Austere Dentistry and Temporary Fillings, by J.D., DMD

I am a general dentist, who has been at it for 26 years working part-time in private practice in a small, working class town and part-time on the dental staff in a state prison. I am also the dental director of a small non-profit organization that provides dental and medical care to the rural poor patients in Honduras. One of my main professional interests is low tech, austere dentistry.

The purpose of this article is two fold. First, I want to give the reader some insider, professional advice on how to get their dental needs squared away and met while we still have a functioning economy, and secondly i hope to educate the reader on dental procedures that a lay person could have a good chance of performing in a time or place when the health care system is severely degraded or non–existent.

This information is in no way a substitute for professional dental care, and the views presented are my own and not the views of any of the alphabet dental associations. I am not your dentist, and there is no doctor-patient relationship. If you remember nothing else after reading this piece, remember this before attempting any DIY dental or medical procedures: Do no harm. In other words, don’t make things worse.

Attending to Dental Needs

Don’t be part of the problem. Getting your teeth and the teeth of those in your circle of concern fixed up is mentioned in every prepper article about dentistry that I have read. Modern dentistry is very dependent on supply chain and the grid. Getting dental care without supplies, anesthetics, and electricity is very ugly. Go to YouTube and search “street dentistry”; you will get the idea real quick. One thing about these street dentists is that they are actually good operators. They work quickly and smoothly with purpose and little wasted movement. I can only imagine how miserable it would be for an unskilled operator in a similar environment.

Get your teeth fixed before the collapse. However, this simple advice is surprisingly nuanced. What is fixed? How fixed?

Some background on the economics of dentistry in the U.S. is in order. Large segments of the population have tremendous dental needs and are unable or unwilling to spend the money to get dental care. Organized dentistry calls this the “access to care” problem.

At the same time, large numbers of dentists have a “busyness” problem, open time in their schedules, coupled with high overhead. Raising fees is a common method to compensate for fewer patients. It’s called the target income theory and is in contrast to supply and demand theory. As the supply of dentists in an area rises, each dentist overall sees fewer patients, but all dentists have similar costs, so they raise the fees to compensate for seeing fewer patients. More dentists actually increases cost for patients. When dentists compete, it’s usually over service not price.

Many dental students graduate with over $350,000 of debt that must be serviced before they can even pay office overhead. The end result is that a number of my colleagues are engaging in “creative diagnosis”, which is unnecessary treatment, and doing so at high fees. Even dentists who are (or would like to be) honest are under heavy financial pressure to potentially over-treat dental problems. Dental magazines are a buzz with articles on selling dental procedures, right down to the firm hand shake and confident gaze. Over treatment even has a new euphemism; it’s called “creating optimum health”.

Okay, so what is a person to do? The standard bit of wisdom is to find a dentist you trust or has a good reputation. This is a good place to start, but be aware of whether you are perceiving or projecting. In other words, do you perceive that the dentist is actually honest, or are you so hopeful that he or she is honest that you project that attribute on someone who isn’t.

Here are some guidelines that may help you out in getting appropriate dental care while it’s available. Again, these are my personal opinions:

  • Hopeless, broken teeth that aren’t hurting you. Get them removed. They may already have a low grade infection. They will flare up if your nutritional status goes down or if you are burdened by other diseases. Maybe they will act up just because it’s the worst possible time. Have them removed while it can be done safely and comfortably. This would include partially impacted wisdom teeth in younger people. Fully impacted wisdom teeth are a case by case situation.
  • Fillings, silver or white. Get your cavities fixed. Both types of fillings can be good. Silver fillings may leach out some mercury while being placed and removed. Very little mercury is released when they are in your mouth. The health risks for mercury are on the dentist, not the patient.
  • Gum treatment. This is a very common area for over treatment but also a concern as gum disease is a leading cause of tooth loss in the USA. Ask yourself if your gums bleed easily. Are they receding, loose, shifting around in your mouth? If so you may have gum disease that if left untreated will result in tooth loss and potentially affect your overall health. The blood that flows around the diseased gum travels throughout your body. People who smoke and are unwilling or unable to spend the time and effort to floss and brush consistently often have poor outcomes even after expensive, professional gum treatment. If you are one of those people, maybe save yourself the expense and have no treatment or have them removed instead.
  • Dental implants. These can be quite expensive. If well done will probably last many years and are unlikely to cause problems.
  • Crowns. These are very profitable for the dentist and costly the patient, and crowns are often an area of over treatment, it’s difficult to make a generalization. If you have a very large filling that is intact without decay and not bothering you, it may be you don’t need that crown. If you have a sharp pain when biting that goes away almost instantly when you bring your teeth apart, a crown may be a good treatment option. Consider a metal crown instead of a tooth colored. Metal crowns are sturdier and wear better.
  • Cosmetic dentistry. We all want to look nice, but tread carefully here. This is a big revenue source for dentists. Any procedure that removes healthy tooth structure and replaces it with synthetic material can weaken your tooth. Orthodontics can move your teeth so that they look nice, but this also moves them out from where the balance of force has placed them. The end result for many cosmetic procedures is teeth that appear attractive but are weakened and unstable. This is often a manageable problem when the grid is up, but it’s an unnecessary liability when society is in crisis. Not all cosmetic dentistry is bad, but it has the potential to give patients a worse set of dental problems.
  • Mouth guards. For many people who grind, a professional made mouth guards is a good investment. They fit and protect better than over-the-counter mouth guards. They also last longer. In stressful situations, people who grind tend to do it with more intensity and can damage their teeth and jaw joints. If the situation persists for a long time, intense grinding can cause disabling pain in both teeth and jaw joints. Some of the most affected by grinding are tough people who don’t complain.

    I have some limited experience with very stressful situations, both with recently incarcerated inmates and medical volunteers on their first mission in Honduras. When individuals used to a comfortable first world lifestyle suddenly moved into a very different environment, sort of a mini TEOTWAWKI, the grinding/clenching picks up. Alteration in sleep seems to be a key factor in intensity of grinding, and the teeth that seem to cause the most problems are the ones that have had cosmetic procedures.

  • Root canals. Root canaled teeth tend to fracture and often require crowns. If the cost of a root canal is going to cause you financial stress or if the tooth is very broken down with a guarded outlook after treatment, you may well be better off having it removed.

The Real Secret

The truth is that most dental disease is optional. The real solution to limiting your need for extensive dentistry and the associated expense and hassles is to severely limit the amount of sugar in your diet, put forward the effort to keep your teeth clean, and don’t smoke. In Honduras, the poorest can’t afford much sugar, tobacco, or tooth brushes, and they don’t have that many dental problems. Those slightly better off, eat some sugar, smoke, and their teeth crumble.

I want to avoid a rant about sugar, but sugar consumption in the USA is skyrocketing and is largely responsible for the “dental access to care problem” in addition to obesity and other health problems. The worst is carbonated beverages. I have been to a number of prepper training courses and am staggered by the number of preppers drinking mountain dew and smoking. The heat and particles from tobacco smoke are very irritating to your gums, and I don’t know what the nicotine does, but I can assure you it’s nothing good.

My professional dental advice is to wean yourself off sugar and tobacco now. Stop adding sugar to your coffee and tea, and stop drinking soda. If you are too weak to totally stop, at least drink it fast, so the amount of time it’s in contact with your teeth is minimized. No amount of brushing is going to stop the damage from a high sugar diet and smoking. Sugar and tobacco will be in short supply when we collapse; you will be less miserable if you get used to not having it now.

Home care, brushing, and flossing is of course important as well. I have some concerns about the overall health effects of fluoride and Triclosan. Fluoride is an element that affects mineralization and is in most tooth pastes, Triclosan, is an insecticide that is in one popular brand. Both seem to limit dental disease but may well negatively affect your overall health. Cut out the sugar and tobacco and you’ll probably do just fine with just brushing with water and won’t have to wonder about what those chemicals are doing to you.

Dental Treatment- Temporary Fillings

I recommend the book Where There is No Dentist. However, nothing in this section is a substitute for professional dental care. I would advise you to get right with your dentist and try to recruit one for any preparedness group you might have. I do know several veterinarians, who are surprisingly good dental operators, that would work well in a pinch.

Again, this information is provided for a time when the health care system is serious degraded or non-existent. I can’t recommend any of the following information be used in any other scenario.

All the procedures discussed can be done without anesthetic. Several components are needed. These are all available on e-bay for low cost.

