Tag Archives: emergency dental

Temporary tooth filling & crown repair

(Survival Manual/6. Medical/a) Dental/Temp filling  & crown repair)

A.  Temporary filling
Temporary tooth filling compounds can either hold displaced crown in place or fill a tooth for up to about two weeks. They are  a great thing to have if you cannot consult a dentist right away – like when you’re camping in the middle of nowhere and have a dislodged crown.

The typical sign of a dislodged crown or a lost filling is when you feel pain when cold liquids, food, your tongue, or cold air touches the delicate area that was previously protected with a filling.

What you need for the temporary filling or repair
Use the mixture available with a few first aid kits or stand alone dental repair kits, i.e., Dentemp. In a case where this is not available, you could roll a ball of sugarless gum or use candle wax or ski wax instead.
•  Premixed compounds/kit i.e.; Dentemp OS, Refilit, Temparin, Recapit
•  Antiseptic soap
•  Latex gloves
•  Some disinfected water, and
•  Oil of cloves to act as a painkiller.

Procedure for applying a temporary tooth filling
__1.  Clean your hands with the antiseptic soap and put on the pair of latex gloves.
__2.  Prepare the temporary filling – roll a ball of sugarless gum ( or wax ) or if you have it – use the premixed compound.
__3.  Use the disinfected water to thoroughly rinse the mouth.
__4.  Apply a drop of oil of cloves (or eugenol ) to the spot in the mouth where the filling or crown was earlier. This should ease the pain in the mouth.
__5.  Place the temporary filling carefully into the hole and be sure to cover exposed tissues if any.
__6.  Gently bite down and line the tooth with the one either below or above it.
__7.  You might want to wait before the filling hardens in case you are using either the premixed compound or the one from a first aid kit.

More about tooth fillings
•  Fillings are very common with dental work, as they present a way to repair a tooth that has suffered from decay or a cavity back to its original shape. When performing a filling, the dentist will remove the decayed area of the tooth, clean around it, then fill in the area that he has removed with a special material that will cater to the shape and form of the tooth.
•  Fillings work by closing out the area where the bacteria enters into teeth, helping to prevent any type of decay in the future. The materials used for fillings include porcelain, gold, composite resin, and amalgam. There is really no best type of filling, as several factors come into play. Your reaction to different material, the shape of the tooth, extent of repair, and where the filling is needed will be determining factors as to what material is used with your filling.
•  The gold fillings that are used are made in a laboratory, then cemented into place by the dentist. Gold material fits well with the gums, and can last you for many years. Gold is considered by many to be the best, although it is also the most expensive and will require you to visit the dentist several times before the filling will be complete.
•  Silver fillings on the other hand, are less expensive than gold materials and they can be quite resistant to wear. With their color being dark, they are easier to notice than composite or porcelain fillings, and aren’t recommended for visible areas of the mouth, especially the front teeth. Composite fillings are a common type of material, as they match the color of your teeth. The material that makes up the composite filling is mixed then placed directly in the cavity, where it hardens. They last several years, although composite isn’t recommended for large cavities, or areas where they may chip.
•  The final type of filling is porcelain. Porcelain is very common, and produced in lab where it will be matched to your teeth then bonded to the affected tooth. Porcelain fillings match the color of your teeth, and are resistant to any type of staining. The costs for porcelain fillings can be very expensive, some costing as much as gold fillings.

If a cavity, decay, or even a crack has managed to damage a large area of the tooth, you may need a crown or a cap. If the decay has managed to get to the nerve, you may end up needing a root canal to get rid of the dead pulp. When the dentist decides he can fill your tooth, he will remove the cavity then fill the hole with a material listed above. Depending on your insurance and what you can afford, you can choose which one you want or take his recommendation. In most cases, porcelain or composite fillings will be recommended. Gold fillings are popular, although most people want a filling that will match the natural color of their teeth.

Keep in mind that only a dentist can make the decision regarding fillings. When you visit for your routine checkup, the dentist will look in your mouth and use instruments that will let him examine the surfaces of your teeth. If he finds any cavities, he will usually recommend a filling. You won’t feel anything, as he will numb the area he is going to be filling. It normally takes less than an hour, and you’ll be up and at ‘em before you know it. A filling is great for cavities, as most look natural and they won’t result in the loss of your tooth.
Pasted from <http://www.loveableface.com/teeth%20includes%20files/TemporaryToothFilling.htm>

See demo videos at (this is a long website address):
<http://images.google.com/imgres?imgurl=http://i.ytimg.com/vi/nDHFCYrxUQ0/0.jpg&imgrefurl=http://modernhmong.com/home-dentistry-Putting-temporary-filling-in-tooth-cavity/K_v0pQF1INo.html&usg=__wF4cb6fLqJPrgonYQlyv1L_quWM=&h=360&w=480&sz=10&hl=en&start=120&sig2=5QQJFHyVvdpELkhn9QyByQ&zoom=1&itbs=1&tbnid=qDMKxlZco9xWdM:&tbnh=97&tbnw=129&prev=/images%3Fq%3Dmaking%2Ba%2Btemporary%2Bfilling%26start%3D100%26hl%3Den%26sa%3DN%26rlz%3D1T4GGLL_en%26ndsp%3D20%26tbs%3Disch:1&ei=ybh7TeH5MMaV0QGZkdjeAw>

B.   How to temporarily fix a loose dental crown
Buy a Dental Repair Kit at Walgreen’s or Amazon.com that consists of the adhesive and a little stylus.
This procedure is easy.

Things You’ll Need:
•  Dental Repair Kit
•  pointed knife or other sharp pointy object
•  crown
•  toothbrush
•  Dentemp or other dental temporary adhesive

Procedure
1.  For a loose crown. Remove crown and clean the crown and your tooth with a toothbrush.
2.  Take a pick or pointy knife and carefully remove all tooth and old dental adhesive product from the inside of the crown.
3.  Press crown back on tooth to make sure it will still fit. If it does not you are stuck and must wait till you can see your dentist. If it fits remove it and lightly fill inside of crown with the Dentemp or other temporary dental adhesive material.
4.  Press crown back on the wet tooth, press firmly. Then bite down a few times to make sure that it is a comfortable fit.
5.  If any of the Dentemp or dental adhesive material leaked out of the sides of the crown you will want to clean it up and remove it. Rinse mouth well with water.
6.  Most dental repair kits require that you do not eat anything for at least 1 hour after applying.
7.  For a lost filling or broken tooth. Brush tooth to remove any debris. Wash hands.
8.  Open canister of Dentemp or other temporary dental adhesive. remove a small amount of the Dentemp or other dental adhesive and form it into a small ball.
9.  Firmly press the little ball of Dentemp or other dental adhesive into the tooth that lost the filling and make sure to fill hole, bite down to insure it is comfortable.
10.  Remove any excess Dentemp or other dental adhesive, rinse mouth thoroughly, then Do Not eat for one hour to allow it to set firmly.
Pasted from <http://www.ehow.com/how_4845502_fix-loose-dental-crown.html>

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Home dental procedures

(Survival Manual/6. Medical/a) Dental)

Any dental emergency, like an injury to the teeth or gums can be potentially serious and should not be ignored. Ignoring a dental problem can increase the risk of permanent damage as well as the need for more extensive and expensive treatment down the road.

1.  Home exam
http://www.homedental.com/selfexam.asp

_A. Mouth Check
For many… pain was the major telltale sign that a dental appointment was needed. Bleeding gums were not a significant warning, because some people just didn’t know if they had cut their gums a little or what. Now, with the help of computers, we will be able to show you some of the warning signs, you, yourself, can see. Education is your best ally so you will easily know what you’re looking for. All you have to do, from time to time, is to take a look at our page and call a dentist when you see you’re having a problem.

