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MAY 20

Article written by Dr Nissit Patel

One of the most pressing issues in dentistry at the moment is when will we be able to re open for emergency dental appointments. It is has been nearly 2 months since we were forced to close our doors. Despite what the Government may say, on the 25th March the Chief Dental Officer stated:

  1. All routine, non-urgent dental care including orthodontics should be stopped and
    deferred until advised otherwise.
  2. All practices should establish (independently or by collaboration with others) a remote
    urgent care service, providing telephone triage for their patients with urgent needs during usual working hours, and whenever possible treating with:
    • Advice
    • Analgesia
    • Antimicrobial means where appropriate
  3. If the patient’s condition cannot be managed by these means, then they will need to
    be referred to the appropriate part of their Local Urgent Dental Care system. These
    new arrangements will involve providers working with defined groups of patients to
    manage urgent dental care needs only, with appropriate separation arrangements in
    place to manage patient status and professional safety

    By all accounts, this ordered an immediate halt to all dental services within primary care. In my local area, Fulham, SW6 London, I have not been informed of a local urgent dental care centre that I am able to refer extreme emergency cases to. The advice given by various bodies ( I shall not name them) was to call 111. Frankly, this may have been almost acceptable in the early stages of the pandemic but NOT 7 weeks after the statement. Thousands of patients across the country have been left in pain and distress with the advice to take pain killers and anti biotics, which as we all know, are only effective when infection is present.

    In this respect, I spent many hours reviewing the literature to provide some evidence based analysis on how we can protect ourselves, our patients and get back to work after lockdown. If you are interested in reading this article, it was published by Dentistry and the link is:

    The summary involves 10 key points which are easy to implement and allow us to get back to work as soon as possible. These include:

  1. Careful screening of patients pre treatment
  2. Alteration of patient appointment times/ flexible time frames
  3. Reception screening, social distancing measures  
  4. Consider clean air systems within reception areas and surgeries such as those involving air suctioning pre filters, HEPA filters, carbon filters and UV lamps
  5. Reducing aerosol
  6. Always use high volume suction or HVA
  7. Use rubber dam or consider additional isolation systems such as Isovac/Isolite
  8. Provide assistants to hygiene/therapists for HVA
  9. Enhanced PPE especially for those at greater risk of Covid 19
  10. Extra time for cleaning and disinfecting surfaces including areas not previously cleaned

    These are measured points that will go a large way to help our profession back to work and re start the process of opening our dental clinics in London and across the UK.

    Should you have a dental emergency, please do not hesitate to contact me. Although we cannot see you right now, I can try to help as best as I can remotely and arrange an appointment as soon as we can re open.
    t 0207 7311162

APR 20

If you are undergoing orthodontic treatment at this present time, I can appreciate that it is probably quite a worry about when your next appointment may be. After all, orthodontic treatment is all about seeing progress for teeth straightening and it is unlikely the next adjustment or review appointment will be for some time yet.

However, it is important to stay positive and remember the fact that things will return to some level of normality in the near future and that teeth can always be straightened despite the time delay!

On that note, I thought it would be useful to discuss orthodontic emergencies and how to manage them at home during lock down. The most common types of problems encountered listed below with some helpful tips on how to manage them at home.


This is a very common orthodontic emergency and can be very annoying. In most cases, the bracket will simply slide on the wire it is attached to.

On this model, several brackets have come off the teeth

The most simple way to deal with this is to use orthodontic wax over the bracket to hold it in place until you can eventually visit the orthodontist. Silicone putty can also be used but your dentist would need to provide this for you as it has to be a dental putty and not one found in hardware stores.

Wax on the central tooth bracket holding it in place


This can be incredibly annoying and sharp on the tongue or cheek. If the wire is quite long, it can be cut using wire cutters or nail scissors if the wire is thin. However, make sure who ever is cutting the wire holds the end so that a piece does not fly down the back of your throat!

If the wire is short, orthodontic wax can be used.

Wax covering the end of the wire on the molar tooth


In the case of the wire fracturing fully, I would advise pulling the wire fully out. Ideally, hold the wire with a tool that can lock into place and pull horizontally in gentle tugging action. This should be done for both fragments of the wire.


Sometimes, stain less steel ligatures are used around brackets to keep the wire firmly within the bracket slot. These are tied around the bracket, curt short and tucked under the wire. Sometimes they become loose and can irritate the tongue.

At home, you should be able to find a pencil with an eraser end. Use the soft end to push the ligature lie back down and ideally under the wire. This way, it will prevent it from coming back up again.

