Chapter 29- Accidents, Emergencies and Disasters.

Sports Gum Shields.

It goes without saying that if you are going to play any type of contact, rough, or bat and stick sport  you need to wear a gum shield. Rugby, football, hockey, lacrosse, cricket, boxing, judo, tai-chi the list is endless.

You can buy cheap gum shields in a sports shop that you heat up in hot water and mould to the shape of your upper teeth and jaw. These are better than nothing in an emergency but are very unsatisfactory as they don’t fit very well and require the wearer to run around more or less with their teeth clamped together to hold the appliance in.

The best type of gum shield is one that is custom made by a dentist or a clinical dental technician. They are slightly different thicknesses and designs depending on the sport played. Alternatively the best good quality mouth guards are probably those made by OPRO the official suppliers to lots of professional sports teams in the UK and abroad. Your guard can be in made in lots of different colours and designs. The website also has very good little video with clear instructions for taking your own impressions. www.opro.com

A word of warning- if your child needs a sports gum shield bear in mind that their dentition changes constantly due to teeth being shed/ growing all the time. Do not have a gum shield made at the beginning of the summer holidays as by the time term starts 6 weeks later it won’t fit any more. Better to miss a couple of games at the beginning of term.

Of course you are bound to break your front tooth/ teeth doing something quite innocuous, cycling your bike, going for a walk, side of the swimming pool etc. Here is what to do in those circumstances;-

Broken tooth.

If you are a person with a high lip line so you show a lot/ all of your front teeth you are more likely to have an accident with them because your lip is not there to cushion the blow. If you break a chunk of a front tooth and you can find the broken portion wash it for 10 seconds under cold running water, put it in a little box and take it with you as soon as you can to the dentist as it can often be stuck back on.

Tooth completely knocked out.

Find the tooth and hold it by the crown only [the bit you see in your mouth] .

If it is dirty wash it for 10 seconds only under cold running water.

If you think you can and the person concerned is not too distressed, replace it in the socket, try and get it the right way round! Get the person to bite gently on a clean handkerchief to hold it in place and go straight to the dental surgery.

If you don’t feel you can replant it, milk is the best solution to put it in to transport it. It needs to be placed in milk without delay, an hour at maximum.

Speed is of the essence, you need to get to a dental surgery as soon as you possibly can.

Lost baby teeth.

It is not recommended to replant baby teeth as pushing the tooth into the socket may damage the adult tooth growing underneath. An accidentally lost front tooth in anyone over the age of 6 years or so is going to be an adult tooth. If you are not sure, put it in milk and go straight to the dental surgery.

Broken back teeth/ lost fillings etc.

If a small piece breaks off a back tooth and you are not in pain, don’t leave it forever but there is no need to panic. You will probably be perfectly safe to leave it ‘till you come home from holiday, take your exam etc.

If a big chunk of tooth or filling breaks off you need a temporary dressing.

If you are going abroad;- for a long trip, to take part in sports or other physical activity, to out of the way places I suggest you take a dental repair kit with you. You can buy them at the airport chemist or you can be really organised and buy some online before you go from amongst others www.bootsonline.co.uk just put ‘dental repair’ into the search bar.

Failing everything else a bit of sugarless chewing gum, chewed up ‘till it’s nice and soft and wedged into the hole will hopefully do the trick. With temporary dressing the thing is ‘less is more’. You just want enough to go into the hole and cover the sensitive base of the cavity. Don’t put too much in or you will just knock it off as it will interfere with eating. It doesn’t matter if the hole is not completely ‘full to the brim’.

Broken Braces.

If the wire on your brace breaks or comes out from the bracket that it slots into it will dig into the cheek and cause you a lot of trouble. If it’s just a little bit you may be able to bend it out of the way enough for it not to be a problem or you may be able to cope with orthodontic wax available from a big chemist or boots online as above. If you can’t get to your orthodontist a dentist may be able to cut the offending piece of wire off until you can have it replaced. What ever you do you need to see your orthodontist.

Toothache.

Before I go any further just let me say ANTIBIOTICS WILL NOT CURE TOOTHACHE.

Toothache has many causes and it is important that you visit the dentist for the problem to be diagnosed correctly and the correct treatment administered.

