Having Dental Implant Treatment in the middle of Coronavirus Outbreak

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During these unprecedented times we would like to give you some useful tips to help you resolve and reassure any possible dental implant related concerns you may have.

Recently placed implant(s)

If you have had implant(s) placed in the last week or two you will be due to have the stitches removed soon. You will have been informed if these are dissolvable or not. If they are dissolvable then there is no urgency to attend the practice, stay safe at home. A member of our team will give you a call to check on how you are doing. If the stitches are not dissolvable please contact the practice and we will arrange an appropriate time to have them removed.

3-month healing phase

After having had the implant(s) placed you will have a 3-month gap before the next stage of treatment, implant expose. Due to the current situation, several of our patients will be waiting longer than 3 months before this is carried out. Please do not worry, no harm will be done to the implant or you if this stage is not carried out after 3-months. This stage can be carried out any time after 3 months.

Implant expose

This stage is routinely carried out 3 months after placing the implant. Some patients will have had this part of the treatment already carried out. You will have had a small circular disc called a healing cap or healing abutment placed into the implant that protrudes through the gum. It is very important that this cap/abutment is kept very clean. You must brush the cap directly with your toothbrush (electric or manual) twice a day just like your teeth to keep it clean. No harm will be done to it. If it is kept clean and the gums around it healthy you will minimise any risk of problems.

A common issue with these healing caps is that over time they can become loose. Do not be concerned if this happens. Carry on brushing it and it will unwind fully and drop out. Keep the cap in a safe place. The gum will heal over the top and close the hole. Under current guidelines this is not a dental emergency and so you do not need to attend for any treatment. However, please do give us a call so we can make a note of it and plan to get you booked in as soon as we are able to resume normal services. It would also be very helpful if you can send a picture of the cap so that we can reassure you no further intervention is required.

Implant impressions

A small number of patients will have had impressions (moulds) of their teeth carried out to make the implant teeth or to start the stages to make the teeth. With the Government’s advice regarding social distancing and our governing bodies advice of not using any aerosol generating procedures, most laboratories will have closed or significantly limited the work they will be carrying out. Rest assured that when the time comes to fit your new teeth, if there are any adjustments, discrepancies or need for remaking you will not be charged for these. Many cases will be routine and we will be able to fit your new teeth with minimal disruption, once we are able to resume our normal service.

Completed Treatment

If your implant treatment has been completed, you will have been placed on our implant recall list. If you are due your implant check-up, this will be postponed until we are able to resume normal service.

Complications which may occur which are not deemed an emergency:

  1. Loss of a healing abutment. If the healing abutment (Small metal stopper protruding through the gum) can occasionally come loose during the healing phase. This is not a problem and can remain out during the healing phase and beyond.
  2. Loss of a dental implant. If the dental implant becomes loose and falls out the area will heal as normal. Please contact the surgery to advise of the situation and we can make appropriate arrangements to assess you for further treatment after it is safe to do so.
  3. Loss or loose implant crown. If the implant crown has fallen off, simply keep the crown safe and the area in your mouth that the crown once fit clean. Contact the surgery to advise of the situation. If the implant crown is loose and causing pain contact the surgery for further advice.
  4. Broken/chipped implant crown. This is not an emergency and no treatment is necessary.

 

Complications which may be deemed emergency care:

  1. Pain, swelling, with facial swelling associated with a dental implant or teeth
  2. Trauma due to a fall, RTA which has fracture, loosen or avulsed your implant/teeth.
Wisdom Tooth Pain

Managing Wisdom Teeth Pain During Coronavirus Outbreak

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Adults can have up to 32 teeth. The wisdom teeth are the last to appear, right at the back of the mouth. They usually appear when you are between 17 and 25, although sometimes they appear many years later.

People often have jaws that are too small for all 32 teeth to fit (28 is often the most we have room for) so, if all the other teeth are present and healthy there may not be enough space for the wisdom teeth to come through properly.

Often there will be some slight discomfort as they do come through, but this will disappear once the tooth is fully in position.

If there is not enough room, the wisdom tooth may try to come through, but will get stuck against the tooth in front of it. The wisdom tooth will be at an angle, and will be described by the dentist as ‘impacted’.

What problems should I be prepared for?

If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and perhaps swollen. This is called ‘pericoronitis’. Bacteria and bits of food can collect under the gum edge, making it difficult to clean the area properly.

This is a temporary problem that can be dealt with by using mouthwashes, special cleaning methods and possibly antibiotics. If the problem keeps coming back, it may be better to have the tooth removed once we resume normal surgery in the coming months.

