First aid guide (part 3)

36. Insect bites and stings: First aid

Signs and symptoms of an insect bite result from the injection of venom or other substances into your skin. The venom causes pain and sometimes triggers an allergic reaction. The severity of the reaction depends on your sensitivity to the insect venom or substance and whether you've been stung or bitten more than once.

Most reactions to insect bites are mild, causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. A delayed reaction may cause fever, hives, painful joints and swollen glands. You might experience both the immediate and the delayed reactions from the same insect bite or sting. Only a small percentage of people develop severe reactions (anaphylaxis) to insect venom. Signs and symptoms of a severe reaction include:

• Nausea
• Facial swelling
• Difficulty breathing
• Abdominal pain
• Deterioration of blood pressure and circulation (shock)

Bites from bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome. Bites from mosquitoes, ticks, biting flies, ants, scorpions and some spiders also can cause reactions. Scorpion and ant bites can be very severe. Although rare, some insects also carry disease such as West Nile virus or Lyme disease.

For mild reactions

• Move to a safe area to avoid more stings.
• Remove the stinger, especially if it's stuck in your skin. This will prevent the release of more venom. Wash the area with soap and water.
• Apply a cold pack or cloth filled with ice to reduce pain and swelling.
• Try a pain reliever, such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others), to ease pain from bites or stings.
• Apply a topical cream to ease pain and provide itch relief. Creams containing ingredients such as hydrocortisone, lidocaine or pramoxine may help control pain. Other creams, such as calamine lotion or those containing colloidal oatmeal or baking soda, can help soothe itchy skin.
• Take an antihistamine containing diphenhydramine (Benadryl, others) or chlorpheniramine maleate (Chlor-Trimeton, others).

Allergic reactions may include mild nausea and intestinal cramps, diarrhea, or swelling larger than 4 inches (about 10 centimeters) in diameter at the site, bigger than the size of a baseball. See your doctor promptly if you experience any of these signs and symptoms.

For severe reactions
Severe reactions affect more than just the site of the insect bite and may progress rapidly. Call 911 or emergency medical assistance if the following signs or symptoms occur:

• Difficulty breathing
• Swelling of the lips or throat
• Faintness
• Dizziness
• Confusion
• Rapid heartbeat
• Hives
• Nausea, cramps and vomiting

Take these actions immediately while waiting with an affected person for medical help:

1. Check for medications that the person might be carrying to treat an allergic attack, such as an autoinjector of epinephrine (EpiPen, Twinject). Administer the drug as directed — usually by pressing the autoinjector against the person's thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption.
2. Loosen tight clothing and cover the person with a blanket. Don't give anything to drink.
3. Turn the person on his or her side to prevent choking if there's vomiting or bleeding from the mouth.
4. Begin CPR if there are no signs of circulation, such as breathing, coughing or movement.

If your doctor has prescribed an autoinjector of epinephrine, read the instructions before a problem develops and also have your household members read them.

37. Motion sickness: First aid

Any type of transportation can cause motion sickness. It can strike suddenly, progressing from a feeling of uneasiness to a cold sweat, dizziness and then vomiting. Motion sickness usually quiets down as soon as the motion stops. The more you travel, the more easily you'll adjust to being in motion.

You may escape motion sickness by planning ahead. If you're traveling, reserve seats where motion is felt least:

• By ship, request a cabin in the front or middle of the ship near the water level.
• By plane, ask for a seat over the front edge of a wing. Once aboard, direct the air vent flow to your face.
• By train, take a seat near the front and next to a window. Face forward.
• By automobile, drive or sit in the front passenger's seat.

If you're susceptible to motion sickness:

• Focus on the horizon or on a distant, stationary object. Don't read.
• Keep your head still, while resting against a seat back.
• Don't smoke or sit near smokers.
• Avoid spicy and greasy foods and alcohol. Don't overeat.
• Take an over-the-counter antihistamine, such as meclizine (Antivert), or one containing dimenhydrinate (Dramamine), at least 30 to 60 minutes before you travel. Expect drowsiness as a side effect.
• Consider scopolamine (Transderm Scop), available in a prescription adhesive patch. Several hours before you plan to travel, apply the patch behind your ear for 72-hour protection. Talk to your doctor before using the medication if you have health problems such as asthma, glaucoma or urine retention.
• Eat dry crackers or drink a carbonated beverage to help settle your stomach if you become ill.

