What is a dental emergency?Facial swelling extending to eye, neck or floor of the mouthBleeding following an extraction that does not stop after 20 mins ofsolid pressure with a gauze/clean hankie. A small amount or taste ofblood is normal, just like if you had grazed your knee. Bleeding due to trauma.Severely broken tooth causing severe painTooth fallen out from trauma Significant toothache that is preventing sleep, stopping eatingcombined with swelling or fever that is not manageable with painkillers.

Guidance: NHS England and the Department of Health have instructed dental practices to stop face-faceroutine dental care during the pandemic period to reduce the risk of virus transmission and prioritise urgentdental problems by telephone advice only where possible. The following guidance is to support you in helpingmanaging minor symptoms at home. Please do call us though if you have a problem and want advice orguidance.  Accessing dental care: If you have an urgent dental problem, there are local Urgent Dental Care Centres beingset up to enable treatment to be undertaken should you need it. Please call us and we will advise you.

Go straight to A & E if: Non-Urgent Dental Problem(may have to wait until practice re-opens)

Loose or lost crowns, bridges or veneers.Broken, rubbing or loose dentures.Bleeding gumsBroken, loose or lost fillings.Chipped teeth with no pain.Loose orthodontic wires.Lost invisalign button Broken brace or retainer problem

What if I am in the middleof treatment?

Tips for managing dental problems at home during Covid-19 pandemic

Please callthe

practice

if you have adental

emergency orneed advice

Facial swelling affecting yourvision, breathing, ability totake in fluids or preventingyour mouth opening morethan 2 fingers width.

Trauma causing loss ofconsciousness, double visionor vomiting

We know it is not ideal at the moment,but we must follow the strict guidancewe have been given. We ask anyone who is in the middle oftreatment to call or email us to discusstheir case individually

How Get in touch

01926 423564 (on duty dentist)

clinicians@thegrovepractice.co.uk (email goes direct to our dentists)

Thanking Dentist's Dr. Becky Davies, Dr. Nilesh Parmar and Dr. Yasmin George for the building blocks of this. Made by Upen Vithlani, April 2020Source

A swelling can happen inside oroutside your mouth soon after atoothache. Most often, it is a result ofan infection. Applying icepacks to the jaw may helpease discomfort and some of theinflammation. Using ice can also havea numbing effect. Try holding an icepack with a tea towel around it againsttheir jaw for up to 15 minutes. If you do not have an icepack usefrozen peas etc. Get in touch with us if you have aswelling. We can help by remotelyprescribing antibiotics to ease theswelling.

Swelling

ToothacheGet in touch with us about your pain. Very rarely antibiotics may help, but it is best tospeak to us to decide if you need to be referredto a local urgent care hub Toothache usually happens because the toothnerves are angry and inflammed inside thetooth as a result of decay, a leaking filling, orbroken tooth.  It can sometimes lead to a swelling

Painkillers (analgesics)

Over the counter pain killers can helpThere is currently no strong evidence, butuntil we have more information: Patients who have confirmed COVID-19, orbelieve they have symptoms: should takeparacetamol in preference to ibuprofenif possible, unless your GP has told youparacetamol is not suitable for you. Caution: Any medication should be takenin accordance with instructions on thepacket. Taking too many of anymedication can cause serious healthproblems and can be life threatening

Tooth SensitivityIf you have sensitivity to hot/cold food ordrink that goes away quickly - desensitisingtoothpastes can help. Rub toothpaste directly on the affected areatopically like a cream and don’t rinseafterwards. Do this particularly around the tooth at nighttime to give it longer to work

There are many toothpastes on the market forsensitivity such as:

Lost FillingsIf the tooth is broken or a filling is lost, you maynot need treatment straight away if it is notpainful and it is a clean fracture. Sometimes, anover-the-counter temporary filling materialfrom a pharmacy or online may help - along withclove oil. Some kits will have everything needed to handlethe situation until you can see us.

