Tooth Abscess in Austere Settings

Many readers of our Survival Medicine Handbook are surprised to find entire chapters devoted to the treatment of dental problems. Visitors to our store are likewise surprised to find dental supplies in some of our medical kits. Why is it important for the survival medic to be “dentally” prepared as well as medically prepared?

A standard first aid kit will usually suffice for most short-term disasters. When you’re talking about a long-term survival setting, however, you’ll need a more varied set of supplies. Dental issues probably won’t be of major concern if the power’s out for a few days; if you’re off the grid for a few months or longer, though, dental care will become an important part of your role as survival medic.

The effects of dental disease can be severe, and, at the very least, impacts negatively on work efficiency. Have you ever gone to work with a toothache? It’s fair to say you probably weren’t at 100% efficiency, which is where you need your people to be if you’re off the grid long-term.

There are many dental problems, but today we’ll talk about a potentially life-threatening one: Tooth abscesses. In long-term survival, problems maintaining good dental hygiene will make tooth abscesses a challenge for every medic.

A tooth abscess is a collection of pus that’s caused by a bacterial infection. Pus is comprised of dead and live bacteria, white blood cells, and debris.

Most abscesses are related to tooth decay, poor hygiene, dental trauma, gingivitis (gum infections) or problems related to previous dental work. The abscess can occur in different areas, either at the tip of the root (periapical), or in the gum next to a tooth root (periodontal). Periapical abscesses are more common, although both can occur together.

An abscess first forms when bacteria enter through a defect in enamel, the tooth’s armor; a cavity or a chipped tooth is usually where it begins. The bacteria spread all the way down to the root, causing damage to the nerve, which causes pain. Once the nerve is dead, pain in the tooth might cease, but significant painful swelling, inflammation, and accumulation of pus can develop at the base of the root or in nearby gums, soft tissue, and even bone. Left untreated, the bacteria may enter the bloodstream, causing a life-threatening infection called “septicemia“.

It’s important for the medic to be able to recognize an abscess when it forms. It is commonly seen as a swelling in the tissue at the base of the tooth. It may have a pimple-like head. Other signs and symptoms include:

• Severe throbbing toothache, sometimes spreading to the jaw or ear
• Sensitivity of the tooth to hot and cold
• Sensitivity when biting down on food or gnashing teeth together
• Red, swollen gums
• Fever
• Facial swelling on the side of the diseased gum/tooth
• Tender, swollen lymph nodes under the jaw or in the neck
• Foul smelling breath

Without modern diagnostic imaging, it may be difficult to tell the difference between a periapical abscess and a periodontal abscess. There are, however, low tech ways to tell the difference: In periodontal abscesses, the swelling usually comes before the pain; in periapical abscesses, the pain often comes before the swelling.

Tapping on the tooth may also give you a hint: If you tap vertically on the tooth and elicit pain, it’s probably periapical. If you tap laterally and get pain, it’s generally periodontal. If the tooth has no obvious crack or decay, it’s probably periodontal. Sensitivity of the tooth to hot and cold may point to a periapical abscess.

The differences between the types of abscesses matter in modern dentistry: An abscess mainly in the gum, for example, might have a relatively healthy tooth nearby which could be saved via root canal surgery or other modern procedures. In survival, however, this is not an option, so extraction of the tooth to eliminate the pain and infection is likely to be the end result. Extraction will be the answer, in my opinion, for the majority of dental emergencies in grid-down scenarios.

Although drainage usually occurs via the tooth socket after an extraction, an incision with a sterile scalpel may be needed to drain the entirety of the abscess. This procedure is called “incision and drainage“ or “I & D“. Thorough flushing of the area with warm salt water or hydrogen peroxide (called “irrigation“) afterwards is helpful. Give pain meds and apply warm moist compresses.

Although extraction, drainage, and irrigation may be all that’s required, it is prudent to begin a course of antibiotics, especially for those with fevers or facial swelling. Options include penicillin (Fish-Pen), amoxicillin (Fish-Mox), clindamycin (Fish-Cin) and/or metronidazole (Fish-Zole). A course of treatment should last 5-7 days. Dosing for each of the above antibiotics can be found in various articles at doomandbloom.net.

Medical preparedness for long-term events involves having dental supplies and some knowledge of dental anatomy. If you believe a major event is coming, consider a good dental kit to go along with the rest of your medical storage.

Joe Alton

Fill those cavities, I mean, holes in your medical storage by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.