Thursday, April 19, 2018

Dental Emergencies

Having lived with and without dental insurance, I've dealt with dental issues over the years in different ways. I prefer to use a dentist, but have had a few times where one was not available or affordable, such as losing a filling on the Friday of a three-day weekend; being on a road trip a day's drive from home and chipping a tooth; and being in-between jobs when a cavity works its way to a nerve. 

Toothaches suck the joy out of life and can be distracting enough to destroy situational awareness. As with any medical issue, if you have access to a professional you should use them rather than try to treat yourself. A good dentist can find and fix problems before they get too bad to repair, and most have some form of payment plan option available for those without insurance. For the times when you don't have a dentist available (TSHTF, foreign travel, remote camping, natural disaster, etc.) you may want to have a few supplies and some knowledge on hand.

Toothaches can be caused by a lot of different issues, from bad sinus infections (puts pressure on the nerves from your teeth) to damage to a tooth's nerve. Anyone who has raised children knows the usefulness of Ora-gel as a topical anesthetic to deaden a toothache, and in a pinch a cotton swab dipped in clove oil placed near the ache will kill the pain for quite a while. General analgesics like Tylenol and Advil will also help take the edge off of a toothache and are a normal part of most first-aid kits.

Since the media started hyping the “opioid epidemic”, dentists are wary of (or just won't) prescribe useful pain-killers. T3's (Tylenol with codeine) used to be normal, with 5/325mg Hydrocodone/Tylenol being used for the serious pain, but you'll have a hard time getting them today. I can't advocate breaking the law, but there are options for finding pain-killers that don't involve a doctor;  before the “War on Drugs”, dentists used cocaine to deaden toothaches, and in some areas of the world cocaine is probably easier to find than a pharmacy. Just be careful who you trust with supplying anything you're going to ingest.

Cavities are formed when the outer layer of the tooth (enamel) has been breached and decay has started on the dentin. Once the decay reaches the pulp and nerve, the pain will intensify. If the nerve is damaged or destroyed and blood flow is lost to the tooth, that tooth is dead and your options are to have it removed (extracted) or have a root-canal or implant installed. 

Cavities are repaired by cleaning out the damaged material (debridement) and then filling the hole with a material that is at least as hard as tooth enamel. The debridement is difficult to do on yourself, so you'll need an assistant the you trust as well as the tools to clean and smooth the hole in your tooth. Once the hole is clean and dry, mixing the filling material according to the instruction and packing it in the hole is pretty straightforward. 

A lost or chipped filling is as bad as a cavity, and there are plenty of repair kits on the market. They come in both temporary and permanent versions, so if you can get to a dentist in a reasonable amount of time you may want to stock the temporary type.

Extraction of a tooth is going to cost a couple hundred dollars at most, but the root-canal/insert option can cost thousands. Root-canal procedures come with no guarantee; they may last a year, or they may last 40 years. Mine failed after 35+ years, so I got my money's worth out of it. 

Prevention is cheaper, but not always an option (I'm not going to start the fluoridation of drinking water debate), so brush and floss every day even if it means using a chewed-on stick as a toothbrush. Baking soda makes a good replacement toothpaste since it is mildly abrasive and will neutralize the acids that damage teeth, and table salt will work if you run out of baking soda.

Chips and Cracks
Chipping a tooth is common. The enamel layer is hard and somewhat brittle, so any sharp impact can chip an edge or corner: biting down on an unexpectedly hard, small object; getting hit in the mouth; or falling on a hard surface are all common methods of chipping or cracking a tooth, sometimes leading to a tooth breaking off above or below the gumline. In order to protect the inner layers of the tooth, the chipped area needs to be sealed to keep food and bacteria out.

Sealing a chipped or broken tooth is simple if you have the right materials, usually some form of 2-part epoxy with a filler to match the color of a tooth. Emergency dental first-aid kits are fairly cheap (less than $30) and will usually provide enough material for several teeth. If you don't have a kit, use a piece of wax or sugar-free gum to cover the damage to protect it from hot/cold food and air exposure until you can get to a dentist.

Whether through trauma or extraction, the loss of an adult tooth is permanent. Depending on the amount of damage done during the loss, it will take a few weeks or months for your gums to heal over the missing tooth, and even longer for the bone of your jaw to fill in the hole where the root(s) used to sit. Until the gums seal the hole, keep it as clean as possible by rinsing with warm salt water and gently brushing. Avoid trying to chew food with that part of your mouth to reduce the chance of getting food trapped below the gumline.

Replacement teeth have been around for centuries, and the technology is getting better every year. One or two missing teeth can be replaced with a partial denture (AKA a partial plate), something I will so have to go through. As I understand the process, once everything has healed up enough the dentist will use a quick-setting gel to make a copy of my existing teeth and gums, which will be used to craft a plate that will fill in the gaps and conform to the folds and bends of the jawbone and gums.

I have insurance, so I don't have to get a second mortgage to afford my dental care, but I found an option for those who need to improve their bite but can't afford a traditional dentist. The Do It Yourself Dental Impression Kit is an online way of ordering a kit that will allow you to make a mold of your mouth at home and then send it to a lab where they will create the dentures or mouth-pieces you need for a fraction of the price of a visit to the dentist/orthodontist. I crunched the numbers and they were only about $200 more than I'd have to pay as my deductible/co-pay, so I'm keeping them in mind for future needs. If I ever lose my dental insurance, it'll be nice to have an option to get new plates made without having to wipe out my savings account.

While searching for links for this post, I ran across several articles dealing with DIY dental care. There are a lot of areas of the world that lack the level of dental care that we enjoy in the USA, and people are starting to use the resources of the internet (YouTube videos) and overnight delivery to take matters into their own hands. I see this as a good thing, because I believe that people should be more self-reliant and learning how to take care of yourself is always better than relying on others for your comfort. Minimizing or eliminating pain and improving your ability to eat are quality-of-life issues that can have a major impact on other areas of your life.

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