If the tie has begun to unravel, then it will be worth trying to remove it fully but twisting in an anti clockwise direction. It should then come apart easily.


Elastics are often used connecting brackets to close space between teeth. If this snaps, it is best to try and remove the elastic fully. Again, use an tool that can lock onto the elastic and try to unhook from the bracket at the top and bottom. However, if the elastic has been placed underneath the wire with separate ligatures to hold the wire, this will not be possible. In this case, just try to cut away the broken part using nail scissors.


The elastics will often become stained after eating foods such as curry or drinking red wine. Sorry, this is not an emergency!


If you are using Invisalign aligners and lose one, simply revert back to the previous one and use this as a retainer. Contact your dentist and Invisalign will be able to make another aligner for you. There is usually a charge for this. The key is to keep the aligners safe. Treat them like precious jewellery.


If your aligner or retainer cracks, as long as it fits well, it will still be fine to continue using it until the next visit to the dental practice. Even if a piece breaks off, it is better to use the remaining part than not at all especially for a retainer


During this unprecedented time, visiting us or your local dentist is not possible. However, hopefully this information was of some help and keep you going until restrictions are lifted and everyday treatments can resume.

Feel free to contact me:

Video consultations available 7 days a week via the home page of the website

T 0207 7311162

APR 20

As of 8/4/20, there have been no general updates with regards to the provision of general dental care in a practice like ours, based in Fulham London. This is an incredibly frustrating time for of all us here especially for those of you who are in need of routine emergency dental care which could be a simple tooth fracture, a lost crown, a broken denture, a lost filling, an ulcer or gum bleeding for example. Most dental emergencies are not classified as being urgent or life threatening such as a rapidly increasing swelling, head trauma or difficult in breathing from bleeding after a tooth extraction.

Whilst we accept that the decision by the health and governing bodies are designed to stop the spread of coronavirus by limiting face to face contact between dentist and patient, this does leave many hundreds if not thousands of patients with anxiety about when their emergency can be seen to and whether the problem is going to get much worse during the delay.

What options do you have to access emergency dental care?

Well, the simple answer to this is that you are very limited options. NHS England have advised us that Urgent Local Care Centres were being set up with the view that dental emergency care could be referred to these centres based on a triage system. However, as of today, Tuesday 8th April 2020, these centres have not been established and we have no means of referring patients to them. Personal protective equipment (PPE) is a real issue and that fact that these centres will be at high risk of transmission of the virus, PPE is critical. Personally, I would be more than happy to treat emergency dental cases with our current protocols we follow at Progressive Dentistry which include the use of a surgical mask, full facial visor along with a cap and full surgical gown.

There are various hospitals that are accepting emergency care in London such as Kings College, Guys Hospital, Royal London and Whipps Cross. However, I appreciate that a hospital setting is the last place you may want to visit in terms of social distancing for a simple issue such as a chipped tooth.

How can we help?

Free Video Consultations are now available

I am delighted to announce that we have set up video consultations which can be booked via the website. On the home page, simply click the VIDEO CONSULTATION icon at the top next to the telephone number. You will then be sent to this page:

Then pick a topic, I don't mind if you simply want to talk about Invisalign for example!

You will then be able to pick a date and time and a verification will be sent. It is really that simple.

The consultations are via the Zoom platform which all businesses seem to be using these days, which is great for Zoom. There are always winners and losers with any crisis! However, the interface is very easy to use and secure. We can even record the consultation so that references can be made to our discussion later down the line when 'normal' practice can resume. When that will be? Your guess is as good as mine but hopefully weeks rather than months.

How can a video consultation help?

Well good question. In fact, a video consultation is far better than a telephone or e mail one. I can physically see you and close ups of your teeth and face are possible with practice. Very obvious problems with present easily on screen and I can make a differential or definitive diagnosis with options to help. This may be advising on self care remedies, prescribing pain relief, anti biotics to sending out products which may help such as temporary filling paste, silicone putty to cover a sharp edge or prescription based toothpaste or gels such as Duraphat 5000 or MI Plus Paste. The end goal is to provide a level of care that is still bespoke to your need until such time that we are able to see you here on Fulham High Street.

Can you still contact us the old fashioned way?

Yes, of course. Our contact details are the same as ever and we now have a mobile phone number for calls and WhatsApp:

T 0207 7311162


M 07508 663942

Please stay safe!

Written by Dr Nissit Patel Clinical Director

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©2020 Progressive Dentistry is the trading name of Orviol Ltd, a registered company in England and Wales 8973656
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