Images above, L>R: L) Swollen gums, C) Cavities, R) Plaque and Tartar

If you see or think you see any of these conditions in your mouth or your child’s mouth, you will be smart by quickly making a dental appointment. Of course, prevention is always better than cure. If you know you have a condition that a dentist should treat, the sooner the better is always the best way to go.

_B.  Giving Plaque the Brush-Off
<http://corner-dental.olhblogspot.com/other-dental-news/taking-care-of-your-teeth/&gt;
In order to prevent cavities, you first need to remove plaque, the transparent layer of bacteria that coats the teeth. The best way to do this is by brushing your teeth twice a day and flossing at least once a day. Brushing also stimulates the gums, which helps to keep them healthy and prevent gum disease. Brushing and flossing are the most important things that you can do to keep your teeth and gums healthy.

Toothpastes contain abrasives, detergents, and foaming agents. Fluoride, the most common active ingredient in toothpaste, is what prevents cavities. So you should always be sure your toothpaste contains fluoride. If you have teeth that are sensitive to heat, cold, and pressure, you may want to try a special toothpaste for sensitive teeth.

_C.  Cleaning Tartar from your teeth
About 1 person in 10 has a tendency to accumulate tartar quickly. Tartar is plaque in a hardened form that is more damaging and difficult to remove. Using anti-tartar toothpastes and mouthwashes, as well as spending extra time brushing the teeth near the salivary glands (the inside of the lower front teeth and the outside of the upper back teeth) may slow the development of new tartar.

  1. Buy an antiseptic oral cleanser to help clean the tartar deposited from your  teeth. Gargle with this liquid every day, which will loosen the tartar from the edges of the gums. People should make it a habit to rinse their mouth with oral cleanser after each meal. This will remove the food particles which get stuck in the mouth after eating food.
  • After rinsing the mouth with an oral cleanser,  floss your teeth.
    It’s important to know the correct manner of flossing the teeth otherwise you can hurt your gums. People should floss their teeth thoroughly upwards and downwards. [I could never get my fingers in my mouth  just the right way to work the string version of dental floss,  so I use the dental floss picks shown at right. This brand has 90 picks per pouch which cost about $3.50 at Wal-Mart.]
  • If you eat lots of spicy foods, you’ll find it easier to remove tartar from your teeth. Spicy foods increase the production of saliva in the mouth. Saliva is very important to drain out those food particles which get stuck between teeth.
  • Rubbing your teeth with a mixture of salt and baking soda is very effective for removing tartar.
    Mix a small quantity of salt in baking soda and apply with a finger. The best thing about this method is that you can get instant results from it. It is one of the most effective home remedies for teeth tartar removal
    .

2.  Homemade tooth paste recipes
a)  Mix equal parts of baking soda and salt. The result tastes like dirt, but it does a decent job of cleaning your teeth and gums.
Simply moisten the toothbrush, dip it into the mixture and brush as usual.
Recipe from the book, Dirt Cheap Survival retreat by M.D.  Creekmore.

b) Two more recipes for  homemade toothpaste
http://naturallycheerful.blogspot.com/2011/09/homemade-toothpaste.html

Homemade Orange Toothpaste Recipe
1 tablespoon baking soda
⅛ teaspoon salt
3 tablespoon glycerin or  1- 1/2 tablespoon of peroxide
1 teaspoon orange extract or  ½ teaspoon dried orange*

Homemade Vanilla Toothpaste Recipe
1 teaspoon vanilla extract
4 teaspoons baking soda
1 teaspoon salt
1-2 teaspoons water, or peroxide to be added if desired

These store well in empty baby food jars.

*Place some grated orange rind in a blender and grind until it is fine and powdery.
or you could even use mint leaves if you like it minty.  Pretty much any kind of good tasting essential oils can be used as flavoring, just a couple drops though.  Easy does it.

NOTE: This is from the back of the ‘Arm & Hammer baking soda toothpaste tube’.
“Ingredients:
Active Ingredients: Sodium fluoride (0.24%) for anticavity.
Inactive Ingredients: Sodium bicarbonate, water, glycerin, sodium saccharin, PEG 8, flavor, cellulose gum, sodium lauryl sulfate, sodium lauroyl sarcosinate

You see the only things missing from the homemade toothpaste are:
1)  fluoride (which is bad for your bones),
2) lauryl sulfate (Google it. It is found contributing to the cause cancer and Alzheimer’s disease, it is not good for us in any form), and
3) saccharine (which is sugar), rubbing sugar on your teeth?
Go with homemade and avoid all the other garbage. Don’t take your health, including your dental health lightly.
..

3.  Summary of what to do for some common dental problems
<http://www.webmd.com/oral-health/guide/handling-dental-emergencies&gt;
_A. Toothache
First, thoroughly rinse your mouth with warm water. Use dental floss to remove any lodged food. If your mouth is swollen, apply a cold compress to the outside of your mouth or cheek. Never put aspirin or any other painkiller against the gums near the aching tooth because it may burn the gum tissue. See your dentist as soon as possible.

Tooth pain is one of the most painful types of discomforts known to man. Unlike other types of pain, that can be relieved with a temporary remedy, in most cases, tooth pain is something entirely different as it throbs consistently, is sensitive to hot or cold, or both and because you have to eat so you’re constantly irritating the painful area three times per day.

When you first experience tooth pain, your first instinct might be that you have food in between your teeth. If the pain is affecting your gums more than the tooth, then that is exactly what the pain will feel like. Around the infected area, check for any food that is stuck in small spaces. Do not try to aggravate the area by overly brushing or flossing, but gently use the brush or floss to get the food out.

1.   If you are able to stand warm liquid on the tooth, rinse your mouth out with warm salt water to help remove excess food. The wonderful benefit of warm salt water is that it can be done as often as you need to and it helps treat your gums.

2.   There are a number of ways to treat tooth pain that may or may not provide you with temporary relief. The most common ways of treating it is taking an anti-inflammatory drug, such as Advil, which
can be bought at most any store over the counter. This will help the pain and also help to ease the swelling and inflammation in the surrounding area. However, it’s still only a temporary relief.

3.   An ancient home remedy that might be very effective for your mouth pain is to use clove oil. Soak a cotton ball in the clove oil and then apply it directly to the tooth that is giving you trouble.  Clove oil has many soothing benefits, with the addition of infection fighting ingredients that can help relieve the pain and treat the area at the same time. If your tooth has a negative reaction to the clove oil and it causes the area to hurt worse, then rinse immediately with warm salt water. [Clove oil and q-tips should be maintained as part of your emergency medical supply kit. Mr. Larry]

Regardless of what type of temporary treatment you choose, it is still crucial that you visit the dentist as soon as possible. Even if you are able to find a home remedy that relieves the pain, there could still be a serious problem with your tooth that will need to be treated appropriately. Make sure that you inform the dentist of any pain relieving methods that you tried at home.

