Dentistry is the medical speciality a household can least improvise, and dental pain is among the worst there is. In a scenario with no dentist, prevention stops being sensible advice and becomes the entire strategy.
But one dental emergency is genuinely fixable by an ordinary person in the first minutes, and it is worth knowing well.
A knocked-out tooth
The reason for the urgency: the root is covered in living periodontal ligament cells, and those cells are what allow the tooth to reattach. They die quickly once exposed to air, and beyond roughly 60 minutes of dry time they are likely gone whatever you do next. Once they are gone the tooth cannot reattach, however perfectly it is put back.
The hour is dry time, not total time, and that distinction saves teeth. A tooth put into milk in the first minutes is not on a one hour clock: milk keeps the cells alive for up to about six hours. So the sequence is get it wet fast, then travel. A household that believes the tooth is lost after sixty minutes may throw away one that was still perfectly saveable.
That is also why you must not scrub the root: scrubbing removes the very cells the reimplantation depends on.
A tooth that has been pushed in, loosened or moved rather than knocked out: leave it alone, do not wiggle it, soft diet, and see a dentist. Do not try to reposition it yourself.
Why milk and never water
Worth its own note because milk is such an odd-sounding answer that people second-guess it and reach for water.
Milk is close to the body's own osmolality, roughly the right pH, and contains growth factors. Root cells survive in it for several hours. In water they die in minutes.
In a household, this means a carton of long-life milk in the first aid kit is genuinely useful, and costs almost nothing. If there is no milk at all, the person's own saliva, held in their cheek, is the next best thing, and dry in a sealed bag is a distant last resort.
A broken or chipped tooth
- Find any fragments and store them in milk as above. A dentist may be able to bond them back.
- Rinse the mouth with warm salty water.
- Cover a sharp edge with orthodontic wax, sugar-free chewing gum, or a small piece of softened candle wax, to stop it lacerating the tongue and cheek.
- Cold compress on the outside of the face for swelling.
- Painkillers. Paracetamol and ibuprofen together are more effective than either alone for dental pain.
- Soft food, avoid extremes of temperature, and chew on the other side.
If the break exposes pink or red tissue in the middle of the tooth, the nerve is exposed. That is intensely painful and needs a dentist urgently, because it will become infected.
Toothache
Manage the pain, and understand that you are buying time rather than curing anything.
- Paracetamol and ibuprofen together, at normal doses, alternating or combined. This combination is genuinely effective for dental pain and better than either alone.
- Clove oil on a cotton bud applied to the tooth. This one folk remedy has real pharmacology behind it: eugenol is a genuine local anaesthetic and antiseptic and is still used in dentistry. Use sparingly, keep it off the gum and tongue where it burns, and never swallow it.
- Warm salt water rinses, several times a day.
- Cold compress outside the cheek.
- Sleep propped up. Lying flat increases blood pressure in the head and makes dental pain markedly worse at night.
- Avoid very hot, very cold and very sweet food and drink.
A lost filling or crown
- Keep the crown. Clean it gently.
- Temporary dental filling material from a pharmacy is cheap, keeps for years, and is one of the highest-value items you can add to a preparedness kit. It seals the cavity, stops the sensitivity and prevents food packing into it.
- Sugar-free chewing gum works as an emergency plug for a lost filling if you have nothing else.
- A crown can be temporarily re-seated with dental cement, and in an emergency with a dab of toothpaste, which holds it well enough to protect the stump.
- Keep the area very clean and avoid chewing on it.
Dental abscess, which is the dangerous one
Preventing all of this
In a scenario with no dentist, this section is the whole page.
- Get dental work done now. Any known problem, any deferred filling, any wisdom tooth that plays up. This is the single most valuable preparedness action for this domain and it has to happen while dentists exist.
- Stock the basics: toothbrushes, floss or interdental brushes, and a lot of toothpaste. It keeps for years and weighs nothing.
- Fluoride matters more when diet gets worse. A high-fluoride toothpaste is worth asking a dentist about in advance.
- Add to the kit: temporary filling material, dental wax, clove oil, and long-life milk.
- Expect diet to get more cariogenic. Emergency food is disproportionately dried fruit, sugar, honey, jam and refined carbohydrate, all of which attack teeth. Brushing becomes more important as the diet gets worse, exactly when it is most likely to be neglected.
- Brush before bed without fail, even when water is short. Saliva flow drops overnight, which is when most damage occurs.
- Water rinse after every meal if brushing is not possible.
- Do not use teeth as tools. Opening packets, cutting cord, gripping things. This is how people break teeth in ordinary life and there is no dentist to fix it.
- Mouthguards for children if anyone is playing rough games, and helmets for cycling.