Managing toothache during self isolation.

Managing Toothache during self isolation

If you are self isolating and unable to leave the house then the last thing you want is to develop toothache. The practice is open for emergencies but we recommend everyone, especially those over 70 or at increased risk of severe illness due to COVID-19 follow stringent social distancing measures. If you have symptoms of Coronavirus (new persistent cough and/or fever you should not attend the practice).

If you are not able to see us, there are a few things you can try to manage the pain until you can. It is unclear at this point when normal service will resume. If you have a swelling on your face or difficulty swallowing, this requires urgent professional attention so don’t be afraid to contact us for advice.

What counts as a dental emergency?

Urgent Dental Treatment:

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

Go straight to A&E:

• Facial swelling affecting vision or breathing, and preventing mouth opening more than 2 fingers width
• Trauma causing loss of consciousness, double vision or vomiting

Non-Urgent:

• 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

Pain from teeth:

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 no strong evidence that drugs like ibuprofen could make COVID-19 worse.

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

So, until we have more information, take paracetamol to treat symptoms of coronavirus, unless you doctor has told you paracetamol is not suitable for you (Updated 20th March 2020).

Painkillers should always be taken in accordance with instructions on the packet. Taking too many tablets, or taking medications incrrectly will not improve your symptoms, and can cause serious stomach and liver injury which can be life threatening.

Toothache:

If the toothache is extremely sensitive to hot or cold, antibiotics will not help. The decay must be removed and filled.

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

• 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 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.
• Desensitising/ sensitive toothpaste (such as 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.

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 is vital, even if it is painful to brush, the area must be kept clean to encourage healing)
• Corsodyl mouthwash or corsodyl toothpaste will help reduce inflammation, but don’t use the mouthwash for more than 2 weeks, otherwise it will stain your teeth.
• Stick to a soft diet to reduce trauma when biting.
• Use painkillers like ibuprofen or paracetamol.
• Use a warm, salty mouth wash.

Ulcers:

Although painful, most ulcers will heal within 7 to 10 days. Non-healing ulcers/oral lesions present for more than 3 weeks should be assessed by a dentist or doctor. To treat, try:

• Use a warm, salty mouthwash
• Excellent cleaning
• difflam spray or mouthwash
• Soft diet
• Painkillers
• Bonjela or anbesol
• Corsodyl mouthwash

If your dentures are rubbing and causing an ulcer, you can try using a denture fixative, not only to soften the denture against the gum, but to secure the denture in place. Sharp edges can be removed with an emery board. Also, try leaving your dentures out as much as possible to allow the ulcer to heal.

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 daily with fluoride toothpaste for 2 minutes, concentrating especially on the areas that are bleeding. Use floss or a tepe every day to clean between your teeth.

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.

Lost crown:

• Clean and check the crown. If the crown is mostly hollow, you can attempt to recement it at home if you feel confident enough 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 the debris must be removed from both the crown and the tooth for it to seat properly.
• Check the crown fits without cement. Check that the bite feels correct. If it feels like you are hitting the crowned tooth first, then it’s not fitted correctly. Double check for debris. Never force a crown into position as this may cause the tooth to fracture. If you cannot get the crown to fit, please wait to see your dentist, but keep the tooth as clean as possible in the mean time.
• Crowns can be replaced using a dental cement, which you can get from most pharmacies. Do not use super glue!
• 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.
• Remove any extra cement with a toothpick and floss between your teeth to make sure they do not stick together.