DO NOT TAKE SOMEONE ELSES PAINKILLERS OR ANTIBIOTICS.

The painkiller may not be suitable for toothache and the antibiotic may not be the right one for the type of bacteria that cause toothache.

The best painkillers for toothache are Ibuprofen and/or Paracetamol.

For more advice visit www.nhs.uk and put toothache into the search bar.

The thing about pain is that it is a lot easier to stop pain from happening than to try and get rid of it once it’s there. So if you have had an extraction, a big deep filling, a root filling, some other type of surgery etc don’t wait for the pain to start just dose yourself up before it kicks in. If the procedure has been done under local anaesthetic pain will start to kick in as soon as your anaesthetic starts to wear off by which time you will be home and worried about what to do.

The other thing about pain is your pain threshold goes down if you are cold, tired or not very well. This is why dental surgery waiting rooms are kept warm to keep patients pain thresholds down. The trigger times for pain are about 6pm in the evening when you are tired after a day at work/ looking after the kids and the middle if the night when your painkillers have worn off and you feel you are the only person in the whole wide world awake with toothache.

The best thing to do is take your painkillers through the night rather than through the day time. Otherwise it takes 40 minutes for the pain to wake you up, you take a painkiller and it then takes 40 minutes to work, by which time you have lost 1.5 hours of sleep. If that happens twice in the night you wake up the next morning and you are wrecked because you have had no sleep, even worse if you have a crying baby to look after!

Read the back of the packet, take a painkiller before you go to bed, work out when your next one is due, set your alarm, put the tablet where you can find it easily in the dark, wake up and take it before the pain kicks in. Then you will get a good night’s sleep, you will be refreshed and you will be able to cope in the day because you will be distracted as you are busy.

For further advice, dosages for all age groups, regimes etc put ‘National Pain Relief Poster’ into google or similar and you will find [what was a draft but has now been issued] a very useful poster produced by the NHS and The British Dental Association. It has everything on it you need to know.

If you have had a complicated procedure at the dentist you will have been issued with post-operative instructions and pain relief advice. Make sure you understand the instructions before you leave the surgery, make sure you have it in written form as well, you might not be in a fit state to take it all in, MAKE SURE TO FOLLOW IT TO THE LETTER!

Most of the time if I have a patient who has trouble after treatment it is because they haven’t done what I told them to do!

The environment.

Health care uses a great deal of plastics;- syringes, tubes, aprons, masks, visors, gloves, I could go on for ever, this is just a few of the things I can think of. This all has to be disposed off and incinerated in as safe a way as possible with as little cost to the environment as possible. Not to mention drugs, chemicals, gasses, bits of bodies, fluids etc

In dentistry as I am sure in other branches of the medical profession we are doing as much as we can to minimise environmental impact. More and more environmentally friendly bits and bobs are gradually being invented and produced but all of this takes time as it’s not just the invention and the developing of systems, machinery and manufacturing supply chains but of course if it’s for use in health care it has to be rigidly tested and approved by the relevant safety standards authority.

We now have paper cups, ‘green’ suction tips, air and water syringe tips but of course the best thing would be to have everything able to be sterilised and re used rather than single use. More and more robust plastics that can be sterilized to high temperatures are being produced, so they can be used over and over again.

There are other things to be disposed of in dentistry such as waste amalgam, out of date drugs and chemicals, gypsom etc and all of this ‘clinical waste’ is governed by very strictly controlled waste management systems. It all has to be separated into various types and collected and disposed of in the appropriate manner. Not to mention records kept of its disposal for a legally stipulated length of time.

The public water supply also has to be protected and so there are also regulations ensuring no ‘back flow’ of substances into the public water supply and separating/filtering out harmful materials [such as waste amalgam] before they enter the public drainage system.

A COSH [control of substances hazardous to health] report of all substances [including household chemicals and body fluids] used in a surgery has to be undertaken. This is a carefully thought out regime of storage, use, safety measures, persons who may be affected, disposal etc. This has to be kept updated on a regular basis. All to ensure everyone’s safety but also to minimise environmental impact as well.

DO YOUR BIT FOR THE ENVIRONMENT AND LOOK AFTER YOUR TEETH, THE BEST TYPE OF DENTAL TREATMENT IS NOT TO NEED ANY!

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