One of the things which we are most concerned about during this period when we, and all dental practices, must remain closed is what happens when a patient has a dental emergency. So, we have put together a guide on what to do if you have toothache or any other dental emergency during this period.

If you need to access emergency care, first ask yourself the following questions- have you or anyone in your house been self-isolating, or do you have any symptoms of COVID-19 eg. high temperature or continuous cough? If yes, call 111. They will direct you to an emergency facility with appropriate protective equipment which will allow staff to treat you safely. If you answered no to the above questions and cannot manage your symptoms at home with the guidance outlined in this blog, call us. We will be able to provide telephone advice and offer painkillers or antibiotics if appropriate.

Dental Emergencies

So, what counts as a dental emergency? You should head straight to A&E if you are experiencing the following symptoms:

• Facial swelling affecting vision or breathing, preventing mouth opening more than two fingers width.
• Trauma causing loss of consciousness, double vision or vomiting.

Symptoms which are classed as urgent but do not require a trip to A&E include:

• Facial swelling extending to eye or neck.
• Bleeding due to trauma.
• Tooth broken and causing pain, or tooth fallen out.
• Significant toothache preventing sleep, eating, associated with significant swelling, or fever that cannot be managed with painkillers.

Non-Urgent symptoms (may need to wait):

• Loose or lost crowns, bridges or veneers.
• Broken, rubbing or loose dentures.
• Bleeding gums.
• Broken, loose or lost fillings.
• Chipped teeth with no pain.
• Loose orthodontic wires.

 

Painkillers

 

Painkillers are effective at reducing sensitivity and pain from teeth. Combining anti-inflammatories like ibuprofen with paracetamol has also been shown to be effective. Currently, there’s no strong evidence that ibuprofen can make COVID-19 worse, but until we have more information, stick to taking paracetamol if you are showing symptoms (unless your doctor has advised that paracetamol isn’t suitable for you). Painkillers should always be taken in accordance with instructions on the packet- taking too many tablets or taking medications incorrectly will not improve symptoms and can actually cause life-threatening stomach and liver problems, so be sensible when taking painkillers.

 

Toothache

If you have an especially painful or sensitive tooth, antibiotics are unlikely to help. Unfortunately for the time being, toothache has to be managed using home measures. Good cleaning with fluoride toothpaste and reducing sugar intake will stop decay from getting worse. Desensitising toothpaste such as Sensodyne can also help- rub toothpaste directly on the affected area and do not rinse afterwards. Anaesthetic gel such as Orajel is also helpful with reducing pain. If there is a hole in the tooth, or a tooth has cracked and is now sensitive/sharp, a temporary filling can be packed into the space- these fillings are widely available from supermarkets and pharmacies.

 

Wisdom Teeth

Wisdom tooth pain is usually due to inflammation of the gum over the erupting tooth, which can be worsened by trauma from biting. Most flare-ups should settle in a few days to a week and can be managed with the following good home care:

• Excellent cleaning (even if it’s painful to brush, the area must be kept clean to encourage healing).
• Corsodyl mouthwash (avoid using for over 1 week as may cause staining) / warm salty mouthwash.
• Soft diet (soft food will reduce trauma from biting).
• Painkillers (ibuprofen or paracetamol following packet instructions).

If you have difficulty swallowing, swelling in your face or cheek or difficulty opening your mouth, call your dentist. You may need antibiotics if the infection is spreading.

 

Ulcers

Although painful, most ulcers will heal within 7-10 days. Non-healing ulcers/ oral lesions present for more than 3 weeks should be assessed by a dentist or doctor. Follow these home care tips to encourage healing and reduce pain:

• Excellent cleaning (even if it’s painful to brush, the mouth must be kept clean to encourage healing and prevent more ulcers forming. Be gentle and use a baby/soft toothbrush).
• Corsodyl mouthwash (avoid using for over 1 week as may cause staining)/ warm salty mouthwash/ Difflam (Benzydamine) spray or mouthwash.
• Soft diet (soft food will reduce trauma from biting).
• Painkillers (ibuprofen or paracetamol following packet instructions).
• Rubbing Dentures (Denture adhesives like fixodent may help secure a loose denture. Any sharp edges can be removed using an emery board. Remove dentures when possible if causing trauma).

 

Bleeding Gums

Bleeding from gums is NOT a dental emergency. It is usually symptomatic of gum disease, and will not stop until brushing improves. Brush twice a day with a fluoride toothpaste for 2 minutes, concentrating especially on the areas that are bleeding. Use floss or TePe brushes to clean between your teeth every day.

 

Lost Crown

If your crown falls out or is accidentally removed during this time, follow these steps:

1. Clean and check the crown. If the crown is mostly hollow, you can attempt to re-cement it at home if you feel confident to do so.
2. Remove any debris from the crown- you can use something like the tip of a paperclip to scrape the old cement away. Clean your tooth thoroughly. All debris must be removed from both the crown and the tooth for it to seat properly.
3. Check the crown fits without cement. Check that the bite feels correct, if the tooth feels too tall, it is not fitted correctly- double check for debris. NEVER force a crown or post onto or into your tooth, this can cause the root to fracture. If you cannot get the crown to fit, keep the tooth as clean as possible and wait to see your dentist.
4. Crowns should be replaced using a dental cement like Recapit from a pharmacy. Do not use superglue or Fixadent to fit your crown!
5. Once you have practiced placing the crown, dry the tooth and crown, mix the cement as instructed on the packet and fill the crown. Place the crown directly onto the tooth. Bite firmly to press it into place.
6. Remove any extra cement with a toothpick and floss between your teeth to make sure they do not stick together.

 

So, there we have it! Quite a long blog this week, but we think it’s very important that our patients have access to as much information as possible. We’re sure you’re all aware of the importance of not putting a strain on our NHS at this time, so please follow our guidelines and only call 111/ go to A&E if you really have to.