What can I do to help relieve the discomfort of wisdom teeth?

A mouthwash of medium-hot water with a teaspoonful of salt will help to reduce gum soreness and inflammation (check that it is not too hot before using it). Swish the salt water around the tooth, trying to get into the areas your toothbrush cannot reach. Do this several times a day.

An antibacterial mouthwash containing chlorhexidine (CORSODYL) can also reduce the inflammation, but do not use if you have an allergy. Pain-relieving tablets such as paracetamol or ibuprofen (NOTE IBUPROFEN MAY NOT BE ADVISED IN PATIENTS WHO HAVE SYMPTOMS OF CORONAVIRUS) can also be useful in the short term, but talk to your dental team if the pain continues. The tablets should always be swallowed and not placed on the area.

What if this does not help?

If the pain does not go away and there is a swelling under your chin/jaw/neck that you can see from outside or you find it difficult to open your mouth, you should contact your dentist.

If you feel there is any tightness of your airway/throat or difficulty swallowing then you MUST go STRAIGHT TO A+E in hospital.

Bleeding gums

Bleeding Gums during Coronavirus Outbreak

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Gums can bleed for a number of different reasons. Gums might bleed on brushing due to mild inflammation but often stops soon afterwards.

If the bleeding hasn’t stopped within a few minutes press a clean cloth or piece of packing to the area and call the practice for advice.

Common causes of bleeding gums:

  • Trauma or ulcers – this can be due to mild trauma, like a burn from something like pizza, or a cut from a crisp or a graze from your toothbrush. If this is the case keep the area clean by rinsing with a mouthwash like Chlorhexidine or Corsodyl if you aren’t allergic to this. Or even just saltwater-a teaspoon of salt dissolved in half a tumbler full of warm water. If it is painful then Bonjela, Difflam mouthwash or even teething gel from your chemist may help along with whatever pain relief you would use if you had a headache. Also see separate ulcers advice.
  • Gingivitis – This basically means swollen gums which can be down to a number of reasons, but is normally because you need to tweak your brushing. Make sure you are flossing or using interdental brushes every day. Brush twice a day with either a manual toothbrush angling up towards the gum at 45 degrees and using a circular movement, spending a few seconds on each tooth before moving systematically around your mouth so you don’t miss anywhere. If you are using an electric or sonic toothbrush it’s the same advice just no need to do the circular movements as the toothbrush does that for you. Please don’t worry if there is blood or pink toothpaste when you first start doing this. The gums are likely to be swollen so bleed more readily, the good news is that if you persevere, within a few days you will notice less and less bleeding as a reward!
  • Gum Disease or Periodontal Disease – It is highly likely you are already aware that you suffer from gum disease if you come to the dentist regularly. What you may be experiencing is a localised flare up caused by some undisturbed plaque or food that’s become stuck. Normally localised use of an interdental brush to make sure the area is spotless along with some Chlorhexidine gel or mouthwash (as long as you are not allergic) on the interdental brush a couple of times a day will help settle the area within a few days. If it is painful take pain relief that you would normally take for a headache.

 

If you have any concerns please don’t hesitate to phone the practice.

managing a mouth ulcer

Dental Pulpal Pain during Coronavirus

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Correct as of 24th March 2020 9am

Toothache is extremely unpleasant, which is why your dentist always does everything they can to accommodate patients in pain. In these extraordinary times our ability to attend the Practice or have the personnel available to attend may be curtailed.

This guidance is an attempt to tell you what type of dental pain you may have, how severe it is and how you can manage the situation.

We are facing unprecedented times both in everyday life and in healthcare provision. The situation has and will continue to, move and change rapidly as new scientific information becomes available.

We ask you to understand that we are under guidance from the Department of Health and our Professional bodies and regulators which is limiting the treatment we can provide in an attempt to stop the spread of Coronavirus.

We are only able to offer an emergency service and it is important to understand what constitutes a dental emergency.

Teeth have nerve tissue (pulp) in the middle of them. If this nerve tissue becomes inflamed it can lead to mild, moderate or severe pain or infection. Inflammation of the nerve can occur if there is decay in the tooth or the tooth is cracked or has a large filling.

The treatment depends on the status of the pulp.

Normal Pulp

Teeth can still be sensitive to hot, cold or sweet things when the pulp is normal. You may experience discomfort for a few seconds from a stimulus that disappears when the stimulus goes. This is normal and does not need assessment or treatment, the stimulus can be avoided. You can use a sensitive toothpaste to brush the area and after brushing and rinsing, apply some sensitive toothpaste to the area leaving it in place.