_B.  Toothache remedies that you can easily find

  1. A clove of garlic is good. Garlic is a natural anti-biotic. It attacks bacteria and has been known in many instances to work on bacterial infections all on its own without the use of prescribed
    antibiotics. Crush the garlic, and place it in the cavity. It will sting for a few seconds going in, but it settles the pain before long. If you want it to work even better, prepare a strong salt solution and swish the area to get rid of any debris that may be lying around, and then place the clove there. The pain will go, and you may not even need to see a dentist
  2. An onion will work in the same way – it  will kill bacteria and leave you free of pain. Treat it the same way you would the garlic – pound and pack the cavity. If you’re not in too much pain to chew, chew it and take around your mouth, letting it linger around where you have the pain.
  3. Wheatgrass is also excellent. If you can chew it, go ahead and chew it. If you can’t, find a way to crush it and pack it around the painful area. It acts as a strong, natural mouthwash, and it draws out bacteria from both the gum surface and the teeth.
  4. Clove oil has strong antiseptic properties. If you can get hold of some, pour a couple of drops directly into the cavity. If you can’t, crush a clove and pack it against the cavity or get the juice in there.
  5. Activated charcoal can be bought in some pharmacies now, and is good for aching cavities. Just crush it into a paste, pack it into gauze and hold it against the painful cavity. It should take away the pain.

The long term solution for cavities though, is to have your dentist have a look and recommend a permanent course of action – remember that sometimes even filling cavities may not be a permanent solution. Taking regular extra-good care of your teeth if you have cavities is one way to make sure that you get toothaches less frequently. Otherwise, keep all the above handy; you never know when you’ll need them.

_C.  Chipped or broken teeth. Save any pieces. Rinse the mouth using warm water; rinse any broken pieces. If there’s bleeding, apply a piece of gauze to the area for about 10 minutes or until the bleeding stops. Apply a cold compress to the outside of the mouth, cheek, or lip near the broken/ chipped tooth to keep any swelling down and relieve pain. See your dentist as soon as possible.

_D.  Knocked-out tooth. Retrieve the tooth, hold it by the crown (the part that is usually exposed in the mouth), and rinse off the tooth root with water if it’s dirty. Do not scrub it or remove any attached tissue fragments. If possible, try to put the tooth back in place. Make sure it’s facing the right way. Never force it into the socket. If it’s not possible to reinsert the tooth in the socket, put the tooth in a small container of milk (or cup of water that contains a pinch of table salt, if milk is not available) or a product containing cell growth medium, such as Save-a-Tooth. In all cases, see your dentist as quickly as possible. Knocked out teeth with the highest chances of being saved are those seen by the dentist and returned to their socket within 1 hour of being knocked out.
__1)  Extruded (partially dislodged) tooth. See your dentist right away. Until you reach your dentist’s office, to relieve pain, apply a cold compress to the outside of the mouth or cheek in the affected area. Take an over-the-counter pain reliever (such as Tylenol or Advil) if needed.
__2)  Objects caught between teeth. First, try using dental floss to very gently and carefully remove the object. If you can’t get the object out, see your dentist. Never use a pin or other sharp object to poke at the stuck object. These instruments can cut your gums or scratch your tooth surface.

_E.  Possible Broken Jaw
If you think that your jaw might be broken, apply a cold compress to the area to minimize any swelling. You will need to see your dentist immediately or go to the emergency room of a nearby hospital.

_F.  Lost filling. (See Survival Manual/6. Medical/a) Dental/Temporary Filling & Crown post) As a temporary measure, stick a piece of sugarless gum into the cavity (sugar-filled gum will cause pain) or use an over-the-counter dental cement. See your dentist as soon as possible.

_G.  Lost crown. (See Survival Manual/6. Medical/a) Dental/Temporary Filling & Crown doc) If the crown falls off, make an appointment to see your dentist as soon as possible and bring the crown with you. If you can’t get to the dentist right away and the tooth is causing pain, use a cotton swab to apply a little clove oil to the sensitive area (clove oil can be purchased at Amazon.com, your local drug store, or in the spice aisle of your grocery store). If possible, slip the crown back over the tooth. Before doing so, coat the inner surface with an over-the-counter dental cement, toothpaste, or denture adhesive, to help hold the crown in place. Do not use super glue!

_H.  Broken braces wires. If a wire breaks or sticks out of a bracket or band and is poking your cheek, tongue, or gum, try using the eraser end of a pencil to push the wire into a more comfortable position. If you can’t reposition the wire, cover the end with orthodontic wax, a small cotton ball, or piece of gauze until you can get to your orthodontist’s office. Never cut the wire, as you could end up swallowing it or breathing it into your lungs.

_I.  Loose brackets and bands. Temporarily reattach loose braces with a small piece of orthodontic wax. Alternatively, place the wax over the braces to provide a cushion. See your orthodontist as soon as possible. If the problem is a loose band, save it and call your orthodontist for an appointment to have it recemented or replaced (and to have missing spacers replaced).

_J.  Abscess . Abscesses are infections that occur around the root of a tooth or in the space between the teeth and gums. Abscesses are a serious condition that can damage tissue and surrounding teeth, with the infection possibly spreading to other parts of the body if left untreated.

Because of the serious oral health and general health problems that can result from an abscess, see your dentist as soon as possible if you discover a pimple-like swelling on your gum that usually is painful. In the meantime, to ease the pain and draw the pus toward the surface, try rinsing your mouth with a mild salt water solution (1/2 teaspoon of table salt in 8 ounces of water) several times a day.

_K.  Soft-tissue injuries. Injuries to the soft tissues, which include the tongue, cheeks, gums, and lips, can result in bleeding. To control the bleeding, here’s what to do:

  1. Rinse your mouth with a mild salt-water solution.
  2. Use a moistened piece of gauze or tea bag to apply pressure to the bleeding site. Hold in place for 15 to 20 minutes.
  3. To both control bleeding and relieve pain, hold a cold compress to the outside of the mouth or cheek in the affected area for 5 to 10 minutes.
  4. If the bleeding doesn’t stop, see your dentist right away or go to a hospital emergency room. Continue to apply pressure on the bleeding site with the gauze until you can be seen and treated.

_L.  Bitten Tongue or Lip
If you have  bitten your tongue or lip, gently wipe the area clean with a cloth. Apply a cold compress to the area to minimize any swelling. If the bleeding will not stop, you should go to the emergency room of a nearby hospital.

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Emergency home dental kit

(Survival Manual/6. Medical/a) Dental/Home dental kit)

A.  Guide to Emergency Dental Kits (Buy as kit or as individual items)
One of the common themes with dental emergencies is that, the quicker you get treatment, the better long-term prospects that treatment will usually have. Therefore, if you have a tooth knocked out, that tooth can often be saved if you get to the dentist quickly enough. Assuming of course, that you have picked up the tooth and brought it with you!
As more and more people are realising the benefits of early treatment, emergency dental repair kits are becoming far more popular. Emergency Dental Kits are a relatively new phenomena. These are kits that you can buy over the counter in pharmacies and supermarkets and which contain a wide variety of dental treatments for emergency situations.
Essentially, an emergency dental kit will give you the opportunity to effect some preliminary care before going to the dentist. An emergency kit will not give you the materials you need to treat yourself properly. However, it may just mean you can patch yourself up enough to stop the pain, protect your teeth and get professional treatment.
(Internet image above, cover of the book: Where There Is No Dentist by Murray Dickson, 228Pgs. Recommended for reading and inclusion in your library. Amazon.com)

B.  What can be treated with a dental repair kit?
A dental repair kit is not intended to be used to perform permanent repairs. The majority of over-the-counter kits will include materials that are lower grade than your dentist would use. Therefore, materials such as dental cements will only stay in place for a short period of time. However, your dental kits can be used effectively for temporary treatment in a number of different scenarios:
Experiencing toothache: you may be suffering from toothache caused by a cavity which you cannot see or reach. Your dental kit will usually include some clove oil and cotton wool. Clove oil contains eugenol, which is a powerful natural pain-killer. Dilute it with some olive oil and soak the cotton wool, then bite down on the cotton wool with your affected tooth. This should help soothe the pain.

