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 23, Dental: Diagnosis, Equipment, Blocks, and Treatment, for basic information about filling teeth and how to improvise some of the equipment you will need.)
Depending on the materials used, a temporary filling will last from only a few weeks to a few months. It should be replaced, 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 can fill the cavity (it probably doesn't have an abscess) if:
- There is no swelling of the face or gums near the bad tooth.
- The tooth hurts only occasionally—such as when eating or breathing cold air.
- The tooth is not tender to percussion.
Filling Materials and Equipment
To fill a cavity, you first need material to use for the filling. The basic filling material 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, and 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, use any available dental hand tools to fill cavities. Such hand tools can easily be used by non-dentists, can be improvised or purchased at a relatively low cost, and can be easily sterilized between uses. Hand tools are also less painful for the patient than a low-speed drill, such as a foot-pedal-powered drill that may be available in remote or austere settings.
Chapter 23, Dental: Diagnosis, Equipment, Blocks, and Treatment, lists dental equipment you will need to fill a tooth and suggests ways to improvise these items.
If your patient has a cavity that needs filling, these are the steps to do it.
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 ...