38. Nosebleeds: First aid

Nosebleeds are common. Most often they are a nuisance and not a true medical problem. But they can be both.

To take care of a nosebleed

• Sit upright and lean forward. By remaining upright, you reduce blood pressure in the veins of your nose. This discourages further bleeding. Sitting forward will help you avoid swallowing blood, which can irritate your stomach.
• Pinch your nose. Use your thumb and index finger to pinch your nostrils shut. Breathe through your mouth. Continue to pinch for five to 10 minutes. Pinching sends pressure to the bleeding point on the nasal septum and often stops the flow of blood.
• To prevent re-bleeding, don't pick or blow your nose and don't bend down for several hours after the bleeding episode. During this time remember to keep your head higher than the level of your heart.
• If re-bleeding occurs, blow out forcefully to clear your nose of blood clots and spray both sides of your nose with a decongestant nasal spray containing oxymetazoline (Afrin, Mucinex Moisture Smart, others). Pinch your nose again as described above and call your doctor.

Seek medical care immediately if

• The bleeding lasts for more than 20 minutes
• The nosebleed follows an accident, a fall or an injury to your head, including a punch in the face that may have broken your nose

Contact your doctor if

• You experience frequent nosebleeds. You may need a blood vessel cauterized. Cautery is a technique in which the blood vessel is burned with electric current, silver nitrate or a laser. Your doctor may pack your nose with special gauze or an inflatable latex balloon to put pressure on the blood vessel and stop the bleeding.
• You're experiencing nasal bleeding and are taking blood thinners, such as aspirin or warfarin (Coumadin). Your doctor may advise adjusting your medication dosage.

Using supplemental oxygen administered with a nasal tube (cannula) may increase your risk of nosebleeds. Apply a water-based lubricant to your nostrils and increase the humidity in your home to help relieve nasal bleeding.

39. Poisoning: First aid

Many conditions mimic the signs and symptoms of poisoning, including seizures, alcohol intoxication, stroke and insulin reaction. So look for the signs and symptoms listed below and if you suspect poisoning, call your regional poison control center or, in the United States, the National Poison Control Center at 800-222-1222 before giving anything to the affected person.

Signs and symptoms of poisoning:

• Burns or redness around the mouth and lips, from drinking certain poisons
• Breath that smells like chemicals, such as gasoline or paint thinner
• Burns, stains and odors on the person, on his or her clothing, or on the furniture, floor, rugs or other objects in the surrounding area
• Empty medication bottles or scattered pills
• Vomiting, difficulty breathing, sleepiness, confusion or other unexpected signs

When to call for help:

Call 911 or your local emergency number immediately if the person is:

• Drowsy or unconscious
• Having difficulty breathing or has stopped breathing
• Uncontrollably restless or agitated
• Having seizures

If the person seems stable and has no symptoms, but you suspect poisoning, call your regional poison control center or, in the United States, the National Poison Control Center at 800-222-1222. Provide information about the person's symptoms, the person's age and weight, and any information you have about the poison, such as amount and how long since the person was exposed to it. It helps to have the pill bottle or poison container on hand when you call.

What to do while waiting for help:

• If the person has been exposed to poisonous fumes, such as carbon monoxide, get him or her into fresh air immediately.
• If the person swallowed the poison, remove anything remaining in the mouth.
• If the suspected poison is a household cleaner or other chemical, read the label and follow instructions for accidental poisoning. If the product is toxic, the label will likely advise you to call the poison control center at 800-222-1222. Also call this 800 number if you can't identify the poison, if it's medication or if there are no instructions.
• Follow treatment directions that are given by the poison control center.
• If the poison spilled on the person's clothing, skin or eyes, remove the clothing. Flush the skin or eyes with cool or lukewarm water, such as by using a shower for 20 minutes or until help arrives.
• Make sure the person is breathing. If not, start rescue breathing and CPR.
• Take the poison container (or any pill bottles) with you to the hospital.

