Case Study: Dental Emergency while Rafting 

The Setting

You are on day three of a 4-day rafting trip on the Rogue River in Oregon. The trip has been incredible so far. Great rapids, beautiful scenery, skies full of stars, and endless cups of hot cocoa. You’re almost to your campsite on day three, but have one more rapid to go. 

At the bottom of the rapid, one of the folks in your boat looks a little stunned. You ask if they’re okay, and they said, “I hit myself in the mouth with the t-grip of my paddle, and I think I lost a tooth.” 

Hearing this, your raft pulls over to the nearest shore for an assessment. 

SOAP Report

Subjective:

Your patient is a 30 year old male whose chief complaint is, “I think I lost a tooth.”  The mechanism of injury was hitting himself in the mouth with his paddle. The patient is currently A+Ox4. 

Objective

Patient Exam: The patient is found sitting on the side of the raft, holding his mouth. The patient exam reveals a missing front tooth. No other injuries are found.

Vital Signs

TIME	1530
LOR	A+Ox4
HR	78, strong, regular
RR	14, regular, easy
SCTM	pink, warm, dry
B.P.	radial pulse present
Pupils	PERRL
T°	Not taken

History

Symptoms:	Patient is complaining of pain in his mouth.
Allergies:	The patient is allergic to shellfish. He has not had any recent exposures.
Medications:	The patient doesn’t take any medications.
Pertinent Hx:	N/A
Last in/out:	The patient has had 3 liters of water, breakfast, lunch, and snacks throughout the day. Urine and bowel movements have been normal for the patient. The patient hasn’t vomited.
Events:	The patient was going down a rapid when he accidentally hit himself in the mouth.

STOP READING!

What is your Assessment and Plan? Think about this before moving on.

Assessment:

• Knocked out tooth. 

Plan:

• See if we can find the tooth.
• Attempt to replace the avulsed tooth in the socket.
• If unable, we’ll store the tooth until evacuation to a dentist.  

Anticipated Problems: 

• We cannot locate the missing tooth. 

Comments

A tooth can become loose or get completely knocked out of the socket. If a tooth gets knocked out, it can be difficult to reimplant in the mouth after 30 minutes. 

Before trying to reimplant a tooth, it should be irrigated with drinking quality water, but not scrubbed. Attempt to place the avulsed tooth back into its socket. If the tooth cannot be replaced, it should be kept in an appropriate storage medium. Ideally, this is Hank’s Balanced Salt Solution™, but this is rarely carried on backcountry trips. Instead, regular or powdered milk can be used. If this is not available, the patient’s saliva is best (have them spit in a cup, and store the tooth in the saliva).  

Having a tooth knocked out can be incredibly painful, so over-the-counter pain relievers like acetaminophen and/or ibuprofen might be helpful for this person. The patient should be evacuated for emergency dental care. 

What Happened?

You search the raft and are able to find the missing tooth stuck in a crevice on the raft. Using water that has been treated, you irrigate the tooth, making sure to remove debris and river water. 

Attempts to reimplant the tooth are not successful despite your best efforts. You thankfully have some powdered milk in your food bin, so you mix up a batch and place the tooth in the milk. 

You decide to camp for the night and get on the river first thing tomorrow morning. You’ll ideally be back at the car by midday and can be at the dentist by early afternoon.