Chapter 27: Dental: Fillings, Extractions, and Trauma

INTRODUCTION

Non-dental health care providers fear few things more than having to do dental procedures. The most common dental problems that non-dentists face in austere environments are filling cavities, extracting teeth, and managing oral trauma. The information in this chapter will help you manage these cases, even with limited or no formal dental equipment or training. (See also Chapter 26 for basic information about nerve blocks and how to improvise some of the equipment you will need.)

FILLING CAVITIES

Depending on the materials used, a temporary filling will last from only a few weeks to a few months. A dentist should replace this temporary filling as soon as practicable with a permanent filling. In the meantime, the temporary filling helps the patient to feel more comfortable.¹

Never put a filling in an abscessed tooth. You are probably safe filling the cavity if:

• There is no swelling of the face or gums near the bad tooth.

• The tooth hurts only occasionally—such as when eating or if breathing cold air.

• The tooth is not tender to percussion.

Filling Materials and Equipment

The basic filling material for cavities is usually zinc oxide powder and oil of cloves liquid (eugenol). These materials come in a wide variety of brands, but are usually readily available. Intermediate restorative material (IRM) may be available; it provides more durable fillings. Often much easier to obtain is cyanoacrylate, which works well as a temporary filling, although it may not last as long as traditional materials.

While dentists routinely use drills to help fill teeth, these will usually not be available in austere circumstances. In addition, a dental drill is not a tool that the inexperienced practitioner should use. Instead, non-dentists can use dental hand tools, which are easy to use. If there are none available, they can be improvised or purchased at a relatively low cost. Hand tools are also less painful for the patient than a low-speed drill, such as a foot-pedal-powered drill, which may be available in remote or austere settings. Dental tools should be sterilized after each use.

Chapter 26 lists dental equipment you will need to fill a tooth and suggests ways to improvise these items.

How to Fill a Tooth: Procedural Steps

1. The initial task is to isolate the tooth so you can keep the cavity dry. A dry cavity allows you to see what you are doing and, more importantly, strengthens the bond with the cement you are using. To keep the tooth and cavity dry, put cotton or other absorbent cloth between the cheek and gums. When working on a lower (mandibular) tooth, put some under the tongue. Change the cloth whenever it becomes wet, and wipe the cavity itself while you work. Leave a piece of ...