•  Losing a tooth: your mouth is full of blood vessels so, sometimes, when you lose a tooth the cavity can bleed quite heavily. Your dental repair kit will contain cotton wool balls that you can use to staunch the flow of blood. It may also contain some pain-killing gel that can be used to soothe sore, tender and inflamed gums.
•  Losing a filling: we all lose fillings from time to time and a lost fillings can mean that your tooth becomes immediately very sensitive to hot and cold. Some dentists recommend sticking sugar-free gum over the cavity until you can get professional dental treatment. Your dental kit, however, will include dental cement that can be used to cover the cavity. This will also help to stop debris getting trapped in the cavity, irritating the tooth and therefore causing more pain.
•  Fracturing a tooth or losing a crown: if the structure of your tooth is weakened by decay, then the tooth can split or crack unexpectedly. This can of course be painful and it requires immediate professional treatment. In your emergency dental kit, you will usually find a temporary crown and dental cement. This crown can be used to cover the broken tooth and protect it from further damage until you can get to your dentist.
•  Breaking a denture: many people who wear dentures find that keeping an emergency dental kit handy is useful. Dentures can easily be damaged, cracked or broken and, when this happens, it can be uncomfortable and embarrassing to have to manage without them. An emergency dental kit will include orthodontic wax that can help to smooth the edges of damaged dentures. You may also be able to use dental cement to make minor, temporary repairs to broken dentures.

C.  Make your own dental repair kit
Of course, you do not necessarily have to go out and buy a branded dental repair kit. With a little bit of research, you can learn more about the kinds of products that are useful and put together your own pack. In many ways, spending a bit of time getting to know different items will mean you are more likely to know what to reach for when the pressure is on!
•  Clove Oil: Clove oil is used prominently in dental care, in products like mouthwashes and tooth pastes. Clove oil has pain killing properties which help it to soothe tooth aches, inflamed gums and sores such as mouth ulcers. It can also help keep the breath fresh and you can easily buy it in your local chemist or natural health store.
•  Dental Floss: Dentists recommend that you floss regularly. Even if you do not, you should still keep some dental floss in the house. It is useful for removing items or debris that become stuck in your teeth.
•  Antiseptic mouthwash: There are different types of mouthwash available. However, a mouthwash that contains antiseptic can help to clean blood away from a wound or to wash away debris from a shattered filling, for example.
•  Cotton wool: Whether you need to staunch the flow of blood or stop a filling from hurting, the patient often needs to bite down on something. So keep plenty of cotton wool in your kit, as this does the job perfectly.
•  Pain Killing gel: There are a number of pain killing gels available on the market under different brand names. These gels are appropriate for a number of different purposes, from soothing teething pain in children to relieving the pain from canker sores in adults. They can also help with pain caused by ill-fitting dentures.
These are the basics of any home dental emergency kit. Of course, there are many more items that you could potentially add to it. However, it is important that you strike the right balance between equipping yourself for emergencies and ensuring that you know when to call your dentist.

D.  Commercial Emergency Dental Kit
Amazon.com price: ~$28 with S&H
Dental module supplies and complete instruction manual for treating dental emergencies in the field. Module comes heat sealed in a resealable bag for easy access and storage.

Contents:
1  Mouth Mirror
1  Dental floss, 12 yd
3  Orasol Packet
1  Clove Oil (Eugenol)
1  Wax Stick
1  DenTemp (Zinc Oxide & Clove Oil)
1  Spatula
10  Cotton Pellets
3  Gauze Dressing, 3″x3″, 2’s
1  ActCel  Hemostatic Gauze, 2″x2″
5  Cotton Rolls
1  Tweezers
4  Toothpicks
8  Ibuprofen, 200 mg Tablet
2  Nitrile Gloves, Large
2  Nitrile Gloves, Medium
1  Hazardous Waste Bag
1  Instructions

E.  Pain Relief for Tooth Aches
•  Ibuprofen (Advil, Motrin)The best over-the-counter painkillers for toothache are non-steroidal anti-inflammatory drugs including ibuprofen. Ibuprofen is sold under many brand names, but the most common are Advil and Motrin. Dentists often prescribe 800mg Ibuprofen every four (4) to six (6) hours as an alternative to narcotic pain relievers.
•  Acetaminophen (Tylenol) or even aspirin are also pretty good for dental painkiller. However, dental pain often comes from inflammation and pressure on various tissues and nerves of the face. Ibuprofen can be better for dental pain because they are both pain relievers and good anti-inflammatories, vs. Tylenol-acetaminophen, which is only a pain reliever.
•  If a cavity is causing your toothache, rinse your mouth with warm water and use a toothpick to remove food from the cavity. Soak a piece of cotton with oil of cloves and pack it into the cavity, but avoid getting any oil on your tongue.
•  Tip: “If your pain is from nerve damage and you are getting the spontaneous night pain try sleeping in a sitting position. The nerve and pulp chamber doesn’t get filled with fluid and blood and usually u don’t get that throbbing pain.
•  If the pain is from a broken tooth and you have an exposed nerve, if the nerve is still relatively healthy just covering it up will cause a great amount of relief. Take a piece of sugerless chewing gum chewed up and cover the nerve and tooth, it should help alot. I have had patients try it all to cover the nerve, shove cardboard in their tooth, air plane glue trying to seal the tooth, etc. but the sugarless chewing gum is your best temporary solution.”

Tooth Sensitivity and Pain
Pain, especially to cold things, can also be caused by exposed dentine – the inner substance of the tooth, which is covered by enamel. The enamel can get quite thin, especially where the tooth meets the root (at the gumline). The root is covered by a substance called cementum, which is easily worn away. Dentine contains little tunnels (tubules) that link to the nerves on the inside of the tooth, and when dentine is exposed, these nerves are easily stimulated, resulting in pain.
•  Desensitizing agents such as Sensodyne work by blocking off the tubules, so that the nerves don’t get stimulated. Sensodyne doesn’t work that well used as a toothpaste. It works a lot better by gently massaging it into the sore spot with a finger. Do NOT rinse it off with water or mouthwash. It may take several weeks before the desired effect is reached. Sensodyne can be used indefinitely. The warning on the US packet not to use Sensodyne for more than a month is a legal requirement, designed so that people won’t put off seeing a dentist when something might be seriously wrong. There are no actual health reasons for not using Sensodyne long-term
•  QuickStix Oral Pain Swabs (topical anaesthetic): Contains 20% Benzocaine for maximum pain. Also safe to treat canker sores and sore gums. Using the swab tip, apply a small amount of medication to the affected area including the surrounding gum or oral tissue. Use up to 4 times daily or as directed by a doctor or dentist. Caution: Don’t use this product continuously. Do not use if you have a history of allergy to local anesthetics such as procaine, butacaine, benzocaine, or other “caine” anesthetics.
Please note that such products are meant to be temporary measures – so don’t expect them to last long (4-5 days if you’re VERY lucky).

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Filed under Survival Manual, __6. Medical, ___a) Dental

War, Cyber attack

(Survival Manual/1. Disaster/ War, Cyber attack)
(Further reading: Nuclear EMP and Long Term Power Outage

 A.  An All Out Cyber Attack on U.S. Grid Would Be Devastating; the Trojans, Malware & Trapdoors Already Exist
January 16th, 2011, SHTF, by Mac Slavo
Pasted from: http://www.shtfplan.com/headline-news/cyber-attack-on-us-grid-would-be-devastating-trojans-malware-trapdoors-already-exist_01162011

Computer expert, author and  technical trend forecaster James Martin says what many others, including ourselves, have warned about for quite some time. The electric and utilities power grid of the United States is completely unsecured and vulnerable to attack via the internet:

“There is quite a lot of evidence that people have been hacking into the American grid, and probably the grids of other countries to. In the American grid they’ve found quite a large number of Trojan horses and trap doors, they’ve found quite a lot of hidden malware, not coming from the States but coming from somewhere outside the States,” he said.