Call us for advice, and so we can set a follow up

Tips for managing dental problems at home during Covid-19 pandemic

Thanking Dentist's Dr. Becky Davies, Dr. Nilesh Parmar and Dr. Yasmin George for the building blocks of this. Made by Dr. Upen Vithlani, April 2020Source

Wisdom Teeth Wisdom tooth pain is usually due to inflammationaround the gum flap that sits just over theerupting back tooth when the tooth has notcome fully through. Sometimes the pain canspread around the ear too. Usually it is because food or plaque has startedto get below the gum flap. Sometimes the guminflammation can be made worse by trauma fromthe tooth above biting on to the gum

Bleeding from gums is NOT a denta lemergency butcan be worrying. Bleeding gums are usually due to gum disease, wherethe gums get angry (inflamed), in response to plaquebuilding up (food debris and bacteria, left behind fromnot brushing well enough). The bleeding gums will improve when brushing andcleaning in between the teeth improves. DO MORECLEANING AND NOT LESS. Brush TWICE a day with a fluoride toothpaste for 2minutes. Concentrate especially on the areas that arebleeding. Use floss or tepe brushes to clean betweenyour teeth every day.

Bleeding gums

Most flare ups can be managed withgood home care by:

Excellent cleaning (even if its sore atfirst). Cleaning it well encourageshealing.

Use a brush with some bristles thatreach under the gum flap, like a'single tufted brush'

Warm salt water gargles can help.30 seconds at a time, a few times aday, or Corsodyl (but watch out, thatstains teeth after 2 weeks of use)

Soft food in the area

Painkillers if needed

Ulcers.

Tips for managing dental problems at home during Covid-19 pandemic

If you have difficulty swallowing or difficulty opening wide or swelling in yourcheek, you may need antibiotics. Call us for advice

Most ulcers should heal by 7-10 days.Non-healing ulcers or oral lesions presentfor more than 3 weeks should beassessed by a dentist or doctor. We may be able to do this remotelyduring this period.

Warm salt water gargles (like with managingwisdom teeth, as above). Gentle but thorough cleaning with a softerbrush in the area may help, but try not toavoid the teeth in that area. Keeping the areaclean is really important. Eat soft food in thearea too. Mouthwashes, gels or pastilles can help e.g. Difflam (Benzydamine) mouthwash orspray, or Oraljel

Lost Crown or Bridge Keep the crown or bridge until we can seeyou, somewhere safe and clean. Disinfectit first with a simple disinfectant spray likeDettol. It is really important to keep the tooth corein the mouth very clean and brush thesurfaces as normal. Perhaps use a biggerinterdental brush to clean around the sidesand a mouthwash to help keep the gumaround the edges healthy. This may or may not be something the localurgent care centres accept. Call us to discuss your options and if itssuitable to consider glueing it back in andwe can discuss let you know how if itssuitable.

Take painkillers as advised if needed. Some pink spit/taste of blood isnormal after an extraction but if thesocket is bleeding freely, bite hard onsome clean gauze or rolled up cleanhankie for 15-20 minutes.  If bleeding doesn't stop call us andstay biting down with the pressure onwhilst you wait

Pain or bleeding after a tooth extraction

Jaw or joint aches

Open and close the jaw in a straight line, in front of a mirror,with your tongue curled back to the roof of your mouth. Trydo this 2 minutes a day, for a 2 weeks.

Avoid hard food and chewy foods like steak, biting yournails and chewing gum, which can all overwork chewingmuscles.

Be conscious to 'let your teeth apart' when you feel you areclamping down

If very bad, try a heat pack or cold pack, which ever youfind more comfortable, and painkillers

At times of stress like this, the muscles in our face and theones used for chewing an 'overwork' resulting in tensemuscles that may be tight, or painful due to clenching orgrinding. Headaches may happen too as well as more toothsensitivity and gum soreness. To help relax muscles andstretch them, some simple home physio can help:

Tips for managing dental problems at home during Covid-19 pandemic

Thanking Dentist's Dr. Becky Davies, Dr. Nilesh Parmar and Dr. Yasmin George for the building blocks of this. Made by D.r. Upen Vithlani, April 2020Source

There are some simple things you can do at hometo help The trick here is to try and locate those areas thatare rubbing. If you leave the denture in place for 5mins or so then when it is removed you should beable to see any “rubbing areas” or sore spots. Use agood light to see. An Emery board file / nail file,  snapped in half canbe used to smooth down the problem area. Repeatthis at least half a dozen times to feel the difference -remembering that the sore area will still be sore andso you are looking at things being more comfortablerather than perfect after finishing. Leave the dentureout for a day or so to help. Denture fixative can also be used to provide anextra “cushion” even if you don’t normally use it. Call us and we will be able to organise for some Fixodent to be delivered to you.

