Dental emergency guide for temporary care at home

8 May

Managing dental emergencies.jpg — Managing Dental Emergencies

The lockdown due to the Covid-19 pandemic seriously affected emergency dental care in the UK.

As it was essential to manage dental emergencies at home, we put together a guide to help with the temporary home care. This guide includes information that could help if you are having a dental emergency and not able to access emergency dentist.

Toothache

The most common dental emergency is also the one that mostly needs definitive treatment by a dentist. These home measures can help manage the symptoms until care can be accessed.

· Reducing sugar intake and avoiding extreme temperatures (hot or cold) are essential steps to avoid triggers that can initiate toothache.

· If the tooth has cracked, or there is a hole in the tooth, a temporary filling can be used to cover the defect. This will stop the tooth being sharp or sensitive. Some popular temporary filling materials are Refilit, Dentek, Temparin, Dentemp and Tooth-fil. These, and other materials discussed throughout this emergency guide, are available from pharmacies, supermarkets, and online retailers like Amazon, eBay etc. Currently, like many other things, there is a widespread shortage of these materials. Google Shopping is an option to identify other small retailers who may still have these. If you are unable to get these, unfortunately at this stage, we need to manage the emergency by keeping the area clean and following the measures below.

· If there is severe sensitivity to hot or cold, desensitising toothpaste like Sensodyne Repair & Protect or Colgate Sensitive Pro-relief can help. This should be applied at least twice daily, directly to the affected area and left for a few minutes without rinsing.

· Rubbing anaesthetic gel such as Orajel into the area can also help.

· Antibiotics will not help if a tooth is painful to hot or cold. However, painkillers like Paracetamol and Ibuprofen can help reduce toothache. Combining them has also shown to be effective. It is essential to stick to the dose limits, as overdose will not improve symptoms but can cause serious stomach and liver injury, which can even be life-threatening. More guidance on the recommended doses for dental pain is here.

Swelling

Dental infections (abscess) can cause swelling. If you have developed a swelling in the mouth, the following will help.

· You should take painkillers if needed (as above). Ibuprofen is an anti-inflammatory, so can help reduce the swelling.

· You can try and drain the abscess yourself at home. Putting pressure and slightly massaging will drain it (squeezing). Doing this usually relieves pressure and can help relieve pain.

· Regular warm saltwater mouthwash is to be done if the swelling is draining. Half a teaspoon of salt in half a mug of water, at least three times a day is the usual regime.

· If the swelling is extending to eye or neck, you may need antibiotics. We have telephone service to prescribe antibiotics for those who will benefit from them. Please make sure to advise of any existing allergies, so the right medications can be prescribed.

· If the facial swelling is affecting vision or breathing, preventing mouth opening more than 2 fingers width, you need to go to A&E straight away. This could become life-threatening, so immediate attention is essential.

Lost filling / Broken tooth

Fillings can fall out. Also, it is very common to break a tooth, especially around an old silver filling. The design of traditional silver fillings makes the teeth vulnerable to break over time and we see these cases quite frequently.

· If there is associated pain, you may need to take painkillers as needed (as above).

· You need to maintain good oral hygiene and a low sugar diet to prevent any decay from occurring or existing decay from getting worse.

· Emergency dental kit can be used to patch up the tooth at home. Some popular brands are Refilit, Dentek, Temparin, Dentemp and Tooth-fil. You may need to do this a few times before you can be seen for a definitive solution later. These are available from pharmacies, supermarkets, and online retailers like Amazon, eBay etc. Currently, like many other things, there is a widespread shortage of these materials. Google Shopping is an option to identify other small retailers who may still have these. If you are unable to get these, you need to manage it by keeping the area clean and use painkillers if needed.

Lost crown

Old crowns can fail and drop out. This scenario could be quite distressing when it is a front tooth. In suitable cases, home measures can fix this temporarily until a definitive solution can be provided later.

· 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.

· Any debris should be removed first. Something like the tip of a fork or paperclip can be used to scrape the old cement away. The tooth should be cleaned thoroughly too. All debris must be removed from both the crown and the tooth for it to seat properly.

· Check the crown fits without cement and check if the bite feels correct. If the tooth feels too tall, it is not fitted correctly. You need to double check for debris. You should never force a crown or post onto the tooth, as this can cause root fracture. If you cannot get the crown to fit, you need to keep the tooth clean and wait till our normal service resumes.

· If it is fitting fine, the crown can be replaced using a dental cement like Recapit or Toofypegs following the instructions in the pack. These are available from pharmacies, supermarkets, and online retailers like Amazon, eBay etc. Currently, like many other things, there is a widespread shortage of these materials. Google Shopping is an option to identify other small retailers who may still have these. If you are unable to get these, you need to manage it by keeping the area clean and use painkillers if needed.

· You should not use Superglue or Fixodent to fit your crowns.

Wisdom tooth

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 is essential, even if it is painful to brush. The area must be kept clean to encourage healing.

· Soft diet is recommended. Soft food will reduce trauma from biting.

· Painkillers will help. Take Ibuprofen or Paracetamol following dose instructions on the pack.

· Warm saltwater mouthwash is essential. Half a teaspoon of salt in half a mug of warm water, at least three times daily is the recommended regime.

· Peroxyl mouthwash can help too. This is available from supermarkets, pharmacies, Amazon or eBay.

· If there is a swelling in the face or cheek, or difficulty in opening the mouth, you may need antibiotics as the infection could be spreading.

· If the facial swelling is affecting vision or breathing, preventing mouth opening more than 2 fingers width, you need to go to A&E straight away as this could become life-threatening.

Ulcers

Although painful, most ulcers will heal within 7 - 10 days. Non-healing ulcers present for more than 3 weeks will need urgent referral to rule out serious problems.

