Managing toothache at home.

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Tips on how to manage dental problems until you can see a dentist

Following the recent guidelines from NHS England and the Department of Health, dental practices have been advised to STOP AEROSOL SPRAYS and PRIORITISE URGENT TREATMENT where possible. 
As well as reducing the risk to staff and patients this will also prevent unnecessary travel in an attempt to reduce virus transmission. The following information aims to advise people in pain who need to access care and support people managing minor symptoms at home. 

If you need to access emergency care: 

  • Have you or anyone in your household been self isolating? 
  • Do you have any symptoms?
  • High temperature or continuous cough?

If the answer to any of the above is YES, CALL 111. They will direct you to an emergency facility with the appropriate protective equipment which will allow staff to treat you safely. 

What counts as a dental emergency? 

  • Facial swelling extending to the eye or to the neck
  • Bleeding following an extraction that does not stop for 20 mins
  • Bleeding due to trauma
  • Significant toothache preventing sleep, eating, or fever that can not be managed with painkillers. 

Straight to A&E

  • Facial swelling affecting vision or breathing, preventing mouth 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
  • Loose orthodontic wires 

Painkillers

Anti-inflammatories like ibuprofen can help reduce pain from teeth. Combining paracetamol and ibuprofen has shown to be effective. 

There is currently no strong evidence that drugs like ibuprofen 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 it is not suitable for you. 

Remember painkillers should always be taken in accordance with instruction on the packet. Taking too many tablets, or taking medication incorrectly will not improve your symptoms and can cause serious stomach and liver injury which can be life threatening. 

Toothache 

If a tooth is extremely sensitive to hot or cold, antibiotics will not help. 

There are home measures which can help until care can be managed

  • Good cleaning with fluoride toothpaste and reducing sugar intake will stop decay from getting any worse. 
  • If there is a hole in a tooth, or a tooth has cracked and is now sensitive/sharp, a temporary filling can be packed into the space. Temporary filling kits are widely available for pharmacies. 
  • Sensitive toothpaste (like sensodyne) can help. Rub toothpaste directly on the affected area and rinse afterwards. 
  • Anaesthetic gel such as orajel can help ease pain. 

Wisdom teeth 

Wisdom tooth pain is normally 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 ina few days to a week. 

  • Excellent cleaning, even if it is painful to brush, the area must be kept clean
  • Corsodyl mouthwash, avoid use for more than one week as it may cause staining
  • Soft diet, soft food will reduce trauma from biting 
  • Painkillers, ibuprofen or paracetamol, following the packet instructions
  • Warm salty mouthrinses 

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. 

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. The following can help ease pain and promote healing: 

  • Warm salty mouthrinses
  • 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
  • Soft diet, soft food will reduce trauma from biting 
  • Painkillers, ibuprofen or paracetamol, following the packet instructions
  • Rubbing Dentures, denture adhesive 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 can cause staining. 

Pain or bleeding after an extraction

  • Continue to take regular painkillers for several days after an extraction, it is normal for the pain to be at its worse at day 3-4
  • Some pink spit/oozing is normal after an extraction, but if the socket is bleeding freely, bite hard on a gauze or clean handkerchief for 20 minutes. If bleeding has not stopped, call your dentist. 
  • 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 forming. This can be very painful and regular painkillers are unlikely to be effective. You should call your dentist for an emergency appointment. Antibiotics will not solve this, as a dressing is needed to cover over the exposed bone. 

Lost crown 

  1. Clean and check the crown. If the crown is mostly hollow, you can attempt to re-cement at home if you feel confident to do so. 
  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 your tooth and the crown for it to seal 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 post onto or into your tooth, this can cause the root to fracture. If you cannot get the crown to fit, you will need to wait until you can see a dentist. 
  4. Crowns should be re-fixed using a dental cement from a pharmacy. DO NOT USE SUPERGLUE.
  5. Once you have practiced placing the crown, dry the tooth and the 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 toothbrush or tepe and floss between your teeth to make sure the cement does not stick between the teeth.
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