Reversible Pulpitis

This occurs when the pulp is slightly inflamed but no permanent damage has been done. You may experience discomfort to hot or cold that disappears when the stimulus is removed. This doesn’t constitute a dental emergency. You can manage the symptoms by not having food and drink with extreme temperature like ice cream or hot drinks.

Again, sensitive toothpaste may help. Pain relief can be useful in these circumstances, the best pain relief for dental pain are over the counter analgesics. The best evidence is that Paracetamol and Ibuprofen combined offers the most effective pain relief. 500mg Paracetamol and 400mg Ibuprofen taken together 4 times a day with at least 4 hours between doses.

It is very important that you read the advice sheet for both of these drugs as some people shouldn’t take one of both of these drugs. If in doubt we advise to speak to your pharmacist or GP.

There is some emerging evidence that COVID 19 (Coronavirus) can be worsened by Ibuprofen. Whilst the evidence is currently weak, until we know more, we advise that Ibuprofen is not used if you have symptoms of Coronavirus.

Irreversible Pulpitis

This occurs when the nerve is irreversibly inflamed and can result in severe toothache which comes on with no stimulus, lasts for hours not minutes, disturbs sleep and is not controlled with painkillers. The tooth is typically not tender to bite on. The pain may be diffused, difficult to localise or spread to other regions. This constitutes an urgent case and needs assessment. You will need to ring your practice to undergo a phone assessment by members of the dental team. If it is decided you need treatment, you will be given advice on how you will access further assessment possibly at the practice or a regional centre. The guidance is changing by the hour and this information will be regularly updated. You will then be clinically assessed by a dentist who will decide with treatment is most appropriate. The treatment would be extraction of the tooth or removing the inflamed nerve and doing root canal treatment.

Infected Tooth

This occurs when the nerve of the tooth has died off and bacteria have infected the tooth. The symptoms are very different from pulpitis. Typically, the pain is well localised to a particular tooth, this tooth would not be sensitive to hot and cold but would be painful to pressure or biting. This constitutes an urgent case and needs assessment. As above, you would undergo phone and clinical assessment and the most appropriate treatment will be implemented. The treatment would be extraction of the tooth or removing the dead nerve and doing root canal treatment.

If an infected tooth is not treated, or becomes infected quickly, it can lead to localised swelling, severe pain and whole-body symptoms like fever, chills and malaise. This constitutes a dental emergency and needs urgent assessment.

If under these circumstances, the swelling interferes with your swallowing or breathing, or causes an eye to close this would need urgent hospital assessment. The best thing would be to go directly to Accident and Emergency without going to the dentist first.

Mr Michael Turner BDS MSc (Endodontology)

 

 

 

broken tooth

Lost Fillings and Broken Teeth – during Covid-19

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We understand that losing a filling can be a concerning and worrying time.

It can leave your teeth sharp which can make your lips and tongue sore, it can sometimes leave your smile looking unsightly and the tooth can become more sensitive to extremes of temperature or even end up giving you an ache. However, in most cases, everything can be fine.

If you experience a lost filling or broken tooth in these extraordinary times, we need to manage your problem without putting you or our team at any extra risk. We have extremely strict guidelines which we follow to help control the spread of the Corona Virus so our normal ethos of seeing everyone we possibly can, as soon as we can, can’t be implemented.

We are not allowed to do any drilling or use any water so we won’t be able to repair your tooth permanently.

As an alternative, if the tooth isn’t painful or sharp, is to purchase a temporary filling kit from your pharmacist to tide you over until the worst of the Covid-19 Pandemic is over. We would advise you cover the broken area or sharp part and leave for a few minutes to set.

Please don’t hesitate to contact the team, we will be more than happy to give you advice.

Denture Problems during Covid-19 disruption

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Correct as of 24th March 2020.

If your denture is broken, as we write, some labs are still open to mend your denture, however not all are. Please call the practice to see if we can help.

If your denture is loose or rubbing you may find denture fixative like Polygrip or Fixodent may help stabilise the denture in the short term while we get through the acute phase of the Covid-19 Pandemic.

Another option, although we realise this may not be terribly desirable, is to leave the denture out until the sore area has healed, then try the denture in again. Sometimes the sore area is caused by a rogue bit of food getting under the denture and once healed the denture is comfortable again.

Once we are allowed to see patients normally we will be more than happy to see you to discuss how we can help if you are still getting problems.

Please call the practice if you would like any further advice.