· Difflam (Benzydamine) spray or mouthwash will help with the pain. This can be bought from pharmacies.

· Peroxyl mouthwash can help with healing. This is available from supermarkets, pharmacies, Amazon or eBay.

· Warm saltwater mouthwash will help to prevent infection. Half a teaspoon of salt in half a mug of warm water, at least three times daily is the recommended regime.

· Regular painkillers may be needed. Take Ibuprofen or Paracetamol following dose instructions on the pack.

· Bonjela on the area, before meals in particular, can make it better when eating.

· Good oral hygiene should be maintained. This encourages healing and prevent more ulcers forming.

· If the ulcer is caused by a denture, remove the denture when possible. Sharp edges on the denture can be removed using an emery board.

Trauma

It is quite unfortunate to experience trauma at any time.

· If the trauma caused loss of consciousness, double vision, or vomiting, you should go to A&E straight away.

· If there is a break in the jawbone, you need go to A&E, where you will be redirected to the Oral & Maxillofacial Surgery department for management.

· If the tooth is chipped minimally due to trauma and there is no pain/sensitivity, we just need to leave it for now. Avoid biting into the tooth for a few weeks.

· If the tooth is broken more, causing pain or sensitivity, this needs to be managed as in 'Lost filling/Broken tooth' section. Avoid biting into the tooth for a few weeks.

· If the entire tooth is broken to the root level, or bleeding from within the tooth, you will need to be seen to remove the pulp or root if possible.

· If the tooth has fallen out fully, you need to run it under water to remove debris. You should not scrub the root, as it will remove the cells that are needed for re-attachment. If possible, you should try and re-insert it as much as you can. This needs to be done soon, before the blood in the socket clots. Avoid biting into the tooth for a few weeks. If not possible, put the tooth in a bottle of milk and contact us to see if an appointment can be secured. If not possible to reposition the tooth, you may have to consider replacement later.

· If the tooth has not fallen out fully, but has moved position within the mouth, you need to try pushing it back to its original position as much as you can. You should avoid biting into the tooth for a few weeks. You may need orthodontics (braces) later to reposition the tooth.

· Any bleeding from the lips/gums/tongue should stop with local pressure. Soft tissues can take up to a week or two to heal fully. If it is a severe tear, either in the mouth or the skin of the face, you may need sutures. Contact A&E asap to manage this.

Pain after extraction

Most of the times, this just needs good home care.

· You should continue taking regular painkillers for several days after extraction, as needed.

· We cannot provide antibiotics for pain after extraction, unless infection is present – swelling, pus discharge etc.

· Warm saltwater mouthwash will help to prevent infection. Half a teaspoon of salt in half a mug of warm water, at least three times daily is the recommended regime.

· If you smoke or have rinsed too soon after an extraction, there is a risk of dry socket. If pain gets progressively worse after a week, regular painkillers are unlikely to be effective. You may need to be seen for a dressing of the socket to cover the exposed bone.

Bleeding after extraction

This is usually soon after the extraction.

· Pink saliva and a little bit of oozing from the extraction site is normal.

· If the socket is bleeding freely, this tends to respond well to pressure. You need to bite firmly on a gauze or a clean handkerchief for 30 minutes.

· If the bleeding still hasn't stopped, you may need socket packs and sutures.

Rubbing sutures

All sutures we use are resorbable - they will fall out on their own with time.

· You need to keep the site clean with gentle brushing and warm salt water mouthwashes.

· All our sutures are easy to remove when needed. If you are feeling confident, all you need to do is just one cut anywhere on the suture with a clean, small scissors. The whole thing can be pulled out after that. Best to grab hold of the knot to pull it, so you are not pulling the knot into the tissues. There could be more than one suture, so each one has to be removed individually.

· If you couldn't do it, still not a problem as long as you keep it clean as above. The body eats in to the suture slowly and as soon as the thread is broken across, the suture will fall out. Also, with time, the knot will start to unravel, so the suture can be pulled out after that.

Rubbing dentures

These usually require adjustment by the dentist. The following will help in the meantime.

· You should consider using a fixative like Fixodent or Seabond denture pads. These stabilise the denture and make them more comfortable. These are available from supermarkets, pharmacies, Amazon and eBay.

· Any sharp or rough bits can be adjusted at home with an emery board.

· Any ulcers should be managed as in the 'Ulcers' section above.

· If these haven't helped and if it is too sore to wear, you need to leave the denture out until we can see you.

Sensitivity

Teeth can get sensitive due to receding gums, decay or failing fillings.

· Desensitising toothpaste can help. Some popular brands that can help are Sensodyne Repair & Protect or Colgate Sensitive Pro-Relief. Rub toothpaste directly on to the affected area and do not rinse afterwards. This needs to be left at least for an hour like this. You need to do this twice daily for a few weeks.

· Avoid hot or cold food/drinks, so the sensitivity is not triggered.

· You need to maintain good oral hygiene and limit sugar in the diet to prevent this getting worse.

· You may need regular painkillers if it is severely sensitive. Ibuprofen or Paracetamol are the usual tablets.

· If it gets worse, with the pain becoming severe and continuous, you need to manage as in the 'Toothache' section.

Bleeding gums

This is usually due to Gingivitis or Periodontitis (gum disease).

· Gums will not stop bleeding until your oral hygiene improves. You need to brush teeth and gums twice a day, spending extra time on the ones that bleed.

· If not using already, you need to start using floss or TePe brushes to clean between your teeth. This should be done at least once daily.

· We don't recommend using a mouthwash for bleeding gums. If you use Corsodyl for even over a week, the teeth will get stained brown.

· You will need a hygiene session.

Krish Kothand