Outdoor First Aid

Tooth Problems: The Gory Details Backpackers Need to Know

No one wants a dental emergency in the backcountry. Learn how to avoid and deal with them.

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For most of the last few years, I lived with an annoying toothache that bugged me whenever I bit something, and it became excruciating at inopportune moments. Even worse was the timing: It felt like the pain flared up at every trailhead, threatening to become unbearable as I trekked farther away from my local dentist.

Dental problems are rarely life-threatening, but they are a fantastic way to ruin a trip. Before setting out, consider your own dental fitness. Bleeding gums? Pain with chewing or contact with hot or cold? Wiggly tooth? Suck it up and visit the dentist before you wake up at 3 a.m. in a tent in Patagonia somewhere feeling like you’ve been stabbed in the molars.

Even so, accidents happen. A hard fall can lead to a fractured tooth or even a tooth avulsion – when the tooth is knocked clean out of its socket. 

Fractures can be small chips in a tooth’s outer enamel layer, or to a larger extent, they can be full tooth breaks that expose the pulp – the nerves and blood vessels at the core of a tooth. There’s no life-threatening emergency here, but it’s certainly painful. The temporary filling material or glue in some dental emergency kits can protect the tooth and temporarily reduce pain until help is available. Fractures with exposed pulp may require more thorough repair, like a root canal.

Fully avulsed teeth can be replaced if they make it to the dentist’s office in good shape. Your best chance is to gently ease the tooth back into the socket and head for help. The best prognosis comes when a tooth has been reinserted quickly — ideally within 20 minutes. 

“Sometimes the annoyance really does become an emergency.”

But reimplanting a tooth can be challenging if the patient has to travel a considerable distance or if the tooth needs to be splinted in place. When replacement isn’t feasible, handle the tooth gently by the enamel (the white part at the top, not the root that goes into the gum) and convey the patient and tooth alike to definitive dental care. Improvised options for transporting a tooth back to the front-country include whole milk, saliva, or sports drinks — or even tucked in the patient’s cheek. The tooth can be gently rinsed, but avoid vigorous washing or scrubbing.

Sometimes the annoyance really does become an emergency. Any dental problem that progresses to difficulty swallowing or breathing, firm swelling under the tongue or chin, or fever warrants evacuation for an urgent evaluation.

Months after a root canal which didn’t improve my symptoms, in the midst of Covid-related dental denial, a chunk of the tooth adjacent to my troublesome molar popped right off. It turns out that an invisible fracture had been developing slowly all that time, and it finally gave way. Luckily, I was safe at home and headed to the dentist one more time for a repair. Before my next adventure, I’ll be checking in yet again.

Christopher Tedeschi teaches and writes about wilderness and disaster medicine. He is associate professor of emergency medicine at Columbia University and an editorial board member for the journal Wilderness and Environmental Medicine. He enjoys hiking and biking near his home in the lower Hudson Valley.