What NOT to do

Don't give ipecac syrup or do anything to induce vomiting. The American Academy of Pediatrics advises discarding ipecac in the home, saying there's no good evidence of effectiveness and that it can do more harm than good.

40. Puncture wounds: First aid

A puncture wound doesn't usually cause excessive bleeding. Often the wound seems to close almost instantly. But this doesn't mean treatment isn't necessary.

A puncture wound — such as from stepping on a nail — can be dangerous because of the risk of infection. Wounds resulting from human or animal bites may be especially prone to infection. If the bite was deep enough to draw blood and bleeding persists, seek medical attention.

Otherwise, follow these steps:

1. Stop the bleeding. Apply gentle pressure with a clean cloth or bandage. If bleeding persists after several minutes of pressure, seek emergency assistance.
2. Clean the wound. Rinse the wound with clear water. Use tweezers cleaned with alcohol to remove small, superficial particles. If debris remains embedded, see your doctor. Clean the area around the wound with soap and a clean cloth.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment.
4. Cover the wound. Bandages can help keep the wound clean and keep harmful bacteria out.
5. Change the bandage regularly. Do so at least daily or whenever it becomes wet or dirty.
6. Watch for signs of infection. See your doctor if the wound doesn't heal or if you notice any redness, drainage, warmth or swelling.

See your doctor if the puncture wound

• Is deep
• Is in your foot
• Has been contaminated with soil or saliva
• Is the result of an animal or human bite

If you haven't had a tetanus shot within five years, your doctor may recommend a booster within 48 hours of the injury.

If an animal — especially a stray dog or a wild animal — inflicted the wound, you may have been exposed to rabies. Your doctor may give you antibiotics and suggest starting a rabies vaccination series.

41. Severe bleeding: First aid

If possible, before you try to stop severe bleeding, wash your hands to avoid infection and put on gloves. If the wound is abdominal and organs have been displaced, don't try to push them back into place — cover the wound with a dressing.

For other cases of severe bleeding:

1. Have the injured person lie down and cover the person to prevent loss of body heat. If possible, position the person's head slightly lower than the trunk or elevate the legs and elevate the site of bleeding.
2. While wearing gloves, remove any obvious dirt or debris from the wound. Don't remove any large or more deeply embedded objects. Your principal concern is to stop the bleeding.
3. Apply pressure directly on the wound until the bleeding stops. Use a sterile bandage or clean cloth and hold continuous pressure for at least 20 minutes without looking to see if the bleeding has stopped. Maintain pressure by binding the wound tightly with a bandage or clean cloth and adhesive tape. Use your hands if nothing else is available. If possible, wear rubber or latex gloves or use a clean plastic bag for protection.
4. Don't remove the gauze or bandage. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, don't remove it. Instead, add more absorbent material on top of it.
5. Squeeze a main artery if necessary. If the bleeding doesn't stop with direct pressure, apply pressure to the artery delivering blood to the area. Pressure points of the arm are on the inside of the arm just above the elbow and just below the armpit. Pressure points of the leg are just behind the knee and in the groin. Squeeze the main artery in these areas against the bone. Keep your fingers flat. With your other hand, continue to exert pressure on the wound itself.
6. Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.

If you suspect internal bleeding, call 911 or your local emergency number. Signs of internal bleeding may include:

• Bleeding from body cavities
• Vomiting or coughing up blood
• Bruising on neck, chest, abdomen or side
• Wounds that have penetrated the skull, chest or abdomen
• Abdominal tenderness, possibly accompanied by rigidity or spasm of abdominal muscles
• Fractures
• Shock, indicated by weakness, anxiety, thirst or skin that's cool to the touch

42. Shock: First aid

Shock may result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes. When a person is in shock, his or her organs aren't getting enough blood or oxygen, which if untreated, can lead to permanent organ damage or death.

