Dental Pulpal Pain during Coronavirus
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)