“If you knocked out all the power in America, it would be devastating. Normally when you get a blackout it comes back very quickly, but there have been some that don’t. If it was a deliberate attack, then the people attacking it would try to do damage that could not be repaired quickly,” he said.

“If they caused the grid to crash it would be much worse than 2008. This is known today, but what I find rather alarming is that although it is known the authorities are not really trying to stop it by making it secure.

“Certainly an outside entity could have a capability today to send many different malware messages into the grid at the same time in such a way that you could take down most of the grid, and may be all of the grid,” he said.

“The grid is full of huge transformers and pumps that are one off, which means that if you knock them out you can’t go and buy them off the shelf. If you picked out the things that could not be bought or not replicated quickly, and there a lot of those, then that would be damage that you couldn’t repair quickly.

“You have a large amount of company-to-company automation and all of that could be put out of operation. If it was put out of operation it could do immense financial damage, enormously
greater than the 2008 crash,” he told The Independent.

 Forget about financial damage – that would be the least of our worries if the power grid was attacked in any sort of meaningful way. A complete power grid failure, or one that took out large regions in unison would put a complete stop to commerce across the North American continent. Yes, there would be financial damage, but more importantly, there would be no way to re-supply our just-in-time inventory systems. That means there would be no gas, no food, and no way of getting those things delivered until the grid came back up.

As Mr. Martin points out, a coordinated attack focused on the ‘one-off’ elements of the grid would mean that once that hardware was destroyed there would be no way to replace it quickly. And that means not days or weeks, but potentially months, perhaps even years before things were back to normal.

When Hurricane Ike rampaged the Houston, TX area in 2008 it took down 95% of the metropolitan grid. This author was about 25 miles north-west of Houston at the time and can attest to the
difficulties utility workers had with restoring power. It took over 3 weeks to get power running to the outlying areas of the city – and it would have taken much longer had those repair workers not traveled from as far as Florida to assist Texas. Now, consider if a disaster that took out the grid included not
one, but several regional areas, where no workers would be able to come assist.

At the time of the Houston-area outage the first things to go were water, food and gas. Fights were literally breaking out at local gas stations. Those with home generators found them useless, as there was no fuel to keep them going. Grocery stores did not have reserve power, and those that did had it for maybe 12 hours, at which point all refrigeration came to a halt. City water filtration was non-existent, and “Boil Water” notices were posted all over the city – but there was no electricity available, so only those lucky enough to have fuel reserves for their generators or those with natural gas powered stoves were able to drink clean water. Luckily, this only affected a single major city and surrounding areas,
and within a week water and emergency rations became available.

Consider, for a moment, the ramifications of a full-out extended down-grid scenario affecting multiple regions. It would be much like an EMP attack, though some electronic systems may remain operational. Nonetheless, researchers have estimated that a worst-case EMP scenario could lead to 90% casualty rate over the course of a year. We would hope that a grid-attack could be resolved much quicker than an EMP attack, but there would likely still be mass casualties as food stocks ran low, emergency response personnel stayed home to care for their families and violent crime and looting ran rampant.

[Internet photographs:  (left) A nuclear power plant’s control room, TVA. (right) A subterranean power grid control room in Newark, NJ. Imagine the complexity of the things that make our nation what it is, maintaining regional optimized power grids, ‘just-in-time’ retail and grocery delivery/inventories, instant money-credit-financil transaction system,  self service electronic gasoline pumps, on-line brokers, cell phone communications, smart thermostats, transportation fleet controls, automated equipment and robotic workers, iPod- Ipad-microchips here- personal electronics there, conditions that a few decades ago would have almost been considered science fiction.  We live in a modern society bathed and nourished by the flow of digital information, we all depend on the stable flow of energy and the smooth flow of logical, digital language sequences as the machines talk to one another.]

How susceptible are we?
This is a topic of debate. Most of those people who have the power to harden and secure our grids will take no action until after a wide-scale event were to occur – at which point it would be much too late to do anything.

A close friend works for a large power company in the north-east. It just so happened that we had this very discussion a couple of weeks ago. He is a higher level executive at the company and when I asked how secure his company’s grid was in the event of a solar flare, cyber attack or EMP attack he responded, “Officially, we’re prepared to handle whatever comes our way. Unofficially, it will be a complete and utter disaster and we are simply not equipped to handle a mass failure.”

It is common knowledge that many elements of the U.S. power grid are decades old. We hear about smart meters being installed, but according to the friend at the power company, the smart grid portion is less than 1% of the complete grid. That means 99% of the physical grid is essentially running on equipment that has been around since the 70’s and 80’s. All of that old equipment is plugged into computer systems, and all of the computer systems are plugged into and fully accessible via the internet.

According to James Martin and other computer experts, our systems have likely already been breached and there is a real and serious possibility that Trojans, malware and trapdoors have already compromised our systems. They may very well just be sitting there waiting to be activated, at which point they could launch a massive, coordinated cyber attack on essential parts of our power grid infrastructure.

We’re not just talking about software glitches that can be fixed with a quick reboot. We’re talking about cyber attacks that target the physical hardware.

Hard to believe that a computer program can destroy hardware? Think again.

Consider the Stuxnet worm that was recently used to take down 1/5 (or more?) of Iran’s nuclear facilities. According to the New York Times, the Stuxnet worm utilized advanced programming to remain dormant for a time, and once launched, attacked the physical centrifuges used to enrich uranium. While the worm spun centrifuges to the point they destroyed themselves, a portion of the program responsible for sensors and warnings sent human operators and monitoring systems the green light that everything was running like normal. Iran’s nuclear plants,  much like the power grid of the United States, utilized old computer systems that were simply not equipped to handle advanced cyber-attacks that utilized 21st century cyber combat techniques.

There are plenty of enemies of the state who could bring down the US power grid infrastructure – China and Russia to name just a couple. And it’s no secret that the Chinese have been having their way with our networks for quite some time, so it is clearly a real and present danger. The US government regularly runs tests to Simulate Cyber Attacks on US the Internet Infrastructure.

In, 900 Seconds: Cyber Attack Wouldn’t Take Long to Bring Down the USA, [see the article, below] we previously outlined how a cyber attack might play out based on a report from Richard Clark, a one-time counter terrorist specialist with the US government.
In his warning, Mr. Clarke paints a doomsday scenario in which the problems start with the collapse of one of Pentagon’s computer networks.
Soon internet service providers are in meltdown. Reports come in of large refinery fires and explosions in Philadelphia and Houston. Chemical plants malfunction, releasing lethal clouds of chlorine.
Air traffic controllers report several mid-air collisions, while subway trains crash in New York, Washington and Los Angeles. More than 150 cities are suddenly blacked out. Tens of thousands of Americans die in an attack comparable to a nuclear bomb in its devastation.

[Internet photographs: (left) A server farm in San  Jose, CA, holding some of the  near 500bn GB data used on the internet. (right) Typical computer bank, storage, switching and automation controls for medium size business 50-150 employee. There would be many, many thousands of these in USA.]

