Teeth
Here’s a further snippet from up coming book The Beyond.
It’s very easy to skip cleaning your teeth on a trip, especially when you’re having a tough time of it, like getting up at 4 a.m. with the temperature at -29°C or wondering if your tent will last the night as the storm rages outside, but you should. Like washing, brushing your teeth serves both a valuable hygiene purpose, critical personal admin, but also a psychological one as well; you’re on top of something you could easily ignore, that you have spare bandwidth. You’d be forgiven for thinking that cleaning your teeth, which is really about slowing plaque buildup, isn’t a killer on a short or long trip, but problems with your teeth or gums or mouth sores are some of the worst you can suffer. A tooth that has been throbbing on and on for five days, that you feel will never get better or might turn septic and kill you, is something that can scramble your brain (you realise why dentists can charge so much).
One of the chief causes of such issues (if you’ve had your teeth checked beforehand for cavities) is food that has become stuck between your teeth and caused an infection. This is pretty common if you’re eating very stringy meat, like beef or bacon, which is why brushing your teeth and flossing (or having floss) is important. A secondary factor, and another cause of considerable discomfort and low-grade misery, are mouth ulcers caused by a lack of good mouth hygiene. On an expedition, these are commonly caused by drinking too high a concentration of ‘energy’ drink, which is just sugar water, which just attacks your teeth, gums, and tongue. This is one reason why it’s better to drink just water or at least reduce the amount of powder added to one quarter. If you only want to clean your teeth once a day, do it after your evening meal, so you make sure your mouth is cleaned up, but who says you need to clean your teeth in the morning or evening? If you carry your toothbrush in your pocket, you can clean your teeth at any time, while drinking water, for example, or carry one of those 24 g toothpastes (remember, you only need a pea-sized dab) in your pocket as well, to stop it from freezing. Make sure you use a soft toothbrush, as a harder brush might irritate gums that are fatigued.
When it comes to teeth, prevention is key. If you’ve got a mouth full of rotting teeth and gums full of disease, and you eat only Haribo and drink only Coke, then you’d better get used to solo climbs, as you’re just a liability. Rather, you need to treat your teeth as part of your overall physical fitness and aim for the highest level of fitness you can achieve (it’s never too late). This means the basics: brushing twice a day (get an electric toothbrush; they are better) and flossing. Make sure you see a dentist every six months and see them before you go on any big trip (tell them where you’re going and for how long). I would also recommend you see a hygienist every six months, and if you have any gum issues, get them sorted as soon as you can. Think of the dentist as the mechanic who is there to make your teeth roadworthy.
Don’t view all toothpastes as the same; they’re not, and many of the top pastes have differing properties that may help when you’re away on a trip. A baseline toothpaste would be something like Colgate Total, which is great as an abrasive for cleaning your teeth, but it’s pretty limited to that. Pastes like Sensodyne are better at giving some short-term relief from sensitive teeth, which are teeth that may be on the cusp of ‘going rough in your mouth.’ If you damage your teeth or have a history of tooth problems and you’re going off the grid, then maybe you want a paste that gives longer-lasting desensitization (look for pastes that contain Novamin).
With all toothpastes designed to decrease sensitivity, it’s important that you don’t rinse out your mouth with water, as you’re just washing it off. Just spit out the excess.
Once you’re away, if you have tooth problems, you will have a very limited ability to sort them out without being in a dentist’s chair. Broken teeth or bits of your teeth that break off (watch out for pebbles in lentils or rice, or flour) or lost fillings (avoid toffees) can be made less painful by using premixed temporary filling materials. These are used to insulate the pulp from temperature, salt, sugar, or acids (hypertonic solutions), or irritating foods. It will make the tooth feel much better, even if it’s not.
If a tooth is damaged during an expedition—whether through a lost or broken filling, decayed dentine, or cracked or broken enamel—but is not giving symptoms, then a temporary filling can still be useful as a preventive measure. Temporary filling materials, like 3M Cavit, which is like epoxy resin for your teeth (Cavit comes in tiny 7 g tubes, so it can be carried in even a small first aid kit), are ideal. If using this, first clean around the area of the tooth by using an iodine mouthwash (2:100 ratio of iodine to clean water) or salty water.
Then dry the tooth as best you can (use cotton wool), make a ball using the Cavit, and place it over the tooth, either to replace the missing filling, make a cap for a broken tooth, or cover exposed pulp. Bite down on it and leave for ten minutes, and then just be aware it’s temporary (again, no toffees).
If you don’t have any temporary filling material, then sugar-free chewing gum can be used or wax from a candle, but it will be very temporary.
