DENTAL-LACERATION AND BICUSPID FRACTURE

Alaska, Mount McKinley, West Buttress

On June 5th, RMI guide Brent Okita brought a 17-year-old client to the 14,200-foot medical tent to have a dental check. The prior day, the client was eating a frozen nougat bar, and bent a braces collar outwards which presendy was lacerating the inside of the client’s cheek. The braces’ wires had been removed by the client’s orthodontist prior to the expedition, with the collars left in place for later removal. The cheek laceration was minor, although consistently in the same site and reopening with any mandible movement.

Then on June 6th, a climber presented with a fracture of the first bicuspid, maxillary right side. The dentin had been exposed and he was in discomfort when eating/drinking and breathing the cold air through the mouth. Cavit (temporary cement) was applied to the site with saliva as the material setting agent.

Analysis

The first case is an intriguing one, as this is not one a medic ever expects. Upon examination of the client, it was apparent the collar was bent in such a way that covering it with Cavit or wax would be of little benefit. Confirming the brace collars were to be removed in the near future, I utilized the tools available: a needle holder and a nut tool. Great care was necessary, as fracturing the enamel was a possibility. Careful manipulation eventually worked the collar into a loosened state, at which time it could be molded by the tools to curve over and off the molar. The client now has a souvenir from Denali. The cheek laceration would heal itself in time if kept rinsed and teeth brushed often. Oh, yes, don’t forget to floss.

As for the second, if the fracture is completely through the tooth, or if the pulp is involved, this problem can result in a trip being ended. Cavit is a temporary material that can protect the dental tubules and smooth a fracture site. If Cavit is not available to cover a sharp edge, then a piece of emery cloth, a light file to the area, or sugarless gum will give temporary relief. In any case, an expedition would do well to keep some dental first-aid supplies in their kit. (Source: Michael W. Dong, VIP Mountaineering Ranger-Medic) (Editor's Note: Thanks to Michael Dong for sending these forward, along with a few others. While not entered in the data as accidents, the situation is a good illustration of the need to be prepared for medical emergencies—or better yet as in this case, to avoid them by doing some preventive work.)