COVID-19 Update: Managing Toothache at Home

Tips to help manage dental problems until you can see a dentist.

Document date: 04/4/2020

UPDATE 04/04/2020

Specialised Urgent Care Centres are currently being designated across Manchester which can be accessed by telephoning 0333 332 3800. The Vallance Dental Centre is likely to be a designated Urgent Care Centre for specific categories of patients. You can only access this service by telephoning 0333 332 3800, if you telephone the practice we can only provide advice, analgesics and antibiotics (if appropriate), we are unable to book patients directly into the Urgent Care Centre. You Must telephone 0333 332 3800.

All Urgent Care Centres in Greater Manchester are still awaiting appropriate PPE so are still unable to carry out treatment. At this moment in time Urgent Care Centres are only providing telephone advice which consists of advice, analgesics and antibiotics (if appropriate).

Please be assured we are doing all we can to be able to return to a normal service as soon as possible, but this may take some time. At the moment the priority in accordance with guidance is to prevent the spread of COVID-19 through the population.


UPDATE 29/3/2020

Public Health England and Robert Jenrick have advised that adequate personal protective equipment (PPE) has been delivered to dental primary care. We have still not any adequate PPE for aerosol generating procedures (disposable gowns, visors, FFP3 masks). Without this equipment, it is impossible to safely carry out emergency procedures for patients and staff. Given that 10% of infections are healthcare workers (according to the WHO) it is essential to have this equipment to ensure the safety of clinicians and our patients.

We still have no knowledge of any dental clinics in Greater Manchester that have received appropriate equipment to safely carry out emergency dental care. As of yet, no specialist urgent dental care centres are ready or are seeing patients with a dental emergency in Greater Manchester. We are aware that this is still a work in progress and there is a substantial effort to mobilise this service.


UPDATE 26/3/2020

Letter from England Chief Dental Officer –
Summary:
1) All routine, non-urgent dental care including orthodontics should be stopped and deferred until advised otherwise.
2) Move to a telephone triage system
3) Telephone triage will be carried out and advice will be provided, if necessary advice on pain relief and antibiotics will be prescribed if appropriate
4) If pain cannot be managed by this, then specialist local urgent dental care centres will be set up which can be accessed by telephoning 111

As of 26/3/2020 as far as we know, these local urgent dental centres with appropriate highly filtered PPE3 masks and protection are not fully mobilised in Greater Manchester but hopefully will be soon.

Below correct as of 24/3/2020

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.

Due to the above advice, we have had to limit care to the highest priority emergencies only.

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. Currently in Manchester as of 24/3/2020 this specialist service with protective equipment has yet to be set up.

What is a dental emergency?

  • Facial swelling extending to eye or neck.
  • Bleeding following an extraction that does not stop after 20 mins solid pressure with a gauze/clean hankie. A small amount of oozing is normal, just like if you had grazed your knee.
  • Bleeding due to trauma.
  • Tooth broken and causing severe pain.
  • Significant toothache preventing sleep, eating, associated with significant swelling, or fever that cannot be managed with painkillers.

Go Straight to A&E if:

  • 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 (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.

If you are attending an urgent dental appointment it is essential you attend by yourself unless you require a carer, guardian or translator to be present as well.

 

Painkillers

Anti-inflammatories (like ibuprofen) can help reduce sensitivity from teeth. Combining paracetamol and ibuprofen has also been shown to be effective.

There is currently a suspicion that ibuprofen could make COVID-19 worse.

If you have no coronavirus symptoms carry on taking ibuprofen as normal.

Until we have more information, take paracetamol to treat symptoms of coronavirus, unless your doctor has told you paracetamol is not 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 your symptoms, and can cause serious stomach and liver injury which can be life threatening.

Toothache

If the tooth is extremely sensitive to hot or cold, antibiotics will not help. The decay must be removed and filled. Unfortunately at this moment in time, we are unable to do any decay removal as aerosol generating procedures are limited.

These home measures may help make symptoms manageable until care can be accessed.

Good cleaning with fluoride toothpaste and reducing sugar intake will help stop decay from getting any worse.

Desensitising/sensitive toothpaste (like sensodyne repair and protect) can help. Rub toothpaste directly on the affected area and do not rinse afterwards. Anaesthetic gel such as Orajel can help ease 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 are widely available from supermarkets and pharmacies:

 

Wisdom tooth pain

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 for more than 1 week as may cause staining of the teeth)
  • Soft diet (soft food will reduce trauma from biting)
  • Painkillers (ibuprofen or paracetamol following packet instructions)
  • Warm salty mouthwash

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.

Mouth 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.

Warm salty mouthwash 4 times per day

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

You could potentially have a dry socket if you have pain following 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.

We cannot provide antibiotics for pain after extractions unless infection is present. We also cannot prescribe antibiotics over the phone without seeing you in person.

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. You should call your dentist for an emergency appointment.

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 (as in the picture above). If bleeding has not stopped, call your dentist.

Bleeding Gums

Bleeding from gums is NOT a dental emergency.

Bleeding gums are usually due to gum disease, and will not stop until brushing improves. Brush 2x a day with fluoride toothpaste for 2 minutes, concentrating especially on the areas that are bleeding. Use floss or te-pe brushes to clean between your teeth every day.

Corsodyl mouthwash can be helpful if used twice a day (avoid use for more than 1week as may cause staining)

Lost Crown

You can buy temporary crown cement from boots, superdrug or online. For example :

  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. If the crown is out of your mouth for an extended period of time (more than a few days) it may not fit and you may have to pay for a new one to be made in the future.
  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 from a pharmacy like Recapit. DO NOT USE SUPERGLUE or FIXADENT to fit your crown.
  5. Once you are 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.