Yet it would take no more than 15 minutes and involve not a single terrorist or soldier setting foot in the United States. The threat is real, and if it were to ever occur, it would likely come around the same time as an attack on our financial systems – which, as we saw in the May 2009 “fat finger” controversy that brought the stock market down 1000 points in a matter of minutes, is not so difficult to accomplish.

The biggest concern for the average American should be that there is really no emergency response ready to deal with the possibility of a wide-spread power grid cyber attack. The US government has specifically said, through FEMA, that they will not be able to help everyone in the event of a major emergency (think Hurricane Katrina). That means  you need take responsibility for yourself and family now, and Be Prepared to Be Without The System – Make It A Policy. What will you do if there comes a time when there is no electricity, no gas, no clean water and no access to food for several weeks or months?

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B.  900 Seconds: Cyber Attack Wouldn’t Take Long to Bring Down the USA
17 Sep 2011, James Martin (Computer expert, author and technical trend forecaster )
Pasted from: http://nieuwsanita.blogspot.com/2011/09/900-seconds-cyber-attack-wouldnt-take.html

“With our increasing dependence on the internet to transmit everything from emails and electronic payment information to air traffic control and transportation logistics, a properly targeted cyber attack could wreck havoc in the United States within minutes, says Richard Clark:
In his warning, Mr Clarke paints a doomsday scenario in which the problems start with the collapse of one of Pentagon’s computer networks.
Soon internet service providers are in meltdown.
Reports come in of large refinery fires and explosions in Philadelphia and Houston.
Chemical plants malfunction, releasing lethal clouds of chlorine.
Air traffic controllers report several mid-air collisions, while subway trains crash in New York, Washington and Los Angeles.
More than 150 cities are suddenly blacked out.
Tens of thousands of Americans die in an attack comparable to a nuclear bomb in its devastation. Yet it would take no more than 15 minutes and involve not a single terrorist or soldier setting foot in the United States.
An enemy of the United States, whether foreign or domestic, wouldn’t need a nuclear bomb. They would simply need to take down the main computer networks. Many internet operations are centralized, especially in the private sector, so taking down something like the national DNS (Domain Name System) databases would put a stop to pretty much any communications used by the general public.
An attack on Defense Department networks would be even more serious, potentially leading to a cascading effect across the entire nation. Utilities, like water systems and electricity, are highly vulnerable, as they are built on very old technologies and are very dependent on each other due to old-style distribution systems. As an example, consider the massive black out that covered the entire north east for several days in 2003 while emergency crews worked to resolve the problems.
Roughly one fifth of our country was out of power not because local power stations were taken down, but, according to the official story, because one or two main plants experienced outages due to natural causes (trees on power lines). There is still no definitive confirmation on what happened here, and for all we know this could have been a cyber attack testing our networks. It’s no secret that hackers in countries like Russia, and especially China, have spent the last decade infiltrating and testing the stability and security of US networks – including the Pentagon and our satellite systems. At the first sign of potential international conflict, the initial wave of attacks will likely occur on the digital battlefield, resulting in downed communication systems, utilities, cable systems, GPS, cell phone networks, hardline networks and transaction processing systems. Another issue, not related directly to defense computer networks, is that the plans for US water utility, electrical utility, and internet networks are readily available on the internet for anyone to download and analyze for vulnerabilities. We’ve essentially given any potential enemies a road map for how to bring down the United States without even firing a shot.”
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C.  Combined computer attacks could have ‘catastrophic’ global effects
Pasted from: http://www.newkerala.com/news/world/fullnews-125659.html

 ANI, London, Jan 17: A new study has found that coordinated computer attacks could have ‘catastrophic’ global effects.
The report by the Organization for Economic Co-operation and Development (OECD) said that multiple cyber attacks could “become a full-scale global shock” on a par with a pandemic and the collapse of the world financial system.
“What should concern policy-makers are combinations of events: two different cyber-events occurring at the same time, or a cyber-event taking place during some other form of disaster or attack,” the Scotsman quoted the report as saying.
One such example the report cited was “a very large-scale solar flare (bursts of energy from the sun), which physically destroys key communications components such as satellites, cellular base stations and switches.”
Another could involve “a hitherto unknown fundamental flaw” in the technical building blocks of the Internet “over which agreement for remedy could not be quickly reached”, it added.
According to the report’s co-author Professor Peter Sommer, of the London School of Economics, lurid language and poor analysis were blocking government planning for cyber protection.
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D.  Cyber attacks could create ‘perfect storm’
17 Jan, 2011,  Reuters, By Michael Holden
Pasted from: http://www.theglobeandmail.com/news/technology/tech-news/oecd-cyber-attacks-could-create-perfect-storm/article1872682/
LONDON – Attacks on computer systems now have the potential to cause global catastrophe, but only in combination with another disaster, the Organization for Economic Cooperation and Development (OECD) said in a report.

The study, part of a wider OECD project examining possible “Future Global Shocks””such as a failure of the world’s financial system or a large-scale pandemic, said there were very few single “cyber events” that could cause a global shock.

Examples were a successful attack on one of the technical protocols on which the Internet depends, or a large solar flare that wiped out key communications components such as satellites. But it said a combination of events such as coordinated cyber attacks, or a cyber incident occurring during another form of disaster, should be a serious concern for policy makers. “In that eventuality, ‘perfect storm’ conditions could exist,” said the report, written by Professor Peter Sommer of the London School of Economics and Dr Ian Brown of Britain’s Oxford University.

Governments are increasingly emphasizing the importance of cyber security. The United States is preparing for cyber conflict and has launched its own military cyber command. Britain last October
rated cyber attacks as one of the top external threats, promising to spend an extra 650 million pounds ($1 billion) on the issue.

Meanwhile, emerging nations such as China and Russia are believed to see it as an arena in which they can challenge the United States’ conventional military dominance.

The Stuxnet computer worm — which targets industrial systems and was widely believed to be a state attack on Iran’s nuclear program — is seen as a sign of the increasing militarization of cyberspace.
The New York Times reported on Saturday that the worm was a joint U.S.-Israeli effort and had been tested at Israel’s Dimona nuclear plant.

The OECD study concluded that cyber attacks would be ubiquitous in future wars, and that cyber weaponry would be “increasingly deployed and with increasing effect by ideological activists of all persuasions and interests”. But it concluded that a true “cyberwar”, fought almost entirely through computer systems, was unlikely as many critical systems were well protected and the effects of attacks were difficult to predict, and so could backfire on the assailants.

Adopting a largely military approach to cyber security is a mistake, as most targets in the critical national infrastructure, such as communications, energy, finance and transport, are in the private sector.

The US has already experienced two major cyber warning shots. Hackers from Russia or China or both successfully planted software in the US electricity grid that left behind software that could be used to sabotage the system at a later date.

The North Koreans may not be able to feed their people but in 2009 they succeeded in bringing down the servers of the Department of Homeland Security, the US Treasury and several other government departments, along with regular internet providers, by flooding them with requests for data. Most dramatically, it saturated the internet connections of a Pentagon server that the military would rely for
logistical communications in an armed conflict.

“There are significant and growing risks of localized misery and loss as a result of compromise of computer and telecommunications services,” the report said.

Protecting your computer and data
Five steps that every computer user should implement to prevent cyber crime attacks. These days the cyber world is becoming bigger and bigger with rapidly growing number of businesses and individuals using internet as a business place. Naturally, cyber criminals target computers with low antivirus internet security and commit their criminal activities.
However, there are guidelines that need to be followed in order to secure your computer from internet security attacks:
1.  Back-up Data – Savvy computer users are aware of the importance of keeping their data safe and away from internet security attacks and regularly perform backups. You can back up your data on an external data storage device such is CD, memory stick or external hard drive. The device you use will depend on the data size. The overall idea is that if anything happens to your primary data, you can always retrieve them from somewhere.

