Managing Dental Emergencies at Home by Dr Nissit Patel
During this period of lockdown, it will be increasingly difficult to access dental care apart from severe emergency treatment. I have therefore written guide on how to manage routine dental emergencies at home and how we can help over the phone. I hope it is of some use.
Following recent guidance from NHS England and the Department of Health, dental practices have been advised to STOP AEROSOL SPRAYS and PRIORITISE URGENT TREATMENT where possible.
As well as reducing risk to staff and patients, this will also prevent unnecessary travel in an attempt to reduce virus transmission. This information aims to advise people in pain who still need to access care and also support people in managing minor symptoms at home.
If you need to access emergency care:
- Have you or anyone in your house been self isolating?
- Do you have any symptoms?
- High temperature or continuous cough?
If YES to any of the above, CALL 111. They will direct you to an emergency facility with appropriate protective equipment which will allow staff to treat you safely. If NO, then read on for advice.
What counts as a dental emergency?
Urgent dental treatment:
- Facial swelling extending to eye or neck
- Bleeding following an extraction that does not stop after 20 minutes of solid pressure with a gauze. A small amount of oozing is normal, just like if you had grazed your knee
- 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
Straight to A&E:
- Facial swelling affecting vision or breathing, preventing mouth opening more than 2 fingers width.
- Trauma causing loss of consciousness, double vision or vomiting
Non-Urgent (will 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, lost brackets
Anti-inflammatories (like ibuprofen) can help pain relief. Combining paracetamol and ibuprofen has also been shown to be effective.
There is currently no strong evidence that drugs like ibuprofen can make COVID-19 worse. Reference from www.gov.uk
If you have no symptoms of COVID-19, carry on taking ibuprofen as normal.
If you present with symptoms, take paracetamol unless your doctor has told you paracetamol is not suitable for you. (Updated: 20 March 2020)
If these are ineffective, Co-codamol is an alternative which is a mixture of paracetamol and codeine. Lower dose versions can be purchased without prescription. 15mg or 30mg codeine versions are prescription only. We can prescribe these as necessary.
Painkillers should always be taken in accordance with instructions included within the packet. NEVER exceed the stated dose.
If the tooth is extremely sensitive to hot or cold we advise rubbing sensitive tooth paste all over the tooth, spit out any excess and do NOT rinse with water or mouthwash afterwards.
We recommend Sensodyne or Colgate Sensitive. MI plus paste is also excellent for tooth sensitivity (not for those with dairy allergy). This is a prescription based product which we can supply.
If you have a retainer or night guard, rub the affected area, squeeze some paste within the tray and seat. This can then be worn overnight or during the day as needed.
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 can be managed with good home care and should settle in a few days to a week:
- Excellent cleaning (even if it is painful to brush, the area must be kept clean to encourage healing)
- Corsodyl mouthwash (avoid use over 1 week to avoid staining)
- Soft diet (soft food will reduce trauma from biting)
- Painkillers (ibuprofen or paracetamol following instructions)
- Warm salty mouthwash
- If you have difficulty swallowing, swelling in your face or cheek or difficulty opening your mouth, contact us for a video consultation.
You may need antibiotics or urgent referral.
Although painful, most ulcers will heal within 7-10 days. Non-healing ulcers/oral lesions present for more than 2-3 weeks should be assessed by a dentist or doctor.
- Warm salty mouthwash
- Excellent cleaning (even if it is painful to brush, the mouth must be kept clean to encourage healing and prevent more ulcers forming. Be gentle and use a soft/baby toothbrush).
- Difflam (Benzydamine) spray or mouthwash as needed
- 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).
- Corsodyl mouthwash (avoid use for over 1 week as may cause staining)
Pain or bleeding after an extraction
Continue to take regular painkillers for several days after extraction, it is normal for the pain to be at its worst at day 3-4.
Some pink spit/oozing is normal after an extraction, but if the socket is bleeding freely, bite hard on gauze or a clean hankie for 20 minutes. If bleeding has not stopped, call us.
We cannot provide antibiotics for pain after extraction unless infection is present. We would need to arrange a video consultation for any prescription.
If you smoke or rinse too soon after an extraction, you risk a dry socket. This can be very painful and regular painkillers are unlikely to be effective. A dressing is needed to cover the exposed bone which we can supply after a video consultation.
Bleeding from gums is not a dental emergency. This is due to gum inflammation and is generally reversible. Good oral hygiene, cleaning twice a day with either a manual or electric tooth brush and using inter dental brushes / floss will help. Waterflossers such as Waterpik are very useful adjuncts to cleaning. Corsodyl mouthwash can also help. To prevent staining, only use for 1 week.
Lost Crown/ inlay/ onlay
If the crown/ inlay or onlay has simply come out due to the loss of cement, then it will need to be re cemented in the long term. As a short term option, clean the fitting surface of the crown/ inlay or onlay using a toothpick, end of a paper clip or any sharp object to remove any excess cement. Make sure the tooth is clean and then try it in. If the crown seats well it will appear that your bite is normal. If it does not seat or the bite feels strange, then leave to one side.
In the instance the fitting is sound, temporary crown cement can be purchased from most large chemists or we can send you some. This is then placed within the crown and a firm bite for 1-2 minutes is needed to set.
Where the crown cannot be placed, keep the tooth as clean as possible. Unfortunately, if the crown has been damaged or if there has been movement of the adjacent or opposing teeth, it will need to be re made.
Broken Tooth / Lost Filling
It is important to keep the area as clean as possible.
Temporary cements as for temporary crowns can be used to simply seal over the area. We can post material to you which we use for temporary fillings.
Alternatively, a silicone putty can be used. This contains a base and catalyst which are mixed together until a single colour (our one is blue). This is then placed over the tooth and left to set. The material will cover the area overnight and during the day. This should be replaced daily for cleaning.
The putty can also be used over sharp orthodontic wires and loose brackets.
Please let us know and these materials can be posted to you.
At present, the practice is closed. We aim to re open as soon as possible when safe to do so. However, we are still here for you. Please do not hesitate to contact us at any time. We will get back to you as soon as possible.