Various signs and symptoms appear in a person experiencing shock:

• The skin is cool and clammy. It may appear pale or gray.
• The pulse is weak and rapid. Breathing may be slow and shallow, or hyperventilation (rapid or deep breathing) may occur. Blood pressure is below normal.
• The person may be nauseated. He or she may vomit.
• The eyes lack luster and may seem to stare. Sometimes the pupils are dilated.
• The person may be conscious or unconscious. If conscious, the person may feel faint or be very weak or confused. Shock sometimes causes a person to become overly excited and anxious.

If you suspect shock, even if the person seems normal after an injury:

• Call 911 or your local emergency number.
• Have the person lie down on his or her back with feet about a foot higher than the head. If raising the legs will cause pain or further injury, keep him or her flat. Keep the person still.
• Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR.
• Keep the person warm and comfortable. Loosen belt and tight clothing and cover the person with a blanket. Even if the person complains of thirst, give nothing by mouth.
• Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth.
• Seek treatment for injuries, such as bleeding or broken bones.

43. Snakebites: First aid

Most North American snakes aren't poisonous. Some exceptions include the rattlesnake, coral snake, water moccasin and copperhead. Their bite can be life-threatening.

Of the poisonous snakes found in North America, all but the coral snake have slit-like eyes. Their heads are triangular, with a depression, or pit, midway between the eyes and nostrils.

Other characteristics are unique to certain poisonous snakes:

• Rattlesnakes rattle by shaking the rings at the end of their tails.
• Water moccasins' mouths have a white, cottony lining.
• Coral snakes have red, yellow and black rings along the length of their bodies.

To reduce your risk of snakebite, avoid touching any snake. Instead, back away slowly. Most snakes avoid people if possible and bite only when threatened or surprised.

If a snake bites you:

• Remain calm
• Immobilize the bitten arm or leg and stay as quiet as possible to keep the poison from spreading through your body
• Remove jewelry before you start to swell
• Position yourself, if possible, so that the bite is at or below the level of your heart
• Cleanse the wound, but don't flush it with water, and cover it with a clean, dry dressing
• Apply a splint to reduce movement of the affected area, but keep it loose enough so as not to restrict blood flow
• Don't use a tourniquet or apply ice
• Don't cut the wound or attempt to remove the venom
• Don't drink caffeine or alcohol
• Don't try to capture the snake, but try to remember its color and shape so you can describe it, which will help in your treatment

Call 911 or seek immediate medical attention, especially if the area changes color, begins to swell or is painful.

44. Spider bites: First aid

Only a few spiders are dangerous to humans. Two that are present in the contiguous United States, and more common in the Southern states, are the black widow spider and the brown recluse spider. Both prefer warm climates and dark, dry places where flies are plentiful. They often live in dry, littered, undisturbed areas, such as closets, woodpiles and under sinks.

Most presumed spider bites are actually bites from other bugs. If you suspect you have been bitten by one of these spiders, check to see if the spider lives in your area.

Black widow spider

Black widow spider

Although serious, a black widow bite is rarely lethal. You can identify this spider by the red hourglass marking on its belly. The bite feels like a pinprick. You may not even know you've been bitten. At first you may notice slight swelling and faint red marks. Within a few hours, though, intense pain and stiffness begin. Other signs and symptoms include:

• Chills
• Fever
• Nausea and vomiting
• Severe abdominal pain

Brown recluse spider

Brown recluse spider

You can identify this spider by the violin-shaped marking on its back. The bite produces a mild stinging, followed by local redness and intense pain within eight hours. A fluid-filled blister forms at the site and then sloughs off to leave a deep, enlarging ulcer. Reactions from a brown recluse spider bite vary from a mild fever and rash to nausea and listlessness. On rare occasions death results, more often in children.