[Mr Larry: Consider backing up your files in one or more of the ways discussed below:
a)  Seagate Freeagent Go, 250GB or larger,  USB external hard drive. Portable storage solution makes it easy to take your photos, music, videos, ‘historic e-mail’, pdf files, other Internet downloads, and documents everywhere; now they have 1 Terrabyte models.   :-)
b)  Amazon Jungle Disk and S3 olr other “Cloud storage”. The Jungle Disk software is your computer’s interface with Amazon’s cloud drive file servers. Amazon S3 (Simple Storage Service) is basically an infinite hard drive you can buy on a pay per usage basis, and Jungle Disk is a utility that allows you to mount S3 as a hard drive on any OS. Jungle Disk has a backup tool built in. I use the S3 only for back up so have been paying about 25¢ – 30¢ a month for the service. See also,   https://www.amazon.com/clouddrive/learnmore/ref=sa_menu_acd_lrn2
c)  Kingston Data Traveler 32GB, USB flash drive. Supports Windows 7, Vista, XP & Mac. Compatible with Windows 7 Available in multiple colors by capacity.
I’ve included images of these items/services below; they should be thought of simply as examples of the many products ‘out there’ that used together will give a depth to your data bases, documents, spreadsheets, photograph, music, MP3,  video and podcast files, etc.]

Images above include (L>R): Left) Seagate Freeagent Go, external,  drive, Middle) A web cloud service, Right) Portable USB flash drive that is never left connected to the system.

2.  File sharing– Another very important thing to be avoided is sharing files with strangers. This makes your computer internet security vulnerable as the files from other computer users may contain malicious infections that without a good anti-virus internet security can potentially destroy your computer or steal sensitive information. Make sure you turn off and disable file-sharing if it is not needed.
3.  Disconnecting from the Internet– It is additional prevention so whenever you internet is not in use just simply disconnect form internet. It lessens the possibility of cyber criminals passing your internet security.
4. Update security patches– Computer programs sometimes contain bugs that can be an entrance to your computer for any malicious person to attack and potentially harm your computer. Therefore, it is very important to regularly update your security patches and increase.
5.  Maintain up to date antivirus software firewall– Good antivirus software and firewall are crucial components of your arsenal to increase internet security that will protect your computer from attacks. Make sure to keep your anti-virus program and firewall up to date.

 

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Filed under Survival Manual, __1. Disaster

Sprains

(Survival manual/6. Medical/c) General clinic/Sprains)

A.  Sprain: First aid
Mayo Clinic Health Information
<http://www.mayoclinic.com/health/first-aid-sprain/FA00016>
Your ligaments are tough, elastic-like bands that connect bone to bone and hold your joints in place. A sprain is an injury to a ligament caused by excessive stretching. The ligament can have a partial tear, or it can be completely torn apart.
Of all sprains, ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally, the greater the pain, the more severe the injury is. For most minor sprains, you probably can treat the injury yourself.

General instructions for the, P.R.I.C.E., sprain treatment
1.  Protect the injured limb from further injury by not using the joint. You can do this using anything from splints to crutches.
2.  Rest the injured limb. But don’t avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to minimize deconditioning. For example, you can use an exercise bicycle with arm exercise handles, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning.
3.  Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to ice the area as soon as possible after the injury and continue to ice it for 10 to 15 minutes four times a day for 48 hours. If you use ice, be careful not to use it too long, as this could cause tissue damage.
4.  Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
5.  Elevate the injured limb above your heart whenever possible to help prevent or limit swelling.

After two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others), may be helpful to manage pain during the healing process.
See your doctor if your sprain isn’t improving after two or three days.

Get emergency medical assistance if:
•  You’re unable to bear weight on the injured leg, the joint feels unstable or you can’t use the joint. This may mean the ligament was completely torn. On the way to the doctor, apply a cold pack.
•  You have a fever higher than 100 F (37.8 C), and the area is red and hot. You may have an infection.
•  You have a severe sprain. Inadequate or delayed treatment may cause long-term joint instability or chronic pain.

B.  Knee injury
Mayo Clinic Health Information
<http://www.mayoclinic.com/health/knee-pain/DS00555/DSECTION=prevention>
Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.
Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.

Symptoms
The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:
•   Swelling and stiffness
•  Redness and warmth to the touch
•  Weakness or instability
•  Popping or crunching noises
•  “Locking,” or inability to fully straighten the knee

When to see a doctor
•  Can’t bear weight on your knee
•  Have marked knee swelling
•  Are unable to fully extend or flex your knee
•  See an obvious deformity in your leg or knee
•  Have a fever, in addition to redness, pain and swelling in your knee
•  Fall because your knee “gives out”

Causes
Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.
Injuries
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:
•  ACL injury. An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball or go downhill skiing, because it’s linked to sudden changes in direction.
•  Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
•  Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
•  Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous cords that attach muscles to bones. Runners, skiers and cyclists are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.

Mechanical problems
•  Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee-joint movement — the effect is something like a pencil caught in a door hinge.
•  Knee ‘locking.’ This can occur from a cartilage tear. When a portion of cartilage from the tear flips inside the knee-joint, you may not be able to fully straighten your knee.
•  Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out-of-place, usually to the outside of your knee. You’ll be able to see the dislocation, and your kneecap is likely to move excessively from side to side.
•  Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can interfere with the alignment of your kneecap and place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Types of arthritis
•  Osteoarthritis: Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
•  Rheumatoid arthritis: The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
•  Gout: This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
•  Pseudogout: Often mistaken for gout, pseudogout is caused by calcium pyrophosphate crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.
•  Septic arthritis: Sometimes your knee joint can become infected, leading to swelling, pain and redness. There’s usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.

Other problems
•  Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome.
•  Chondromalacia patellae (patellofemoral pain syndrome). This is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It’s common in young adults, especially those who have a slight misalignment of the kneecap; in athletes; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.
•  Osteochondritis dissecans. Caused by reduced blood flow to the end of a bone, osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone. It occurs most often in young men, particularly after an injury to the knee.

Risk factors
A number of factors can increase your risk of having knee problems, including:
•  Age: Certain types of knee problems are more common in young people — Osgood-Schlatter disease and patellar tendonitis, for example. Others, such as osteoarthritis, gout and pseudogout, tend to affect older adults.
•  Sex: Teenage girls are more likely than are boys to experience an ACL tear or a dislocated kneecap. Boys, on the other hand, are at greater risk of Osgood-Schlatter disease and patellar tendonitis than girls are.
•  Excess weight: Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
•  Mechanical problems: Certain structural abnormalities, such as having one leg shorter than the other, misaligned knees and even flat feet, can make you more prone to knee problems.
•  Lack of muscle flexibility or strength: A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don’t absorb enough of the stress exerted on the joint.
•  Certain sports: Some sports put greater stress on your knees than do others: Alpine skiing with its sharp twists and turns and potential for falls, basketball’s jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.
•  Previous injury: Having a previous knee injury makes it more likely that you’ll injure your knee again.

Complications
Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and even disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you’ll have similar injuries in the future.