Anyone who has ever seen Marathon Man with Dustin Hoffman knows that when you’re getting your teeth drilled by a Nazi dentist, you really need a good supply of oil of cloves. These come in small bottles (10 ml), making them perfect for first aid kits, and are used to numb the mouth or gum or applied directly to the pulp using cotton wool (if you have no way of covering the pulp, cotton wool soaked in oil of cloves is your best option). It also provides some relief from toothache, although a 10 ml bottle will quickly run out.
Toothache is a catch-all symptom for many problems, some that might pass, others that won’t and will require a dentist, or they might kill you. One cause of a toothache is a gum that’s become infected due to food trapped between your teeth, like a piece of meat (having rotting food in your mouth is also not nice). This is why it’s important to maintain good tooth hygiene and why flossing is not just ‘going through the motions.’ The chances of this kind of infection or bigger issues, like abscesses, are made more likely due to the stresses and strains of being on a hard trip, so it’s more important to do it then than at home.
Apart from carrying floss, bring a few interdental toothbrushes, as they weigh nothing and can also do double duty for cleaning fuel filters.
The danger of trapped food in your teeth comes down to genetics, past dentistry, and the food you’re eating. Someone who has teeth with more gaps between them than a picket fence or a French model, who grew up in the care of a great dentist, and who is living off mashed potatoes and pasta really has nothing to worry about and really doesn’t even need to floss on a trip. If, on the other hand, you have teeth like Austin Powers (you’re British), your childhood dentist was struck off for malpractice (ditto), and you’re living on a diet of bacon, dried sausage, and biltong, then you’re a high-risk individual (and single).
If you only have limited time to floss or even brush your teeth, then focus just on your bottom back teeth, as they are more prone to infections, as they are partly covered by the sides of the tongue, and anything stuck in there does not have gravity to help shift it.
If you do begin to feel you have some kind of abscess starting, try to catch it early by careful cleaning and flossing and avoiding anything that might make it worse. If you have one tiny bit of food, like a piece of meat or a seed, trapped between your tooth and your gum, then this could be the problem. Don’t just hope it’ll go away or get better. Help your body out.
If the problem gets worse, then try to clean around the area as much as possible, avoid eating on that side, and rinse your mouth with an iodine mouthwash or salty water. Having some form of Corsodyl cream can help fight off the infection, so this should be in any expedition’s first aid kit.
On my first alpine route, a three-day winter ascent of the French Spur, I suffered really badly with painful teeth, like all of them, and it felt as if they were all trying to fall out. If I’d been on an expedition or a longer climb, I might have backed off the climb, fearing I had some real tooth issues on the way. But, looking back, and having been on many longer and harder climbs, what was actually going on was I was just grinding or clenching my teeth the whole three days: while leading, while belaying, while sleeping. I’m not recommending a mouthguard for hard climbing, only that it’s not always a problem with your teeth; it’s just a problem with you.
Climbers have extracted teeth with penknives in extremis, but really, most big issues with your teeth are like issues with your internal organs and require professional attention. Like seasickness, which can’t kill you but you wish it could, a tooth abscess should not kill you either (unless it leads to sepsis), but you’ll be praying for death until your body does a hard reset. So, on any big trip, it’s worth having a plan in place for what you’ll do, like where a good (or any) dentist is and whether you can be evacuated if you have a tooth issue (will you have to be carried out on a donkey or by a helicopter)?
If you’re planning on a multi-month expedition to a remote area, although having some kind of wilderness first aid skills is great, having someone who has done an expedition dentistry course might be better. Such courses cover all aspects of tooth issues, from makeshift repairs to pulling teeth (gulp).
A final note on teeth. I know a climber who has always been dogged by tooth problems, probably because he’s a Brit and has teeth like untended gravestones. There are many climbs and expeditions that came to nothing due to his teeth, which, when exposed to the cold and perhaps a lowering of energy that hard graft brings, rebelled in his mouth. But one such lost climb stood out, when he and a partner went to scale a thousand-meter ice face in the Alps one winter. They walked into a remote mountain hut, the face on the other side of the glacier, looking steep and in condition, even if the temperature was a little warmer than expected, and settled down to a nervous night, one contemplating the next day’s climb, the other a growing pain in his tooth. Come the morning, my friend said his tooth was too sore to climb, and so they packed up and began walking back down the glacier in search of a dentist. Then, from behind them, they heard a loud cracking sound and then a storm of thunderclapping booms, as the whole ice sheet they would have been climbing on at that moment slid off and crashed down onto the glacier.Although you have two eyes, and so technically a spare, two are always better than one. Being blind, even for a short while, is its own kind of hell, and damaging an eye brings a unique form of pain. Eyes are incredibly delicate and sensitive, and can be damaged easily — sometimes only for a short time until they heal, sometimes forever. When it comes to protecting your body, your eyes need to be a top priority.
Hi Andy, Dustin Hoffman's movie is Marathon Man, The Running Man is movie starring Arnold Schwarzenegger. Nazi dentist is only in the first one, the other one is loosely based on Stephen King's book.