In a grid-down scenario, correct diagnosis is everything. Treating the wrong tooth wastes supplies and patient tolerance. This module walks through the examination sequence — chief complaint, visual inspection, percussion, thermal testing, and charting — so you identify the problem tooth before you touch an instrument. Primary references: Murray Dickson's Where There Is No Dentist and the Special Operations Forces Medical Handbook dental protocols.
ALLERGY CHECK REQUIRED: Always ask about allergy to local anesthetics before injection. Ask specifically about reaction to dental injections in the past — not just general drug allergies. If allergy is present or suspected, do not inject. Proceed with maximum non-injectable pain control and consider whether the procedure can be delayed.
Two nerve blocks cover the vast majority of field dental procedures. The inferior alveolar nerve block anesthetizes all lower teeth on one side plus the lower lip and chin. The
A temporary restoration does two things: relieves sensitivity by sealing exposed dentin, and prevents progression by blocking bacteria from reaching or advancing toward the pulp. In a grid-down scenario, a well-placed temporary restoration can keep a tooth functional for months. The most field-practical material is zinc oxide eugenol (ZOE) cement — it is soothing to the pulp, antibacterial, and easy to mix and place without electricity.
For fractured teeth with exposed dentin (sensitivity to air and cold but no spontaneous pain), the treatment is the same — dry the exposed area and seal with ZOE cement. For fractured teeth with exposed pulp (a tiny pink dot visible in the fracture — the patient has severe pain to any stimulus), seal with ZOE immediately as a palliative measure and plan for extraction. A pulp exposure in a grid-down setting has no field-viable treatment other than extraction.
AIRWAY THREAT — KNOW THESE SIGNS: Difficulty swallowing, difficulty opening the mouth (trismus), swelling extending to the floor of the mouth or the neck, fever above 101°F, the patient appears systemically ill (chills, rapid pulse, sweating). These indicate spreading infection — Ludwig's angina or deep space infection. This is a life-threatening emergency. Immediate extraction of the source tooth, high-dose IV antibiotics if available, and evacuation to surgical care if possible.
Extraction is the definitive field treatment for irreversible pulpitis, necrotic teeth, and unresolvable abscesses. Done correctly, it is a safe and effective procedure. Done incorrectly — inadequate anesthesia, wrong instrument technique, or failure to manage the socket — it creates complications that are far worse than the original tooth. Take your time. Adequate anesthesia is not optional.
Dry socket occurs when the blood clot dislodges or fails to form, exposing bare bone. It presents 3–5 days post-extraction with severe, throbbing pain that radiates to the ear or temple — distinctly worse than expected post-extraction soreness. Visual inspection shows an empty socket with exposed whitish bone rather than a dark blood clot. Treatment: gently irrigate the socket with saline, then pack with iodoform gauze soaked in ZOE or clove oil. Replace packing every 24–48 hours until pain resolves. Dry socket is painful but not dangerous — it resolves with time and local dressing.
Dental supply planning follows the same tiered logic as medical supply planning. Tier 1 is what every individual carries. Tier 2 is the group first aid kit. Tier 3 is the community clinic cache — positioned for extended operations when resupply is unavailable. Document your current inventory in each tier below and note gaps.
More than one person in your group should have basic dental first aid skills. If your primary dental responder is incapacitated, someone else needs to know how to pack a socket, place a temporary restoration, and recognize a spreading infection. Document training by member so you know who can do what.
Document every dental procedure. A treatment record protects the patient — if complications arise, you need to know what was done, when, and with what medications. It also builds your group's dental health picture over time. Use callsigns or designations rather than full names if OPSEC is a concern.
Print these outputs and laminate them for your dental kit. A reference card in your hands is worth more than a perfect module on a dead device.
Step-by-step extraction checklist, post-op instructions, and dry socket management. Single laminated card for the dental kit.
Abscess recognition guide, airway threat warning signs, antibiotic dosing quick reference. For group members to recognize when a dental problem has become an emergency.
Complete tiered supply list for Tier 1, 2, and 3 caches with your inventory notes. Use for restocking and procurement planning.
Formatted print output of all logged cases. Suitable for physical filing in your medical records binder.
IVORY contains protocols for field dental care including tooth extraction, abscess drainage, local anesthesia, and temporary restorations. This information is intended exclusively for use in prolonged grid-down or austere emergency scenarios where a licensed dentist and modern dental facilities are unavailable. It is not a substitute for professional dental training or licensed dental care.
This module does not constitute dental or medical advice, diagnosis, or treatment. No provider-patient relationship is created by its use. The information presented is drawn from field medicine references and is intended for prepared laypeople — not as a substitute for licensed professional care. If professional care is available, seek it.
The decisions you make and the actions you take are entirely your own. WATCHMAN, its authors, and its developers accept no liability for outcomes resulting from the application of any information contained in this module.