If bitten by a spider

Try and identify the type of spider that bit you. Clean the site of the spider bite well with soap and water. Apply a cool compress over the spider bite location. If the bite is on an extremity, elevate it. Aspirin or acetaminophen (Tylenol, others) and antihistamines may be used to relieve minor signs and symptoms in adults. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

If bitten by a brown recluse or black widow spider

1. Cleanse the wound. Use soap and water to clean the wound and skin around the spider bite.
2. Slow the venom's spread. If the spider bite is on an arm or a leg, tie a snug bandage above the bite and elevate the limb to help slow or halt the venom's spread. Ensure that the bandage is not so tight that it cuts off circulation in your arm or leg.
3. Use a cold cloth at the spider bite location. Apply a cloth dampened with cold water or filled with ice.
4. Seek immediate medical attention. Treatment for the bite of a black widow may require an anti-venom medication. Doctors may treat a brown recluse spider bite with various medications.

45. Spinal injury: First aid

If you suspect a back or neck (spinal) injury, do not move the affected person. Permanent paralysis and other serious complications can result. Assume a person has a spinal injury if:

• There's evidence of a head injury with an ongoing change in the person's level of consciousness
• The person complains of severe pain in his or her neck or back
• The person won't move his or her neck
• An injury has exerted substantial force on the back or head
• The person complains of weakness, numbness or paralysis or lacks control of his or her limbs, bladder or bowels
• The neck or back is twisted or positioned oddly

If you suspect someone has a spinal injury:

• Call 911 or emergency medical help.
• Keep the person still. Place heavy towels on both sides of the neck or hold the head and neck to prevent movement.
• Provide as much first aid as possible without moving the person's head or neck. If the person shows no signs of circulation (breathing, coughing or movement), begin CPR, but do not tilt the head back to open the airway. Use your fingers to gently grasp the jaw and lift it forward. If the person has no pulse, begin chest compressions.
• If the person is wearing a helmet, don't remove it.
• If you absolutely must roll the person because he or she is vomiting, choking on blood or in danger of further injury, you need at least one other person. With one of you at the head and another along the side of the injured person, work together to keep the person's head, neck and back aligned while rolling the person onto one side.

46. Sprain: First aid

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 tearing of the fibers of the ligament. 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 and swelling, the more severe the injury is. For most minor sprains, you probably can treat the injury yourself.

Follow the instructions for R.I.C.E.

1. Rest the injured limb. Your doctor may recommend not putting any weight on the injured area for 48 hours. 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.
2. 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 15 to 20 minutes, four to eight times a day, for the first 48 hours or until swelling improves. If you use ice, be careful not to use it too long, as this could cause tissue damage.
3. Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
4. 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 numb, 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 develop redness or red streaks that spread out from the injured area. This means you may have an infection.
• You have re-injured an area that has been injured a number of times in the past.
• You have a severe sprain. Inadequate or delayed treatment may contribute to long-term joint instability or chronic pain.

47. Stroke: First aid

A stroke occurs when there's bleeding into your brain or when normal blood flow to your brain is blocked. Within minutes of being deprived of essential nutrients, brain cells start dying — a process that may continue over the next several hours.

Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is given, the more likely it is that damage can be minimized. Every moment counts.

In the event of a possible stroke, use FAST to help remember warning signs.

• Face. Does the face droop on one side trying to smile?
• Arms. Is one arm lower when trying to raise both arms?
• Speech. Can a simple sentence be repeated? Is speech slurred or strange?
• Time. During a stroke every minute counts. If you observe any of these signs, call 911 or your local emergency number immediately

Other signs and symptoms of a stroke include:

• Weakness or numbness on one side of your body including either leg
• Dimness, blurring or loss of vision, particularly in one eye
• Severe headache — a bolt out of the blue — with no apparent cause
• Unexplained dizziness, unsteadiness or a sudden fall, especially if accompanied by any of the other signs or symptoms

Risk factors for stroke include having high blood pressure, having had a previous stroke, smoking, having diabetes and having heart disease. Your risk of stroke increases as you age.

48. Sunburn: First aid

Signs and symptoms of sunburn usually appear within a few hours of exposure, bringing pain, redness, swelling and occasional blistering. Because exposure often affects a large area of your skin, sunburn can cause headache, fever and fatigue.

