Dental Kit for Emergencies

[Dabadger]

I have a question concerning an emergency Dental Kit. I have searched te Web for places to buy equipment, and even ran across the concept of Atraumatic Restoration Techniques. This is supposed to be a painless procedure for filling cavities wit a relatively permanent filling. Have any of you heard of this, and what do you think of it? Since this technique uses no anesthetic, I feel it would be a good austere or survival skill to have on board. I managed to download their manual, and the entire procedure uses only 11 instruments. From the Danish Web page, I managed to download the ART Manual. I found the procedure relatively easy to perform. I don't have the address for the manual, but if you email me, I can send you a copy.

Now, back to my original question: What would a kit for these situations contain? I'm not thinking of using a very complex armamentarium, just several forceps, and hand instruments. Since I am a retired ER Nurse, I feel such a set u would be a welcome addition to a field medical kit. Please help me out, and beforehand, thank you for your comments and concerns.

[Reasonable Rascal]

Is this the manual you are referring to?

http://www.dhin.nl/art_manual___main.htm

RR

[Dabadger]

Sometimes I found this werbsite busy. Keep trying and you can download the whole manual plus the instrument pack. Try it and good luck.

Please advise if this is a good procedure.

[Reasonable Rascal]

As I understand the procedure overall it is a low-tech means of addressing dental problems such as caries (cavities) on a 'temporary' basis. IOW the fillings you build will not last 10-20 years but statistically they will last for a few years. The end result is a tooth saved that would otherwise be lost much sooner.

Given that most of us are not adept at dental anesthesia - even given the means to provide such - and dental drills are not common, affordable items it is probably the best we can do in an austere environment.

My personal thinking runs in this direction, i.e. towards using the ART program, and also stocking what I can of more permanent tools/prosthetics for use by a skill practitioner when I run across one. IOW I may not be able to place a metal crown myself but if I can effect a repair that will last a year, and I run across a dentist in that time period I can hand them the crowns, etc and tell them "Fix me up, Doc." I am assuming here a breakdown in the system that may cause demand to outstrip supply. Skills are always available somewhere, but supplies by their very nature tend to get used up.

RR

[Austerenurse]

The kit that I have found useful when I know that a dentist is not going to be available (and I don't have to carry the stuff) is as follows:

This does not include all the "normal" medical kit stuff like gloves, gauze, etc, or systemic antibiotics:

#2 Woodson plugger - filling instrument
#9 Molt Periosteal elevator
#11 Scalpel blade
#15 Scalpel blade
#17 Forceps - Cowhorn mandibular (1st and 2nd lower molars)
#23 Explorer - Sickle probe
#30 Cryers elevator (left)
#31 Cryers elevator (right)
#53L and #53 R Forceps - Cowhorn maxillary (1st and 2nd upper molars)
#150 Forceps - Universal maxillary (upper incisors, cuspids, bicuspids)
#151 Forceps - Mandibular (lower incisors, cuspids, bicuspids)
4-0 Chromic suture
4-0 Silk suture
25 ga long dental needle (best for inferior alveolar blocks)
27 ga short dental needle (best for maxillary infiltration)
Arkansas sharpening stone
Benzocaine 20% topical
Bupivacaine with 1/200,000 epi in dental carpule
Calcium Hydroxide (Drycal - self setting)
Dental cotton rolls
Dental mirror
Dental spatula
Dental varnish (copalite - for under restorations)
Glass Inonomer Restorative Cement (Fuji IX-GP)
Intermediate Restorative Material (IRM Ivory self-cure)
Lidocaine 2% with 1/100,000 epi in dental carpule
London College Tweezer (Plier)
Mixing Pad
Periodontal Probe - Michigan O with Williams markings
Scalpel Handel
Sodium fluoride powder
Spoon excavator - medium (1.5 mm)
Syringe, Dental aspirating (Harpoon style - Novocol)
Temporary filling material (ESPE Cavit)
Woodson periosteal elevator

This kit has been made after some trial and error. Over time I have added stuff and taken stuff out. It seems to be the happy medium now and I have not yet (knock on wood) found a situation where I have run into trouble and did not have the kit to fix it. (I have run into situations where I ran out of knowledge to fix it, but that is another story).

If you have any questions let me know.

Cheers,

AN

[tangent]

So what would be a good kit if you have to carry it?

-t

[Austerenurse]

When I said I did not carry it, it did not imply that it could not be carried. I have man-ported the above kit on more than one occasion. That being said if I am going work were I will be a "walking clinician" then I alter the contents quite a bit as you will see below in order to reduce bulk / weight.

What are the goals of dental treatment in these cases?:

1) Temporary fill cavities that are causing pain that impacts the mission
2) Drain abscesses (gingival or periapicall)
3) Correct pericoronitis without extraction
4) Close mouth laceration due to trauma

What can wait for evacuation to a DDS/DMD or my main dental kit location (or is not worth carrying due to the weight vs. risk)?:

1) Extractions
2) Permanent restoration of cavities
3) Treatment of sensitive teeth

Thus my list of dental kit in my carried bag:

#2 Woodson plastic filling instrument (plugger) - filling instrument
Spoon excavator - medium (1.5 mm)
4-0 Chromic suture

If the final disposition for proper dentistry will be a dentist with a high-speed hand piece I pack ESPE Cavit as my temporary filling material. If I will be the final location for dental care (when they reach my kit above) I use ESPE Cavit G as it can be removed with hand tools before I do a proper filling. I once made the mistake of placing “normal” Cavit for revision at a later date, but I was unable to get out all of the temporary filling with the tools I had on hand. Lesson learned, and passed along to you all for free, smile.

This is supplemented by stuff in already my carried bag for other non-dental reasons such as:

5" Flat wound probe (works as an elevator / packer. I have even pushed this down between a tooth and the gun to drain an abscess)
#10 scalpel blade (usable even when it is better to use a #15)
#11 scalpel blade
Scalpel handle
Needle driver
5" Addison forceps (toothed) (in place of London College Tweezers)
4-0 Silk suture
Syringes and IV catheters to irrigate under a 3rd molar flap
Surgical gloves (for sterile drain in an abscess)
Exam gloves
Gauze (as opposed to using dental cotton rolls)

And...

Mirror on my compass (or my signal mirror in my survival kit) as opposed to the dental mirror. It is a bit of a squeeze to get it in, but I have found the most adults tolerate it reasonably well and the dental mirror is not worth the limited use for weight and space unless I am doing "full-spectrum (for me) dental work.

I hope that is of some use. Look forward to any feedback / questions.

Cheers,

AN