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34 Fulham High Street, Fulham, London, SW6 3LQ
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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

APR 20

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.

Accessing care

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

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. 

Tooth Sensitivity

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 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 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 gums

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.

Present Situation

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.

T. 0207 731 1162

WhatsApp +44 7508 663942

Video consultations arranged via Zoom

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