On Board Dentistry

Retired dental surgeon Peter Flutter has her kindly put these notes together.

Emergency Dentistry is difficult. Remember it takes 5 ½ years [ longer than basic Medicine ] to turn a student into a competent dentist. 1 ½ years to train a Dental nurse into a Dental Hygenist with a more limited range of skills.

These notes may help decide what is possible in amateur hands and what is impossible.
In early days of Cruising sailors like miners thought a tooth lost was one less to cause trouble. Today even long term cruisers will combine shore based dentistry with long periods at sea.

Prevention : A person who needs continual treatment is more likely to have dental emergencies or accidents. Those over 60 are more likely to have heavily restored or crowned teeth – unlikely to be as strong as the original. If you fall into this group and extended cruising is planned maybe preventive crowning of some teeth ought to be considered – just as a worn engine may need a expensive rebuild. Large X rays of the Jaws [ Panoramic or OPG ] can often show buried teeth / abbesses /deep decay. Those, especially under 40 are likely to have only minor dental repairs unlikely to cause trouble.
Minor breakages: will be sharp on tongue and seem huge but if it doesn’t cause pain with sweet/hot and cold leave until professional repairs are possible [ but don’t put it off !!]

Pain: small areas of decay may cause pain with sweet things and its worth using a sensitive toothpaste [ and WARM water ]

Larger decay will cause hot and cold pain, eventually becoming insensitive to cold and worse with hot. If a large cavity is detected it may be possible to use a temporary filling. This is where the fun starts ! A lower tooth is a better bet as direct vision may be possible. The patient soon realises the mouth is a wet awkward place to work. Temporary filling kits are available but difficult to use. However the plastic Mirrors, tweezers and spatulas are helpful. The Temporary cement is a paste that sets with moisture and any water contamination dooms the repair to failure. Dentists often use a Glass Ionomer Cement in a powder /liquid formulation. Use thin as thick cream for cementing crowns or large chunks of filling / tooth or thick as putty for large holes. However the thicker the mix the shorter the setting time so be warned. Some saliva contamination is not disastrous as it’s water based .Ask your Dentist if he will supply some powder / liquid [ not cheap ] He might throw in some cotton wool rolls to keep the wet at bay or use rolled up Kleenex or kitchen roll [ NOT toilet paper as it is made to disintegrate ] Before it sets bite teeth together to make sure they ‘ mesh ‘ correctly as a high filling / crown re cemented is worse than nothing.
Throbbing: without swelling may indicate terminal damage to nerve. Tooth tincture / Oil of cloves on cotton wool may help. DO NOT dissolve an Aspirin on gum alongside tooth –it will cause a severe chemical burn. Use painkillers Paracetamol, some think Ibuprofen better due to its anti-inflammatory effect [ prolonged use can cause stomach irritation ]
: with swelling will indicate infection [abscess ] and will have to be treated with antibiotics
If not allergic AMOXYCILLIN 500mg 3 times a day for 5 /7 days
Metronidazole 400mg 3 times a day for 3 days
If huge swelling combine them both.

This will with luck control the infection until a shore side dentist can Root Fill [RCT ] to save tooth or extract if not. I strongly advise NOT to try your hand at extracting a tooth unless it wobbles from side to side. Electrical pliers cannot compete with dental forceps [ with multiple shapes to fit differing tooth shapes] in grasping the ROOT not the CROWN. All you will do is break off the tooth – and we haven’t considered injecting anaesthetic either side of the tooth in the wet awkward place previously mentioned.
Trauma : Compared to eyes teeth are poorly protected by bone. Noses and lips are no match for a wayward boom or block. If contact occurs there is likely to be soft tissue damage producing large amounts of the red stuff. Fortunately with firm pressure on a folded handkerchief even severe bleeding will ease allowing assessment. If front teeth are broken there is little a temporary filling will achieve. If a crewmember has some sewing skills a few stitches may help the wound edges approximate[ I recommend steri strips once the wound is dry ] A MEDIVAC may be necessary otherwise take antibiotics and let nature heal.
If a tooth is knocked out completely [Root and crown approx 22 mm in length] wash in water and push back in ASAP.
Useful to attach top of crown with blue tac or double sided tape to thin knife blade to allow positioning without swallowing. If swallowed the long hunt South is possible ........ if inhaled a serious medical emergency [ try coughing up ,back slapping etc] far far worse than a loose crown !!
2 part epoxy – tempting but will go soft in mouth with saliva.
Superglue – useful for attaching denture teeth.
Peter Flutter BDS.Lond.LDS.RCS Eng. Retired