Some deployments we get extremely lucky. Our only medic work will come from
minor sprains and strains from our team guys, pushing themselves in the gym or minor cuts
from building something on the camp. With treatment of some physio bands, some
dermabond, or some straws so they can suck it up. They will be back to full health in no time.
I would like to say that medics are never the ones that get hurt. Unfortunately, this tale involves myself; a SOF medic for the past 9 years. I wish the injury or cause of me seeking medical attention was for something good and juicy like rucking a 50- Cal on a mission. Nope, DENTAL!!!!!! I was enjoying a delicious taffy and as I switched from chewing on the left side of my mouth to the right, I felt it. An extremely hard center of this taffy. I had a crown on a root canal from a year and a half ago that has given me no issues. I have chewed everything from gum to steak with zero issues. Then, this piece of taffy made me swallow a piece of humble pie for the next couple of days. I immediately spat out the taffy and there was my crown. I pulled the taffy off from around it, threw the taffy back in my mouth
(especially after I felt like the taffy knew what it was doing and knew my extent of dental
knowledge) and inspected the crown. It looked intact, no cracks or pieces missing. I did the
tongue tactile inspection on the nub that was my tooth. No rough spots or pieces of the crown stuck in-between my tooth and gum. I figured this isn’t so bad.
I checked my supply. No dental kit! No big deal, I know from my PDSS and doing my job, I
know the Role II has a dentist. This is going to be easy, fly or drive down there hand the dentist my crown, lay down and I will be throwing in a dip 15 min later. The other medic on the team and I informed the leadership and we had a plan. Then murphy came a knocking. The country’s political game came in to play and nobody was allowed to leave their team sites at all. No flights and definitely no driving anywhere. Again, I thought, no big deal. A couple of days and this will clear up and we will have freedom of movement and bob’s your uncle- my crown is back on my tooth.
Sure enough two days pass and I have a flight to go down to the Role II and get seen.
Made the coordinating phone calls, let the leadership know and I was in business. I get to the helo pad and I can hear the helicopters approach. I throw on my helmet and start moving behind the nearest hesco barrier I can get behind to block me from the rotor wash. Then all of a sudden here comes my JTAC. Board shorts and flip flops jogging towards me telling me don’t get on the bird. Guidance has just been put out again that nobody is allowed to fly or drive again because of (insert stupid reason number 42). I take everything back, download my gear and hear the helicopter land and then take off. That’s when the first thought of “Ok, this might be bad”. I head back up to my little clinic to tell the other medic what has occurred and we need to start looking for solutions. The next day the two of us had a tele consult to a dentist to get a full scope of what all could go wrong and to get a better picture of everything. I was lucky that the tooth was covered and no root was exposed to the nerve or had no direct route for infection. It was the number 14 tooth and it having almost direct access to the maxillary sinus superior to it had my heart racing a little on all the complications that I have dodged up to this point. And let’s not forget that I dip more than the average person.
The main concern that came from the tele consult was the shifting of teeth and the
original crown wouldn’t fit. I reached out to a Physician Assistant in the area that had their
dentist doing a battle field rotation soon to see what they could do. The timelines wouldn’t
match up to get me over to them to get the crown put back on but the dentist recommended that I could put Vaseline on the crown to keep it in place till I could get to a dentist to keep the spacing correct in between my teeth. We didn’t have any nor did anybody else. But during our reaching out to adjacent units one of them did have a small dental kit. Bingo, my tooth was saved! I ran over there and picked it up and we went straight to our clinic and read the instructions (because nobody remembers dental from SOCM or gets refreshed).
Step 1. Place crown on tooth to see which way it goes. Check.
Step 2. Clean crown and tooth. Check.
Step 3. Put small amount of this extremely hard to
handle and sticky dentin on inside of crown. Check-ish.
Step 4. Place crown on tooth and bite down to set tooth. Hold in place for 5 min.
Check- oh it doesn’t fit; I will just bite down harder to seat it past the sticking point. If at first you don’t succeed...add more force. A motto we have all used a time or two. CRACK!!!!! I broke the crown. I pull the two pieces off my tooth. Inspect them and think “Awesome, this is how I am going to get sent home”.
I made the necessary phone calls to my leadership and informed them of the updated
situation. The waiting game began to see if the dentist has the ability to make new temporary crowns. After several text messages and a few inpatient hours my medical leadership was informed that the dentist did not have the ability to make new crowns but since being in country the dentist has had to “wing it” a few times and they will see what they can do.
After a few more days of only chewing on one side of my mouth and being constantly
hungry, the travel ban was lifted and I finally made my way to the dentist. I flew and arrived at the dentist office first thing in the morning. The baby-faced dentists says “I can make you an extremely temporary cap out of epoxy in which I have only done one other time in my career (I questioned how long his career could have been) but we will wing it and see what happens”. I thought to myself what other option do I have. Let them have a go and see what happens or say no thank you and risk one of the many complications that can occur. I thought “screw it” and away we went. He cleaned my tooth and applied the epoxy all around my tooth. Pulled off this blob of epoxy and immediately started drilling away at it. Put’s it back on, takes a look at it and then pops it back off and repeats this process for about an hour. At the end of it all they made me a tooth from scratch. Cemented the temporary cap in place, used the little black paper for me to “bite, bite, bite” took his drill to it a couple of more times and I was done. I caught a flight out of there that night and was back to my team ready for the next mission within 16 hours.
Through this experience I learned several factors to consider throughout this very minuet
and humbling experience.
Understanding what dentists can do. I had no idea (nor did any other doctor in the area
that I talked to about this) that they could build a cap from scratch like that. Most caps
and crowns that come off usually get swallowed so there is no just putting it back on.
So, having a sit down with a dentist/medical provider and discussing the left and
lateral limits of their abilities to do everything they can with what they have. And with
that, the ability to translate that information when talking to commanders about
treatment possibilities.
I learned that replacing that crown was a bigger deal than just the possibility of
infection. Teeth shifting around and a patient’s bite being altered by that. I was so tired
of eating on one side of my mouth I actually just stopped eating mid meal because my
mouth was worn out so I was constantly hungry. I was supplementing with protein
shakes throughout the day to make sure my nutritional needs were met. Thinking of
what I had on hand and having to still be able to perform on missions, I needed to make
sure my body would not fail me due to lack of nutrition.
Conveying to team and company leadership the importance of a medical
problem/solutions, even if it as minor as a crown coming off.
Being refreshed with all your skills. We all have gone through refresher and some of us
might have even been lucky enough to do a hospital rotation that our units have set up
for us. But one thing I have never heard about is a medic saying we need more dental
training or that dental rotation was awesome and learned a lot.
Deploying with your capabilities. Many of us have gone down range with an
overabundance of supplies that we will never use and not deploying with all of our
supplies to perform our most basic capabilities. It is our job to make sure we have what
we need to take care of our team and ourselves and in this matter, I failed myself on
two fronts.
Teleconference was key. Calling a dentist on Facetime and being able to convey what
happened and have them give a no BS answer of what needs to happen because of
X,Y,Z. Having that knowledge and those answers so when again, conveying that to
leadership your answers are coming from a place of medical subject matter experts. Not
just what you interpreted from the publication.
So, the long and short of it all. Be on top of your stuff, there will be a day when you are
the one having to treat yourself and find answers so you can get back to your team and take care of them. My hope with writing this is that somebody can learn from my most simple mistakes and just do that last minute sanity check and be that much more successful.
- An SOIDC
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