You might be surprised to find out that an effective survival medic requires a working knowledge of dental problems. Few who are otherwise medically prepared, however, devote much time to learning about dental issues and procuring dental supplies. You may ask: Why bother?
Poor oral health can negatively impact the work efficiency of members of your group in survival settings and could even lead to serious illness. When your people are not at 100 percent effectiveness, chances for survival decrease. Anyone who has had to work while simultaneously dealing with a bad toothache will tell you their concentration and productivity are severely affected; indeed, their mind can only focus on the pain. The medic must learn proper dental hygiene, how to evaluate dental disease, and, when necessary, perform dental procedures to keep people at top efficiency.
If your concern is a few days without power due to a storm, perhaps you shouldn’t worry much about the risk of dental problems. A long-term event, however, is an entirely different story. History tells us that problems with teeth take up a significant portion of the medic’s time if dentists aren’t available. In a long-term survival setting, you may find yourself in the role of dentist as often as that of doctor or nurse. Of course, these duties are best in the hands of a dental professional. Unfortunately, you’re probably not going to have such a person in your group.
A survival medic’s philosophy should be that an ounce of prevention is worth a pound of cure. This thinking is especially apt when it comes to your teeth. By enforcing a regimen of good dental hygiene, you will save your loved ones a lot of pain (and yourself a lot of headaches). The information here will give you a basis of knowledge that will help you deal with some basic issues off the grid.
DENTAL ANATOMY
The anatomy of a tooth is relatively simple. The part of the tooth that you see above the gum line is called the “crown.” Hidden below the gum is the “root,” which resides in a bony socket known as the “alveolus.” Teeth are anchored to alveolar bone with ligaments, just like there are ligaments holding together the knee or shoulder.
The tooth is composed of different materials:
- Enamel: The hard, white external covering of the tooth crown. Enamel is mostly made of calcium phosphate and is the “armor” that protects deeper structures.
- Dentin: Firm yellowish material underneath the enamel. It is composed of many microscopic tubes. When enamel is lost, heat or cold travels through these tubes to cause sensitivity (pain).
- Pulp: Softer tissue in the center surrounded by the dentin. The pulp contains blood vessels and nerve endings and is considered the “living” part of the tooth. When the nerve dies, the tooth dies.
A normal adult mouth has 32 teeth, most of which replace baby teeth by age 13. They are comprised of:
- Incisors (8 total): The middlemost four teeth on the upper and lower jaws.
- Canines (4 total): The pointed teeth just outside the incisors. Sometimes called “cuspids.”
- Premolars (8 total): Teeth between the canines and molars. Sometimes called “bicuspids.”
- Molars (8 total): Flat teeth in the rear of the mouth.
- Wisdom teeth or third molars (4 total): These teeth erupt later, at around age 18 or so. They are often surgically removed to prevent displacement of other teeth due to crowding or impaction, which can lead to pain or infection.
Different teeth have different purposes: Incisor and canines are for cutting, while molars are for grinding.
GOOD AND BAD BACTERIA
Most dental diseases are caused by bacteria. Human mouths are chock full of them, both good and bad. The medic wants to decrease the bad bacterial population to reduce the chance of developing dental and gum disease.
What Good Bacteria affects:
- Immune Defense: Helpful microbes crowd out harmful invaders and prevent them from taking hold.
- Digestion: Bacteria in your saliva help break down food and absorb nutrients.
- Heart Health: Beneficial oral bacteria convert dietary nitrates (found in leafy greens) into nitric oxide, which helps regulate blood pressure.
What Bad Bacteria can cause:
- Tooth Decay: Strains of certain bacteria feed on sugars and produce enamel-destroying acids.
- Gum Disease: Some bacteria species release toxins that cause inflammation, bleeding gums, and tooth loss if left untreated.
- Systemic Issues: Chronic oral inflammation due to bad bacteria can enter the bloodstream and even damage the heart.
A healthy balance can be achieved by eating fermented foods, whole grains, vegetables, and beans. Eating well and limiting sugars and starches off the grid, however, isnt easy to control diet when the you-know-what hits the fan.
DAILY HYGIENE OFF THE GRID
It will be a challenge to ensure good dental hygiene in times of trouble. A daily brushing routine is essential, but at one point or another you will run out of toothbrushes. As an alternative, rub the teeth using a finger and a little toothpaste in a circular motion; this method will work long-term. A clean cloth can also be utilized for this purpose.
Another option is to chew on the end of a live twig until it gets fibrous and use that with some campfire ash to clean teeth. Sweet gum, sweet birch, neem, and dogwood have been used in the past, but any live, bendable twig will serve the purpose (dead wood falls apart in the mouth). Just score the bark off the end and chew until bristles form. A twig toothbrush can serve dual purposes in that the other end could be sharpened and used as a toothpick.
Eventually, commercially made toothpaste will no longer be available and you will have to improvise. As I mentioned, campfire ash works, but it’s gritty. Baking soda is an excellent alternative: It’s inexpensive, available in bulk, and less abrasive to dental enamel than manufactured silica-based toothpaste. Some feel the taste is too salty; in this case, add one or two drops of peppermint oil
When I was growing up, we brushed our teeth by putting a little household hydrogen peroxide on our toothbrushes and then dipping it into a small amount of baking soda. You get used to the taste.
After meals and before going to bed, medics should encourage brushing or, at least, oral rinsing with warm saline solution or a good antibacterial solution. This will decrease inflammation in the gums, foul breath, and the risk of infection.
Another effective and inexpensive option would be to use a solution made of equal parts water and three percent hydrogen peroxide. Swish it around for one or two minutes to obtain the full effect. Beware of higher concentrations of hydrogen peroxide, as these could burn the oral cavity. Salt water can be made into a reasonable mouthwash. Take eight ounces of warm water with one teaspoon of salt and two teaspoons of baking soda. Use two to three times daily.
Many people swear by coconut oil as an option to decrease bacteria in and lower the risk for gingivitis (gum inflammation) and tooth decay. This method, known as “Oil pulling,” is accomplished by oral swishing with a tablespoon of coconut oil. Oil is a fat; as bacterial walls have fatty substances in their membranes, they stick to each other. As the oil hits the teeth and gums, germs are picked up like a magnet attracts iron filings. The action of swishing (“pulling”) extracts bacteria from crevices in the gums and teeth.
Another method of preventing tooth decay is the use of dental floss. It may be inconvenient for some, but a lot of bacteria accumulate between teeth. Flossing not only dislodges microbes but is also useful for removing foreign objects, such as food particles. Tie a simple knot in the floss if a particle is particularly difficult to remove. Floss picks are reasonable alternatives. Some suggest four to six pounds test fishing line as an option. If so, use monofilament line only, which is the type that glides most like regular dental floss. Avoid braided lines.
Next time, we’ll talk about tooth decay and gum disease. How will you handle it off the grid? Later installments of this series will cover dental trauma and procedures.
Joe Alton MD
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