Episode 164 S5-1
Dark Days in Denver Ch 1
~Brad Lewis DMD~
The Dark Days in Denver adventure begins with the characters stranded in the Nevada Desert. Earthquakes are intensifying and survival is uncertain. Vince is recovering from the last adventure where he lost a tooth. Here to talk to us today about survival dentistry and what you can do when there is no dentist around is Brad Lewis DMD.
In order for you to survive, in a post collapse society, you need your teeth! You have to eat to give your body nourishment. A lot of survival foods, like protein bars or travel cakes can be hard on the teeth and impossible to eat with no teeth. You need to chew.
Why do we brush and floss? Is it just to get the food off of our teeth? Nope, we brush to remove bacteria from our teeth. You need to brush every side of each tooth and below the gum line as well. Bacteria will cause cavities and infections. Sugar does not cause cavities but the bacteria love the sugar. The more they have the more they eat and breed. The bacteria that live in our teeth create an acid as a byproduct. The longer you leave the acid on your teeth the more likely it is that it will create a cavity. If bacteria infests your mouth below your gum line you will get an infection in the gums.
A tooth is basically just a hard structure in your mouth. It sits in the gum and is connected to the jaw bone. The outer part of the tooth is the hardest structure in the body known as enamel. The enamel can become compromised with aggressive brushing. The inner part of the tooth is known as the dentin and it is much softer than the enamel. If the bacteria can break through the enamel, they will eat the heck out of the dentin. This will create a large hole hidden beneath a tiny top hole like a sink hole in the ground where asphalt still remains on top and is covering the true expanse of the damage. You need an x-ray to truly see the depth and width of a cavity. Gum disease happens when bacteria are effecting the gum around the tooth. This causes an infection that the body actively begins to fight against. In this process bone can be destroyed. This is known as periodontal disease.
If the grid goes down it will be very hard to judge the extent of tooth damage without seeing an x-ray. You can't just fill the hole. The tooth is dissolving and rotting out. You have to remove the infection before it can be patched. If you had a hole in your wall with termites inside, you couldn't just put a patch over the top. The termites would still be inside causing damage. You need to clean out all of the infection before fixing the problem.
There are also ligaments that connect your bone to the tooth. These ligaments give the tooth feeling so you can feel your bite. Think about when you are at the beach or a picnic. You know immediately if you bite down on sand. This is because of these tiny ligaments.
Dental instruments are specially designed to remove decay and return the tooth back to a healthy structure. Then the tooth is filled back to the proper shape. Sometimes the enamel must be removed to expose the full extent of the damage underneath. If you were able to remove all of the decay what would you fill it with? There is a product available called Intermediate Restorative Material. It is basically zinc oxide powder mixed with clove oil. You can make it thin or thick. Use the thin solution to reconnect a crown. Remember this is not a permanent solution but it will work in a pickle. Use the thick, clay like paste as a filler for your tooth. The IRM material can create problems if it is not applied properly. You want to make the tooth smooth and even or you will be creating another place for bacteria to prosper. There should be no material sticking out. Trim it while it is still soft. The material needs to produce one smooth surface on the tooth.
Fluoride is a topic of much debate now-a-days but after years in the industry, Brad has seen the lasting effects of fluoride. You must use it as directed. Too much of anything is not a good thing. It does make the enamel harder and makes it more difficult for bacterial acid to cause damage. Brad will not try to convince you if you don't believe it. He quotes the book "How to Win Friends and Influence People" by Dale Carnegie: "A man convinced against his will is of the same opinion still."
The pain presentation of a toothache can be a tell tale sign of the problem. If the tooth is in pain due to a dull constant ache, it is likely a problem around the tooth in the bone area. It could be an abscess or necrosis. You will have puss in the mouth because the nerves are literally rotting out. You will not be able to feel any cold or hot sensations if this happens.
If you have a stabbing pain it could be from a few things. If you have a cavity that is so big it starts affecting the nerve, the nerve will start to swell inside the confinement of the tooth. There is no where to accommodate the swelling and it will create a sharp pain. Another possibility is gum disease. The gum will pull away from the tooth, exposing the tooth structure below the enamel. This leaves the soft root structure open to the air and it will cause pain when exposed to hot or cold temperatures. Another possibility is that the teeth are being traumatized. Excessive clenching and grinding enflames the ligament. This can cause the teeth to be more sensitive. Unfortunately, grinding is usually a subconscious activity related to stress levels which would tend to be higher in a survival situation.
If you have missing teeth, you could get them repaired immediately. The existing teeth in your mouth will begin to drift and can turn in unhealthy directions. The actually bite itself might change, resulting in a condition known as posterior bite collapse. Some teeth will get harder and have a new bite structure. We are born with a specific number of teeth for a reason. If you start losing them, they have to do more work and will wear out faster. Missing teeth also leaves room for bacteria to grow and cause more damage. Again, if you are currently missing teeth, you should get this repaired now. If there was a total collapse, it may not ever be possible.
A broken tooth in your mouth can have sharp edges that may cause damage to your gums, lips, or tongue. Now-a-days, you would go get a crown but that would not be possible in a grid down situation. Leaving you with sharp edges and possibly dentin exposed to bacteria, and hot and cold temperatures.
