Patient Advice during the Covid-19 Pandemic

 In Dental tips

The Coronavirus Outbreak has affected the way all of us live our daily lives and this includes being able to visit your dentist for regular care or when you have a problem.

This guidance explains what dental services are available to help you and how best to help yourself if you have a dental emergency. The current guidance across all of the UK is that all routine dental care must be stopped during the pandemic. This is because the virus can be readily spread from a patient to the dentist or team member who can then spread it to other patients. The risk is higher because of the aerosol mist that is created when using dental drills.

Routine care

No routine treatment is being provided by dental practices to the patients during the pandemic. This includes, amongst other things: check-ups/examinations, fillings, root canal treatment, crown and bridge preparation and fits (including veneers), denture stages, any cosmetic dentistry (including whitening) and orthodontics (braces).

All dentists have been instructed to restrict patient contact and provide in the first instance an assessment service based on the principles of Advice, Analgesia (painkillers) and Antibiotics.

Non-Urgent dental problems

If you have any of the following you may need to wait until your dentist re-opens.

  • Loose or lost crowns, bridges or veneers
  • Broken or loose dentures
  • Broken, loose, or lost fillings which are not causing pain
  • Chipped teeth with no pain
  • Loose orthodontic wires

Urgent dental problems

These are conditions, for which self-help is recommended followed by access to dental care if symptoms don’t resolve.

These include:

Dental and soft-tissue infections without any effect to your general health or other existing medical problems – localised swelling around tooth but no significant facial swelling, no temperature and not affecting breathing or swallowing.

Dental and facial pain. It is expected that you try to manage your symptoms with appropriate painkillers. If you can’t control your pain following self-help advice, then dental help will be required.

Fractured teeth or tooth with pulpal exposure (an exposed nerve).

Dental emergencies

These are those conditions that require contact with a dentist:

  • Trauma including facial/oral laceration (cut to your face or inside your mouth) and/or dentoalveolar injuries,
    e.g. knocking out a permanent tooth
  • Oral or facial swelling that is significant and worsening/spreading
  • Post-extraction bleeding that you are not able to control with local measures (sitting quietly and biting down firmly on a damp gauze, handkerchief or flannel placed over the socket for 20 minutes)
  • Dental conditions that have resulted in acute systemic illness orraised temperature as a result of dental infection
  • Severe trismus (not being able to open your mouth) or difficulty in swallowing
  • Mouth or tooth conditions that are likely to worsen other medical conditions such as diabetes

Tooth Sensitivity

If you have extreme ‘generalised’ tooth sensitivity to cold or hot food, it is recommended that specific tooth paste such as Sensodyne® can help with this.

Toothache / Dental Pain

If you have sensitivity to hot and cold drinks around a tooth this may be an early sign of inflammation of the pulp (where the blood supply and nerve supply is in the middle of the tooth) and this is often reversible.

Self-management of this condition with pain killers should ease the pain, this is not a condition which requires antibiotics. If there is no improvement in 5 days then contact your local urgent dental care centre or call 111.

If you have a throbbing pain with hot, but gets better with cold and lasts hours andaffects sleep you may have inflammation of the pulp which requires treatment such as a root canal – or extraction of the tooth if this is not possible. It is advisable in the first instance to take regular pain killers, this is not a condition which requires antibiotics.

If there is no improvement with this then contact your nearest urgent care dental centre.

Pain around wisdom teeth

When wisdom teeth start to erupt, which can be from 17 years upwards, food can often get stuck around the flap of gum partly covering the tooth or the gum gets inflamed causing pain.

It is common for there to be a ‘bad smell’ bad breath, or sometimes a bad taste.

Usually with local measures this improves and as well as using a warm salt-water mouthwash it is advisable to take regular pain killers.

If there is no improvement, or you start to feel unwell (e.g. temperature, difficulty in opening your mouth or swallowing, swelling) then you should contact your local urgent dental care centre or call 111.

If you start to develop a fever it can be a sign of infection which may need treatment with antibiotics.

Mouth Ulcers

The majority of mouth ulcers heal within 2 weeks and are ‘self-limiting. Mouth ulcers are often caused by trauma from sharp teeth, dentures or sometimes hot food.

Initially use warm salt water rinses to keep the ulcers clean and help the healing process. This needs to be done four times a day and may cause some discomfort.
You can also purchase Difflam ® mouthwash or spray from the Pharmacist.

If your ulcers haven’t healed after 3 weeks, then you should seek advice contact your local urgent dental care centre or call 111.

Pain Relief

If you are suffering from dental pain, please refer to the flow diagram to allow either self- management of your condition or advice on seeking care.

Most dental pain can be controlled with ‘over the counter’ pain relief such as paracetamol and ibuprofen. Details of these medications can be found below.

Please ensure that you read the information leaflet with the medication and how it may relate to you if you have any other medical conditions or are receiving treatment from a Doctor.

There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse. Up to date details can be found on the Government website.

Paracetamol

500mg tablets – take 2 tablets four times a day Maximum 8 tablets in 24 hours

**AVOID** if you have

  • an allergy to Paracetamol
  • have any liver or kidney problems.

Ibuprofen

400mg tablets – take 1 tablet four times a day with food or just after Maximum 6 tablets in 24 hours

**AVOID** if you have any of the following:

  • Allergy to ibuprofen
  • Gastric/digestive problems (e.g. ulcers), heart problems
  • Breathing problems (e.g. Asthma),
  • Taking Aspirin or an anticoagulant (e.g. Warfarin, Rivoroxaban)
  • Have an inherited bleeding disorder
  • Been advised to avoid Ibuprofen or non-steroidal anti-inflammatories
  • Pregnant
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