Dental hygiene while at sea: How to relieve tooth pain

Toothaches can cause such an intense pain that no one is easy to withstand for long time. Especially for seafarers on duty, severe toothache is difficult to be treated with the medication means included in the ship’s medical chest. Considering that prevention is better than cure, a proper dental and oral hygiene while at sea is essential since an aching tooth may be the start for more serious issues, including abscesses, gum disease, and tooth loss. What is more, dental and oral health is an essential part of our overall health and well-being.

Common dental problems

• Tooth decay (caries). Bacteria form a film, or plaque, on the surface of teeth that are not cleaned regularly. The bacteria produce acids from sugar in the plaque. The acids dissolve the enamel surface of the tooth. There are no symptoms until the enamel is so damaged that the bacteria can reach and infect the pulp.
• Pulpitis and peri-apical abscess. Bacteria can be present in an infected tooth or in a tooth from which a filling has been lost or is cracked. The bacteria reach the pulp through a gap in the enamel caused by caries. The resulting toothache may be constant or may come and go but is usually made worse by cold drinks and when the patient lies down. Pus can form an abscess around the tooth (periapical abscess or gumboil ).
• Periodontal disease (gum inflammation). The gums are reddened and bleed easily, when the patient brushes the teeth, for example. The gums may withdraw to expose the necks of the teeth. Discolored plaque is clearly visible around the base of the teeth. Pus may be present between the gums and the teeth. There is usually no pain.
• Pericoronitis is a form of toothache caused by infection under the gum flaps around partly emerged wisdom teeth (fourth molars), causing, over the affected tooth, redness, swelling, pain and tenderness.

How to treat toothache on board

Nowadays, dentistry has succeeded in reducing the incidence of dental caries through water fluoridation, oral hygiene education, preventive dental care and advanced technology. As seafarers on board can not have access to advanced dental care, personal hygiene is essential to prevent possible toothaches.

1. Check for red flags.
2. If there is a lost filling or obvious defect in the enamel, apply oil of cloves to the tooth surface.
3. If there is a large defect in the tooth, apply a temporary dressing as for a lost filling.
4. Give amoxycillin/clavulanate, 875/125 mg orally, twice daily for seven days.
5. To relieve pain, begin by giving paracetamol, 1000 mg orally.
6. If a stronger analgesic is needed, as is often the case, replace paracetamol with tramadol, 50 mg orally, twice daily.
7. Have seafarer rinse out the mouth with warm saline solution (a quarter teaspoonful of table salt in 200 ml of warm water) for five minutes of each waking hour.
8. Note that once an abscess forms, pain often subsides and is relieved dramatically when the abscess bursts.
9. Have seafarer continue to rinse out the mouth with saline solution until a dentist can be seen at the next port.