Rubbing Denture

Tips for orthodontic patients duringCovid-19 pandemic

If you are in Invisalign treatment with us, we will be contacting you individually, via email and phone tocheck in and see how you are doing. Each case is individual and in some cases we may be able toprogress your case remotely for a short period, and in others we may need to hold you on your lastaligner, or have a break until we can restart.

Invisalign Aligner Treatment - FAQs

I still have many aligners left, should Icontinue to wear each aligner for 7 or 10days?

No, during this period, as we do not knowwhen we will be allowed to resume anyroutine or elective treatment, wear eachaligner for 2 weeks

I am on my last aligner of the treatment,what should I do?

Continue to wear this aligner for as long asfeels clean and rigid still. Contact us forreplacement holding aligners - During theCOVID-19 period Invisalign will allow up to 3sets at a time, for a reduced cost of £25

I am due to have buttons fitted soon? You will need to stay on this aligner (as yourlast aligner for now), as above

I am moving on to the next aligner but it isnot sitting down well, what should I do?

Go back to your last well fitting aligner asyour holding aligner. Contact us to let usknow, we will want to keep you on that aligner,and perhaps order some replacement holdingaligners on that stage that you have reached.

I have lost a button, what should I do?

I use elastics but have run out?

Stay on the aligner you are on, contact us todecide if you can move on or not and we canorganise for the button to be replaced whenwe are open again.

Don't worry, let us know and we can organisefor some to be sent to you

I am on the last of the aligners I wasgiven, but have more in my series to go,can I continue to move on withtreatment?

Yes - if the main treatment steps havefinished, like the space making, then you can.We can organise for the the next few alignersto be delivered to you. We will also need tohave virtual online consultation to see howyour getting along.

My aligner is irritating the tongue or cheekor digging in the gum

Let us know, and use an Emery board/nail fileto dumb down the area you feel thesharpness or discomfort is coming from. Ifthis doesn't work, go back to the previousaligner

I am on my last aligner, can I wear it atnight time whilst I wait for my nextappointment again?

Yes - in these circumstances, you can, but ifthe aligner feels tight putting it in, or if teethmove back, use full time again and contact usfor a fresh replacement aligner

Made by Dentist, Dr. Upen Vithlani, April 2020Source

Advice for brace problems: The British Orthodontic Society has made a very useful resource for all orthodonitc patients and wewould like to refer to this: https://www.bos.org.uk/COVID19-BOS-Advice/Patients-Advice

Orthodontic Brace Problems

Tips for orthodontic patients duringCovid-19 pandemic

You or a family member may be in brace treatment here orelsewhere, and hopefully these tips may help in the event of aproblem with your brace.

Avoid hard foods like nuts that may lead to a bracket comingoff or the wire bending

Avoid sticky food that can cause more plaque to build uparound the brace

Exemplary oral hygiene: brushing 3 times a day with yourstandard toothbrush, followed by the additional smallinterdental or christmas tree shaped brush all around thebrace brackets. As an adjunct, use of a fluoride mouthrinseeg. Fluoriguard (225ppm), once a day

Low sugar diets - where possible avoid snacking on sugarsand drinks with added sugar. Fizzy drinks should be avoidedin particular.

To prevent problems occuring whilst in braces some simplethings can help:

Generally, whilst your brace is not being adjusted, the wires will still be working a little, and thebrace will naturally become 'passive' - which is safe. We will want to touch base with you via phone or video consultation at least once a month, tosee how you are getting along.

Lost or Broken retainers

Contact us to let us know if youhave lost or broken it. It may be thatwe have a previous model we canmake one off, or your last scan. Although dental laboratories areshut, Invisalign are able to make theirretainers and have them delivered toyou or us (Invisalign's ViveraRetainers)

Broken fixed Retainer

If you can: push wire back down towards the tooth asmuch as possible with fingers or tweezers. Cover thesharp end, with orthodontic wax (which we can send) orblu-tac to stop discomfort. Call us. You can either: cut the exposed unbonded wire usingtweezers and nail clippers/scissors, or gently pull thewire to remove the whole retainer.

You must use of removable your retainers at leastevery night as minimum.

Made by Dr. Upen Vithlani,, with resources from the British Orthodontic Society, April 2020Source

With best wishesF R O M A L L O F U S A T

How to get in touch during COVID-19 closure

01926 423564 (on duty dentist)

clinicians@thegrovepractice.co.uk (email goes direct to our dentists)