What do you do with a yucky tooth? You might think: Remove it! However, Brad does not recommend that course of action. X-rays tell dentists the length and number of roots holding the tooth to the bone. During an extraction without an x-ray, you may do more harm than good. Plus, there are many other considerations about the individual with the yucky tooth. Are they taking and kinds of meds, especially blood thinners, Aspirin, etc. Removing a tooth is an invasive procedure and different factors will effect the outcome. For example, there are some osteoporosis medications that can have lasting effects on the bone and actually prevent it from dissolving. After the extraction, the cells may be weakened and not react properly, resulting in osteonecrosis. The jaw bone could easily break. You need to ask anyone that may need a tooth removal about their medical background, including medication they used to take in the past.
Someone with periodontal disease is the best case scenario if you have to do a tooth extraction. In these cases the tooth is usually in tact and the tooth gets looser and looser in the mouth as the condition worsens, making extraction easier. If the tooth is decayed, typically the nerve and bone are still in tact. This procedure is challenging, even in a modern day dentistry office. If the extraction is done with too much force, the patient may lose a section of jaw bone as well. In a modern day dentistry office, dentists use forceps that are specially crafted for each tooth shape. If you are going to use a pair of construction plyers to do the job, good luck. Hopefully, you have thought about some type of pain medication for while you are trying to yank the tooth out of this person's mouth.
After the procedure, the patient may develop an abscess due to an infection. If the abscess can't drain, it will be very painful. Try to drain it. You may also develop a condition known commonly as dry socket or Osteonecrosis. After the tooth is removed blood goes into the missing area and clots. Then tissue builds back up if it does not get disturbed. However, if it does get disturbed, then the socket is dry and will be painful. You have to wait for it to heal itself. There is a product called Dry socket paste that may come in handy for this situation.
In any case, when it comes to dentistry, you need the right tool for the right job, even just for removing decay. Remember I said, I hope you thought about pain medicine. Think about this for a minute. At a dentist's you may receive nitrous, Novocain, or other various forms of pain killers. Now think about, having none of that. Most work that doesn't affect the nerve of the tooth would be easier to handle but a full on extraction would be excruciatingly painful.
If someone loses a tooth, it is not a good thing. Your teeth are in a constant state of eruption. They don't fall out because they keep hitting into the tooth on the opposite jaw. Removing a tooth on one side can cause a tooth on the other side to super erupt and fall out. If you lose all of your teeth it will affect your appearance and your ability to take in nutrition. The bone also has a relationship with the teeth. When you lose teeth, the muscles in your jaw bone atrophy and this can destroy other teeth. Over time the jaw bone dissolves and it gets harder and harder to fit dentures to the bone as it gets smaller and smaller. The weakness will also leave the jaw susceptible to breaking.
Certain bacteria that causes gum disease is also linked to cardiovascular disease and can majorly affect your health. The bacteria must be removed daily!
Use a toothbrush to remove bacteria all around the teeth.
Floss to get bacteria in between the teeth. Water alone will not wash them away. The bacteria make a sticky substance like fly paper that stays there despite rinsing. Tarter forms if the bacteria is not removed. Plaque forms after that. It gets harder due to calcium mixing with the plaque and forms a barnacle like substance. Once it is hardened the toothbrush can no longer remove it.
Paracord 550 has inner nylon strands. These strands can be broke down again and used for floss, leaving you with a very long term supply.
Toothpaste has an abrasive to help remove tarter.
Baking Soda - neutralizes acid
Hydrogen peroxide - prevents gum disease
Salt - helps kill bacteria
Mouth rinse like Listerine is good for overall mouth health. Use it as directed. Remember that it has alcohol and may be a little acidic.
Toothpicks for large spaces. In some spaces floss may not be enough, get in there with a toothpick. In a survival situation, you could use a sharpened twig.
If you have dentures, do not use crazy glue to fix them if possible. It starts to break down the denture resin, making future repairs even more difficult.
Say tomorrow you have a tooth that gets knocked out. Do not wipe the root!!!!! Clean it very gently and try to replace the tooth. It may reattach. Try your best to keep the tissue viable. You could also put the tooth in milk, until you can reach a dentist. However in a survival setting, that may not be an option. If a tooth comes out of your mouth, you should rinse the dirt off the tooth and put it back in your mouth. The saliva may keep it viable until you can reach help. If no help is available then put it back in the socket and try to attach it to the two teeth next to it (maybe with some of that paracord nylon).
X-Ray of Decayed Tooth With Curved Root
Different Stages of Decay
Decayed and Cracked Molar
Decay Under Filling
Bone Loss From Gum Disease
The Changing Earth Series
~Brad Lewis DMD~
Brad Lewis, DMD, graduated from dental school in 1984 after attending the University of Florida College of Dentistry. Prior to dental school, he studied at Florida State University. Professionally Dr. Lewis is affiliated with the American Dental Association, the Florida Dental Association, and the South Florida District Dental Society. His professional skills include:
Standard Operative Dentistry (fillings), Cosmetic / Esthetic Dentistry, Crown & Bridge, Endodontics, Oral Surgery, Implant (restoration), Removable (Full & Partial Dentures), Occlusal Guards (Regular & NTI-style), Snore Guards and minor cases of Perio Surgery.