Managing dental problems at home during Covid-19
Following recent guidance from the NHS, all face-to-face, routine dental treatment has been postponed. These measures will help reduce the chance of virus transmission and reduce unnecessary travel.
This guide will help you to understand where to access care if you’re in pain, and support you in managing minor symptoms at home. With thanks to Dr Becky Davies
What Counts as a Dental Emergency?
Treat at home, or call usual dental practice for further advice
Loose or lost crowns, bridges or veneers.
Broken, rubbing or loose dentures
Broken, lose or lost fillings
Chipped teeth with no pain
Loose orthodontic wires
Call your usual dental practice for advice first
Facial swelling extending to eye or neck.
Bleeding following an extraction that does not stop after 20 mins solid pressure with gauze/clean hankie. A small amount of oozing is normal, just like if you had a grazed knee.
Bleeding due to trauma.
Trauma resulting in a tooth being knocked out of the socket, or a large fracture resulting from trauma and causing severe pain.
Significant toothache preventing sleep or 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.
For pain relief we advise paracetamol in the first instance unless this is not a suitable option for you.
Anti-inflammatories like Ibuprofen, unless this is not a suitable option for you, can help reduce sensitivity from teeth. Combining paracetamol and ibuprofen has also been shown to be effective.
There is no strong evidence that drugs like ibuprofen can make COVID-19 (coronavirus) worse.
If you have no coronavirus symptoms carry on taking ibuprofen as normal.
Until we have further information, you should take paracetamol to treat symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.
All painkillers should be taken in accordance with instructions on the packet. Taking too many tablets WILL NOT IMPROVE YOUR SYMPTOMS and can cause serious stomach and liver injury which can be life threatening.
If the tooth is extremely sensitive to hot or cold, this may be a sign of decay and antibiotics will not help. These at-home measures may help assist with pain management until you can see a dentist:
Good cleaning with fluoride toothpaste and reducing sugar intake will help stop decay from getting any worse.
If there is a hole in the tooth, or the tooth has cracked and is now sensitive, a temporary filling material can be packed into the space to help make symptoms more manageable. These are widely available both online and from supermarkets or pharmacies.
Toothpaste aimed at reducing tooth sensitivity, such as Sensodyne Repair and Protect, may also help reduce pain. Rub the toothpaste directly on to the affected area and do not rinse. Anaesthetic gel such as Orajel can also help ease the pain.
If the pain is severe, rinsing with cold water can sometimes ease the pain whilst you are waiting to be assessed by a dentist.
Wisdom tooth pain is usually due to inflammation of the gum over the erupting tooth, which is often made worse by the trauma of biting, so introducing a soft food diet will help with the pain.
Most flare-ups can be managed with good home care and should settle within in a few days to a week. It is important that you stick to a very thorough cleaning routine even if it is painful to brush the affected area because this process will encourage healing.
Using a product such as Corsodyl mouthwash will help with alleviating pain but avoid using for longer than a week as it may cause staining of the teeth. Warm salty mouthwashes can also help with alleviating pain.
If you have difficulty swallowing, swelling in your face or cheek or difficulty opening your mouth, please call your dentist for advice. You may need antibiotics if an infection is spreading.
Although painful, most mouth ulcers will heal within 7-10 days. A dentist or doctor should assess non-healing ulcers/oral lesions present for more than 3 weeks. Please call your practice for guidance if required; otherwise follow the home measures described below:
Warm salty mouth washes
Excellent cleaning (even if it is painful to brush, the area must be kept clean to encourage healing and prevent more ulcers forming. However, be gentle and do use a soft/baby toothbrush)
Difflam (Benzydamine) Spray or mouthwash as needed.
Soft diet (soft food will reduce trauma form biting)
Painkillers (paracetamol or ibuprofen following packets instructions)
Rubbing Dentures (Denture adhesives like Poligrip or 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 more than 1 week as may cause staining)
Pain or bleeding after an extraction
Continue to take regular painkillers for several days after an extraction. It is not uncommon for the pain to be at its worst on days 3-4.
We cannot provide antibiotics for pain after extractions unless infection is present. We also cannot prescribe antibiotics without assessing you over the telephone first.
Some pink spit/oozing is normal after a tooth extraction. If the socket is bleeding freely, bite hard on gauze or a clean hankie for 20 minutes. If bleeding still doesn’t stop, please call your dentist.
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 you dentist for an emergency appointment. Antibiotics will not solve this and a dressing may be required to cover the exposed bone.
Bleeding from gums is NOT a dental emergency. Bleeding gums are usually due to gum disease and will not stop until your brushing technique improves. Brush twice daily with fluoride toothpaste for 2 minutes, paying particular attention to the areas that are bleeding. Remember to also use floss or interdental brushes to clean between your teeth every day.
If your gums are extremely painful and look infected (bright red with a grey/green appearance) you should still try your best to brush them even though they will bleed. Take painkillers as required and use mouthwashes such as chlorhexidine or peroxyl which can be purchased from your pharmacist.
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.
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 should be removed from the crown and the tooth for the crown to seat properly.
Check the crown fits without cement. Check carefully that the bite feels correct, if the tooth feels too tall or proud, it is not fitted correctly, double check for debris. Never try to force a crown or post onto 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.
Crowns should be re-fixed back onto the tooth using a dental cement from a pharmacy like Recapit. DO NOT USE SUPERGLUE or FIXADENT to fit your crown.
Once you 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 and bite firmly to press it into place.
Remove any excess cement with a toothpick and floss between your teeth to make sure they do not stick together.
Fractured or knocked out teeth
If a tooth has been chipped and is sensitive and/or sharp then applying a sensitive toothpaste or using an emergency repair kit is advised.
If a baby tooth has been knocked out, do not attempt to put it back in. Clean the area, bite on a clean hankie or towel for 20 minutes if it is bleeding, give the child age appropriate pain relief medicine and keep to a soft diet until the area has healed.
If an adult tooth has been knocked out
handle the tooth by its crown (the white part), avoid touching the root
if the tooth is dirty, wash it briefly (10 seconds) under cold running water
try to re-implant the tooth in its socket and then bite gently on a handkerchief to hold it in position
if this is not feasible, store the tooth for transportation to the designated urgent dental care centre in milk (not water). Alternatively transport the tooth in the mouth, keeping it between molars and the inside of the cheek.
You need to telephone for an emergency dental appointment
Orthodontic / brace problems
The British Orthodontic Society advise that most orthodontic appliances can be left for some months without detriment if you continue with the usual after care instructions;
Exemplary oral hygiene – brushing 3 times a day with their standard toothbrush, followed by interproximal brush use. You can also use a fluoride mouth rinse e.g. Fluoriguard (225ppm), once a day.
Low sugar diet - where possible avoid snacking on foods and drinks with ADDED SUGAR. Fizzy drinks should be avoided in particular.
Avoid sticky and hard foodstuffs that could break the brace wire or fracture brackets off a tooth.
Patients may in the coming weeks experience pain, problems and loose wires. At present, the best advice is to avoid all but the most essential mouth procedures to limit spread of the disease to the wider population.
If you suspect that you may have swallowed or inhaled a piece of your brace, you must call for advice.
A small piece of brace will normally pass through even if you have swallowed it.
An orthodontic patient where possible should contact their orthodontic practice or suitably qualified health care professional first to ensure that they are carrying out procedures safely and for any further advice if their condition deteriorates to resolve the problem.