HEAD AND NECK INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 107

After the pressure has been released, another two or three minutes should be allowed to
pass, and then the cotton roll can be removed gently. If bleeding persists, this procedure
can be repeated as often as necessary until the bleeding is controlled.
DENTAL INJURIES
Trauma can cause several different dental injuries.
Fractured Teeth
Traumatic cracks or fractures in teeth have different features depending upon their
depth.Smallcrazelinesonthesurfaceofatoothrequirenotreatment. Fragmentsthathave
been broken away should be found and preserved if possible.
When the crack is limited to the enamel, the base of the defect has a white appearance.
Teeth with such injuries are usually not tender. This type of fracture has been labeled Ellis
typeIandrequiresnoimmediatetreatment.Iftheedgesofthefracturearerough,theymay
need to be smoothed, which usually would be difficult or impossible in a wilderness situ-
ation. Subsequent treatment is primarily cosmetic.
If the fracture extends into the dentin—an Ellis type II fracture—the base has a yellow
color. If it extends deeper and involves the pulp—an Ellis type III fracture—the base has
a pink, red, or bloody appearance. Teeth with such fractures are tender to touch and hurt
when exposed to air. The pulp of the tooth is very prone to infection. Furthermore, the ex-
posed dentin in Ellis type II fractures does not provide adequate protection for the pulp.
Such fractures should be covered with a protective material such as Dycal or Intermediate
Restorative Material (IRM) to reduce the risk of infection and reduce thermal sensitivity.
Individuals with fractures that involve the dentin or pulp require analgesics and in a
wilderness situation should be treated with penicillin, a cephalosporin such as Keflex®, or
clindamycin. Evacuation to dental care should be carried out promptly, and the individuals
should avoid hot and cold food and beverages.
Some fractures involve the root of a tooth. Typically such fractures can only be dia-
gnosed with dental X-rays. The character of the fracture determines the treatment needed,
which must be provided by a dentist.
Loosened Teeth
Oneormoreteethmaybepartiallyremovedfromtheirsocketsbytrauma,aninjurythat
is termed an extrusion. The tooth may be quite loose or mobile. The tooth should be re-
turned to its socket and gentle pressure applied to force blood from the socket and reseat
the tooth. After the tooth has been restored to position, it should be splinted—with adhes-
ive tape if nothing else is available.