Treatments and drugs
Treatments will vary, depending upon what exactly is causing your knee pain.
Medications. Your doctor may prescribe medications to help relieve pain and to treat underlying conditions, such as rheumatoid arthritis or gout.
__1.  Therapy
•  Physical therapy. Strengthening the muscles around your knee will make it more stable. Training is likely to focus on the muscles on the front of your thigh (quadriceps) and the muscles in the back of your thigh (hamstrings). Exercises to improve your balance are also important.
•  Orthotics and bracing. Arch supports, sometimes with wedges on the inner or outer aspect of the heel, can help to shift pressure away from the side of the knee most affected by osteoarthritis. Different types of braces may help protect and support the knee joint.
__2.  Injections
•  Corticosteroids. Injections of a corticosteroid drug into your knee-joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. The injections aren’t effective in all cases. There is a small risk of infection.
•  Hyaluronic acid. This thick fluid is normally found in healthy joints, and injecting it into damaged ones may ease pain and provide lubrication. Experts aren’t quite sure how hyaluronic acid works, but it may reduce inflammation. Relief from a series of shots may last as long as six months to a year.
__3.  Surgery
If you have an injury that may require surgery, it’s usually not necessary to have the operation immediately. Before making any decision, consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction in relation to what’s most important to you. If you choose to have surgery, your options may include:
• Arthroscopic surgery. Depending on the nature of your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, repair torn or damaged cartilage and reconstruct torn ligaments.
• Partial knee replacement surgery. In this procedure (unicompartmental arthroplasty), your surgeon replaces only the most damaged portion of your knee with parts made of metal and plastic. The surgery can usually be performed with a small incision, and your hospital stay is typically just one night. You’re also likely to heal more quickly than you are with surgery to replace your entire knee.
• Total knee replacement. In this procedure, your surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Lifestyle and home remedies
Over-the-counter medications — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — may help ease knee pain. Some people find relief by rubbing their knees with creams containing such ingredients as lidocaine, a numbing agent; or capsaicin — the substance that makes chili peppers hot.

Self-care measures for an injured knee include: (Think, ‘R.I.C.E’.)
•  Rest: Taking a break from your normal activities reduces repetitive strain on your knee, gives the injury time to heal and helps prevent further damage. A day or two of rest may be all that’s needed for minor injuries. More severe damage is likely to need a longer recovery time.
•  Ice: A staple for most acute injuries, ice reduces both pain and inflammation. A bag of frozen peas works well because it covers your whole knee. You can also use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don’t use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin.
•  Compression: This helps prevent fluid buildup in damaged tissues and maintains knee alignment and stability. Look for a compression bandage that’s lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation.
•  Elevation: Because gravity drains away fluids that might otherwise accumulate after an injury, elevating your knee can help reduce swelling. Try propping your injured leg on pillows or sitting in a recliner.

Prevention
Although it’s not always possible to prevent knee pain, the following suggestions may help forestall injuries and joint deterioration:
•  Keep extra pounds off: Maintaining a healthy weight is one of the best things you can do for your knees — every extra pound puts additional strain on your joints, increasing the risk of ligament and tendon injuries and even osteoarthritis.
•  Get strong, stay limber: Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees. Balance and stability training helps the muscles around your knees work together more effectively. And because tight muscles also can lead to injury, stretching is important. Try to include flexibility exercises in your workouts.
•  Be smart about exercise: If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.

C.  Sprained ankle
Mayo Clinic Health Information
<http://www.mayoclinic.com/health/sprained-ankle/DS01014/DSECTION=prevention>
A sprained ankle is a common injury. Sometimes, all it takes to sprain your ankle is a roll, twist or turn of your ankle in an awkward way. This unnatural movement can stretch or tear the ligaments that help hold your ankle together.
Ligaments are tough, elastic bands of fibrous tissue that connect one bone to another. They help stabilize joints, preventing excessive movement. A sprained ankle occurs when the ligaments are forced beyond their normal range of motion.
Treatment for a sprained ankle depends on the severity of the injury. Although self-care measures and over-the-counter pain medications may be all you need, a medical evaluation might be necessary to reveal how badly you’ve sprained your ankle and to put you on the right path to recovery.

Symptoms
Signs and symptoms of a sprained ankle include:
•  Pain, especially when you bear weight on it
•  Swelling and, sometimes, bruising
•  Restricted range of motion
Some people hear or feel a “pop” at the time of injury.

When to see a doctor
Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Self-care measures may be all you need, but talk to your doctor to discuss whether you should have your ankle evaluated. If your signs and symptoms are severe, it’s possible you may have broken a bone in your ankle or lower leg.

Causes
A sprain occurs when your ankle is forced to move out of its normal position, which forces one or more of the ligaments that surround and stabilize the bones out of its usual range of motion, causing the ligament to stretch or tear.
Examples of situations that can result in an ankle sprain include:
•  A fall that causes your ankle to twist
•  Landing awkwardly on your foot after jumping or pivoting
•  Walking or exercising on an uneven surface

Risk factors
Factors that increase your risk of a sprained ankle include:
•  Sports participation. Ankle sprains are a common sports injury. Sports that require rolling or twisting your foot, such as basketball, tennis, football, soccer and trail running, can make you vulnerable to spraining your ankle, particularly if you’re overweight. Playing sports on an uneven surface also can increase your risk.
•  Prior ankle injury. Once you’ve sprained your ankle, or had another type of ankle injury, you’re more likely to sprain it again.

Complications
If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:
•  Chronic pain
•  Chronic joint instability
•  Early onset arthritis in that joint

Tests and diagnosis
If the injury is severe, your doctor may recommend imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage.
__1.  X-ray
During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for bones but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
__2.  Bone scan
For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
__3.  Computerized tomography (CT)
CT scans are useful because they can reveal more detail about the joint and the soft tissues that surround it. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
__4.  Magnetic resonance imaging (MRI)
MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.

Treatments and drugs
Treatment for a sprained ankle depends on the severity of your injury. Many people simply treat their injury at home.
__1.  Medications
In most cases, over-the-counter pain relievers — such as ibuprofen (Advil, Motrin, others), naproxen (Aleve, others) or acetaminophen (Tylenol, others) — are enough to handle the pain caused by a sprained ankle.
__2.  Therapy
A few days after your injury, after the swelling has gone down, you may want to start performing physical therapy exercises to restore your ankle’s range of motion, strength, flexibility and balance.
Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint. These exercises may involve various degrees of balance challenge, such as standing on one leg.
If you sprained your ankle while exercising or participating in a sport, talk to your doctor about when you can begin your activity again. You may need to wear an ankle brace or wrap your ankle to protect it from re-injury.
__3.  Surgical and other procedures
If your ankle joint is unstable, your doctor may refer you to a joint specialist for evaluation. You may need a cast or walking boot to immobilize your joint so that it can heal properly. In rare cases of severe ligament tears, or if you are an elite athlete, you may need surgery to repair the damage.

Lifestyle and home remedies
For immediate self-care of an ankle sprain, try the P.R.I.C.E. approach, see top of article.

Prevention
Take the following steps to help prevent a sprained ankle:
•  Warm up before you exercise or play sports.
•  Be careful when walking, running or working on an uneven surface.
•  Wear shoes that fit well and are made for your activity.
•  Don’t wear high-heeled shoes.
•  Don’t play sports or participate in activities for which you are not conditioned.
•  Maintain good muscle strength and flexibility.
•  Practice stability training, including balance exercises.
A physical therapist will often recommend use of an ankle brace for a year after a pretty strenuous injury. Sometimes, it’s necessary to wear it always. I’m in the latter category. I can’t run without it. And if I didn’t have it, I’d not be running any more. To order by shoe size see the chart below. I wear a 9.5

See discussion, various ankle braces and video at  SportsMedInfo:
<http://sportsmedinfo.net/ankle-brace-reviews/47-aso-ankle-brace-lace-up>

Ω Category: (Survival Manual/6. Medical/c) General Clinic/ Sprains)

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