If you have a sunburn

• Take a cool bath or shower. You can also apply a clean towel dampened with cool water.
• Apply an aloe vera or moisturizing lotion several times a day.
• Leave blisters intact to speed healing and avoid infection. If they burst on their own, apply an antibacterial ointment on the open areas.
• If needed, take an over-the-counter pain reliever such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Don't use petroleum jelly, butter, egg whites or other home remedies on your sunburn. They can prevent or delay healing.

If your sunburn begins to blister or if you experience immediate complications, such as rash, itching or fever, see your doctor.

49. Tick bites: First aid

Some ticks transmit bacteria that cause illnesses such as Lyme disease or Rocky Mountain spotted fever. Your risk of contracting one of these diseases depends on where you live or travel to, how much time you spend in wooded areas, and how well you protect yourself.

What to do if a tick bites you

• Remove the tick promptly and carefully. Use tweezers to grasp the tick near its head or mouth and pull gently to remove the whole tick without crushing it.
• If possible, seal the tick in a container. Put the container in your freezer. Your doctor may want to see the tick if you develop signs or symptoms of illness after a tick bite.
• Use soap and water to wash your hands and the area around the tick bite after handling the tick.
• Call your doctor if you aren't able to completely remove the tick.

See your doctor if you develop:

• A rash
• A fever
• A stiff neck
• Muscle aches
• Joint pain and inflammation
• Swollen lymph nodes
• Flu-like symptoms
• Light sensitivity to the eyes or skin (photosensitivity)

If possible, bring the tick with you to your doctor's appointment.

Call 911 or your local emergency number if you develop:

• A severe headache
• Difficulty breathing
• Paralysis
• Chest pain or heart palpitations

50. Tooth loss: First aid

If a permanent tooth is knocked out, get emergency dental care. It's sometimes possible to successfully implant permanent teeth that have been knocked out, but only if you follow the steps below immediately — before you see a dentist.

If your tooth is knocked out:

• Handle your tooth by the top or crown only, not the roots.
• Don't rub the tooth or scrape it to remove debris. This damages the root surface, making the tooth less likely to survive.
• Gently rinse your tooth in a bowl of tap water. Don't hold it under running water.
• Try to replace your tooth in the socket. If it doesn't go all the way into place, bite down slowly and gently on gauze or a moistened tea bag to help keep it in place. Hold the tooth in place until you see your dentist.
• If you can't replace your tooth in the socket, immediately place it in some milk, your own saliva or a warm, mild saltwater solution — 1/4 teaspoon salt to 1 quart water (about 1 milliliter of salt to about 1 liter water).
• Get medical attention from a dentist or emergency room immediately.

51. Toothache: First aid

Tooth decay is the primary cause of toothaches for most children and adults. Bacteria that live in your mouth thrive on the sugars and starches in the food you eat. These bacteria form a sticky plaque that clings to the surface of your teeth.

Acids produced by the bacteria in plaque can eat through the hard, white coating on the outside of your teeth (enamel), creating a cavity. The first sign of decay may be a sensation of pain when you eat something sweet, very cold or very hot. A toothache often indicates that your dentist will need to work on your teeth.

Self-care tips
Until you can see your dentist, try these self-care tips for a toothache:

• Rinse your mouth with warm water.
• Use dental floss to remove any food particles wedged between your teeth.
• Take an over-the-counter (OTC) pain reliever to dull the ache.
• Apply an OTC antiseptic containing benzocaine directly to the irritated tooth and gum to temporarily relieve pain. Benzocaine has been linked to a rare but serious, sometimes deadly, condition (methemoglobinemia) that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, because this age group has been the most affected. Never use more than the recommended dose of benzocaine. Direct application of oil of cloves (eugenol) also may help. Don't place aspirin or another painkiller directly against your gums, as it may burn your gum tissue.

Call your dentist

• When you have signs of infection, such as swelling, pain when you bite, red gums or a foul-tasting discharge
• If the pain persists for more than a day or two
• When you have fever with the toothache
• If you have trouble breathing or swallowing

http://www.mayoclinic.com/health/FirstAidIndex/FirstAidIndex