth. Suture can be used. A crude arch bar can be cut from a SAM splint and dead-soft wire obtained from copper wiring or twist ties). A temporary filling can be fashioned from soft candle wax, a hickory twig can be chewed to form a makeshift toothbrush and a Swiss army knife can be used to perform a drainage procedure. (Note that the coverage of drainage and applying drains is very good).
Additional coverage is given to anesthesia, w/ lidocaine recommended, all sorts of trauma treatment and selection and use of antibiotics, with penicillin and erythromycin recommended as the most commonly used in dental Tx, but noting that the broad spectrum antibiotics commonly carried on expeditions are acceptable.
Plants - from [5]:
Hercules Club (Xanthoxylum clava-herculis), a.k.a. Tickle tongue, toothache tree or Novocain tree. The white inner bark, when placed against the tongue, gum or inner cheek has a numbing effect. Boiling down larger quantities and applying directly to the problem tooth or gum can make stronger potions. Easily identified by its rough thorny bark. Found growing along fence rows and under power lines.
Western red cedar - chew buds to relieve toothache. Found in NW part of US
Arizona Cypress - chew leaves to relieve toothache. Found in SW part of US.
Dogwood as expedient toothbrush, peel bark, chew, brush. Somewhat bitter, but is supposed to have an anti-bacterial effect.
Wild mint or sassafras root may be chewed raw or boiled into a tea and used as a breath freshener or antiseptic.
Other plants w/ dental applications: wild asparagus, sweetgum, birch and yellow dock. (No additional information provided - anyone know more about these?).
Misc. notes and questions:
Analgesics: I do remember that aspirin and eugenol applied to vital pulp will cause necrosis (tooth death).
Drill speed: slow HURTS!, fast is good!. The old foot powered ones are slow… [10]
Antibiotics: seem to remember that some types of antibiotics are bad for the teeth, esp. for kids - anyone know which ones and why?
Abscesses: sewing needle applied between tooth and gum is one way to relieve them. Sterilize first.
Oral rectumessment: any dentists or dental techs out there that can give a summary of this? (hot/cold/sweet) sensitivity? I asked my dentist about this and got a rundown, but can't find my notes. Do remember that palpating a tooth that was going south will cause the pt to levitate… just like palpating certain abd conditions.
Refs:
[1] Emergencies in General Practice; Dentistry for the Ship Surgeon, by E. Joseph, F.D.S., British Medical Journal, p679-681, March 1956. This is one of the best articles available. Things have not changed much since it was written, and the info is still good.
[2] Expedient Dentistry; Experts Outline Emergency Procedures, by Dr. Devore E. Killip and Dr. John F. Nelson, p34-37 and p64-68, Survive, January 1984. This is a suprisingly good article for a mass-market publication, highly recommended.
[3] SF 31-91, SF Medical Hbk, ch. 19. This book should already be on your shelf, go fetch and re-read that chapter while your waiting for your ILL requests to come in. I like to xerox related chapters and put them in a file folder w/ articles. You don't overlook things later, that way, and it makes putting references and information together easier.
[4] Where there is no Dentist - a MUST HAVE book, if it's not on your shelf, go get a copy. Tells you how to make some of your own equipment. (Ditto the companion volume "Where there is no Doctor").
[5] Field Dentistry, Teeth, by David M. Knots, p8-11 and 68, Survival Guide, March 1984. This article focuses on use of the commercial temporary filling kits, however it does discuss other problems and the discussion of plant use is excellent. I have summarized the plant info above.
[6] Wilderness Medicine; Management of Wilderness and Environmental Emergencies, 3rd edition, 1995, by Paul S. Auerbach, editor. This is a large book - about the size of a phone directory, but well worth borrowing from your local library. P343-354 covers dental emergencies and the coverage is outstanding! Those who have not had medical vocabulary will want to keep a medical dictionary handy, but the
language is not so highbrow as to discourage the lay reader. The book is 1506 pgs long and heavy - not something you want in your BOB…
NOTE: I have not seen refs {7-9] yet, they were listed in the refs from [6], but look very promising. The core info from these refs looks to be summarized in [6], as it seems to cover the "meat" of the topics in a very hands on, loaded w/ info, fat free way. You still might want to see the primary source articles for a bit more depth.
[7] Dental Emergency: incision and draining technique for non-dental personnel, by DD Antrium, US Navy Med 75(1):20, 1984.
[8] Treatment of traumatic dental injuries by non-dental personnel, by DD Antrium, US Navy Med. 74(3):18, 1983
[9] Kit for temporary treatment of dental emergencies by laymen found useful, by Christiansen, G., Clin Res rectumoc Newsletter, 11(2):4 1987
[10] Personal correspondence w/ RR
Q) lidocaine vs. other anesthetics - any comments on pros/cons?
Q) Does anyone have any experience or tips on enalgum(sp?) or silver for permanent fillings?
Another ref. And I'm sorry to say, I don't have a good reference for this. Here's what I have: It's an
Article by Nick Williams, D. O., dated March 1993, that was published in the proceedings of NASAR
(National rectumociation for Search and Rescue). It's 18 8 ˝ x 11 pages and the best article on putting together a disaster, SAR or relief org medical kit that I've ever seen. I don't have a publication date on the proceedings or even a title. This was later expanded and went through 2 editions as:
The Wilderness Medical Kit; Selection and Use of Field Medical Supplies, by Nick Williams, D.O., Second Ed. 1998, 5x7, wirebound, soft cover, ~120pgs. Published and available through NASAR. OK, "available" is a misnomer. They sold out and even their library copy disappeared, so they can't even reprint the second edition. They have been after Nick for a couple of years to finish his revisions and get the third
edition out the door, but to no avail. Nick is supposedly living in NM or AZ - if anyone can track him down, please kidnap him and FORCE him to finish this - it's too good to not have available! At the minimum, please call NASAR (703-222-6277, bookstore@nasar.org) and bug them about the book so they will put more pressure on him. Ask for a catalog while you are at it. They have many books of interest.
He's what he has to say about dental supplies in the 18-page version:
Dental Module:
1) Cavit or Eugenol/Zinc oxide for temporary dental repair or re-cementing of loose dental work. Cavit is easy to use but Eugenol/zinc oxide is stronger.
2) Bupivicaine (Marcaine or Sensorcaine 0.5%) can be applied topically to painful area, often with good, long lasting results.
3) Dental floss
4) Small, sharp bucks curette - for scraping out cavity material after anesthesia.
5) Consider a small dental burr mounted on a pin vice to further clean and slightly undercut cavity prior to filling with Cavit or Eugenol/zinc oxide. (My personal experience has been that any fillings that are not completely dry will be lost within hours and any that are not undercut will be lost within days).
6) Consider a small pulp removal tool if skilled in use.
7) A very complete and compact dental emergency kit is available commercially. (No source given, the commercial kits I've seen are not good).
Off topic, but while I'm looking at it, another resource given in this paper is: Margaret Cole specializes in miniaturized equipment for field laboratory work.
Margaret S. Coles, M.T.
R.R. 1 Box 43AA
Delhi, IA 52223
(319) 927-3152
(1993 address)