Fillings

You are not going to be able to skillfully place a filling without training. However, I have seen a number of patients do a surprisingly good job with temporary fillings. The following section will give you some tips and guide lines.

ZOE, the temporary filling material available at pharmacies, is excellent and should be in every medical kit. The material is formulation of zinc oxide power and Eugenol liquid, abbreviated as ZOE. It is very soothing to teeth, and for a temporary material it’s pretty strong. In addition to being a filling material, it can be mixed thinner and used as cement for loose crowns as well. The Eugenol liquid can be irritating and can permanently stain some plastics, and ZOE is not always the easiest to mix.

The ZOE that dentists use can be purchased reasonably on eBay. Popular brand names are Dentsply Caulk IRM, and Temerex ZOE filling material, but there are also many generic ZOE filling options as well. Some brands of ZOE are for foreign markets, but most likely are fine for emergency purposes. The price per serving is much less than the same material in a pharmacy emergency kit.

Buy the bulk kit, not capsules. Do not use any type of temporary filling material called Cavit. Cavit is used only on root canal teeth and can harm non-root canaled teeth.

If you have the inclination, it is not a bad idea to practice mixing ZOE before you need it. As a filling, you want it dry enough not make a ball that doesn’t flake.

ZOE is indicated for lost fillings, especially if the tooth is sensitive to temperature. Dry the tooth with a very small wad of paper tower or tissue paper and apply to the tooth. I don’t recommend trying to get any decay out; just gently dry it and fill it. When it’s in the hole, have the patient gently tap their teeth before it sets, so that their bite is right.

Depending on the tooth and the skill level of the operator, ZOE fillings can last between a few hours and a few years. In a long-term situation without a dentist, you may use quite a bit of ZOE on a tooth, so consider buying a bulk kit for that reason as well as cost.

For re-cementing a loose crown with ZOE, practice placing it on the tooth without any ZOE and be sure the patient can close properly. Then mix a thin mix of ZOE and place the crown on the tooth and check the bite. If the patient can no longer close properly with the ZOE in place, get if off quickly, clean it out, mix thinner, and try again. Repeat until the bite is right, and then keep some pressure on it for about 10 minutes.

There are several ways to get in trouble with ZOE. One way is to put too much in the cavity so that it interferes with biting, so under filling slightly is better than over filling. Another way is putting it in a tooth that is badly decayed and has an abscess that is draining through the cavity. Shortly after placing the ZOE, the patient will start to swell because the drainage is clogged with ZOE. For that reason, be cautious about placing ZOE in large cavities that have been open for a long time, especially if they are not sensitive to temperature and air.

Glass Ionomer Material

Zoe has a limitation that it won’t stick to a tooth without some mechanical retention (a hole). Glass ionomer materials will stick somewhat to smooth surfaces. While not as useful as ZOE, they deserve some consideration in an expanded dental kit.

These materials are particularly useful for dentists but are not too difficult for lay people. They are not soothing and can be quite painful if placed directly over the nerve of the tooth. Their main indication is as a bandage for front teeth that have been traumatically fractured and are air or temperature sensitive but the tooth nerve has not been exposed. The cement will cover the sensitive part of the tooth.

They also can be purchased on eBay. You will want a chemical cure type, not light cure. Popular brands are GC fuji ix, Equia, or any glass ionomer cement that is chemical cure. The cost is generally quite reasonable as well. Mix according to directions, and dry the tooth as you would with ZOE. Smooth as much as possible, and be sure it does not interfere with biting. Keep it dry until is sets, usually at least five minutes.

YouTube

Be very careful about trying DIY dentistry procedures, which you can learn about on YouTube; you can cause yourself or your patient a lot of harm. That said, there are a number of useful videos on mixing and using both ZOE and glass ionomers.

Some Closing Thoughts

When time permits, I may well write some another article to add some additional procedures that a lay person could have a reasonable chance of accomplishing. I can not recommended purchasing dental extraction instruments unless you are already have fantastically well equipped retreat. You are not likely to be able to purchase dental anesthetic or needles on the Internet, and therefore are equally unlikely to use it properly without some training. I would advise seeking out like-minded dentists, and if that doesn’t work out, seek veterinarians or medical doctors, and get them on board. That would be a much better use of your time and energy.

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