As dentists have now been instructed by NHS England NOT to provide any face to face emergency treatments other than in designated hubs, we felt it would be useful to give you a few tips to manage less serious dental concerns.

Please contact us for further advice and possible referral if you try the following but are still struggling with persistent problems.

Toothache

• Over the counter painkillers can be helpful (always read and take in accordance with the instructions on the packet).
• Patients who have confirmed or suspected COVD-19 should NOT take ibuprofen (otherwise known as Neurofen).

Toothache/Gum Disease

Sometimes toothache–like symptoms can originate from gum inflammation around a tooth.

Most people don’t brush their gums nearly enough and then when they do, their gums bleed and they think they should stop brushing…

Gum disease is very common in adults and can cause gum abscesses, as well as teeth becoming loose and falling out!

Try these tips:

· Use a small, soft toothbrush and tilt it into the gum line at 45 degrees. Brush side to side or in small round circles focusing on a tooth at a time before moving on…

· Take your time: good brushing should take at least 2 mins.

· Try disclosing tables – they stain up plaque a bright colour so it can be seen and removed… read the instructions carefully.

· If you get bleeding when you floss or use your in-between brushes, try stepping up your routine. Use at least once a day between all the teeth.

· Use the largest in-between brush you can get into the space and remember you need to work the brush right against the gum line when you push it in and take it out.

Tepe brushes go up in size as follows: blue, yellow, green ,purple, grey , black.

· Remember to close your teeth together when you use in between brushes as it will really help you get into the back teeth. Sometimes, slightly bending the handle also helps…..

· Using a bigger in- between brush will hurt but this should settle as you do it more… you will probably get a lot of bleeding too, again this will stabilise as the gum starts to recover.

· Warm salt mouthwashes may also help (but as well as not instead of the in- between brushes) as mechanical removal of plaque is really the only way to settle inflamed gums.

· Corsodyl mouthwash may also be useful (beware allergies to chlorhexidine/ staining ) and only use for 1 week maximum !

And remember, stick with your routine if/ when the pain settles, as it will soon come back if the habit stops!!

Sensitivity

• Sensitive toothpaste can be really effective for this. Brush with a small soft toothbrush and warm water.
• Electric toothbrushes often have a special monitor to stop us putting too much pressure (over scrubbing) which can make the problem worse. You can get special sensitive heads for most electric toothbrush brands.
• Avoid rinsing after brushing so that the toothpaste leaves a slurry in the mouth. This is because sensitive toothpastes work by creating a barrier to block out the little holes in dentine that transmit the sensitive sensation.
• If you have a particularly sensitive spot, rub a little sensitive toothpaste into it just before you go to bed and leave on.
• Remember sensitive toothpastes may take a few days to build up in effect and when things settle, continue using or the problem will come back!!!

Ulcers

These can be common. Some people get them regularly and have learnt to manage them but they can be very sore to start with. Most ulcers heal within 7-10 days.

To ease the pain, try:

• Warm salty mouthwashes (1 teaspoon of salt in half a glass of warm water)
• Difflam spray or mouthwash
• Corsodyl mouthwashes (max-1 week use)
• Soft diet
• Pain killers

If ulcers persist for more than 3 weeks and are not painful, contact your dentist.

Sore dentures

• Sometimes a loose denture can rub. Using a denture adhesive like Fixodent may help secure a loose denture.
• Make sure you dry the denture thoroughly first and only use a small amount. Hold the denture up against the mouth, pressing firmly with your thumb for about a minute to allow the fixative to “set.”
• Sharp edges can be filed using an emery board.

Pain associated with wisdom teeth

Problems with upper and lower wisdom teeth often arise due to food packing around the gum next to them. This is called pericoronitis and is often worse when teeth are not fully through (erupted). The gum swells and becomes inflamed ,then you bite on it and the problem becomes worse.

Most flare ups can be managed with good home care:

• Clean well under the swollen gum flap using a small pointed brush (wisdom do a nice one called the tuft- similar to the one that kids use for braces).
• Warm salt mouthwashes are also good to swill round the mouth after each meal: 1 teaspoon of salt in half a glass of warm water.
• If these measures aren’t sufficient a mouthwash such as corsodyl (*chlorhexidine gluconate) can be used. This is for acute gum conditions only and can stain. It should be used with caution as a few people can be allergic to chlorhexidine and never for more than 7 days.
• An alternative is Difflam (which is sold as sore throat rinse). This is particularly good for pain as it contains a local anaesthetic. It can be diluted with water if stinging occurs in a ratio of 1:1
• Pain relief can be used and soft food is advised.

If you have difficulty swallowing or swelling in your cheek, you may need antibiotics. Call your dentist or 111.

Non-Urgent Issues

Unfortunately, non-urgent dental care will have to wait until the situation with COVID-19 has stabilised.

This includes:
• Loose or lost fillings ,crowns, bridges, or veneers (with no pain)
• Broken, rubbing or loose dentures
• Chipped teeth with no pain
• Loose orthodontic or retainer wires: wear your removable retainers to stop teeth moving back into their pre-treatment position
• Detached orthodontic brackets in patients having short-term cosmetic straightening: the bracket usually stays on the wire as it’s tied in on with an elastic band but, if it falls off, please keep it safe in a small box until your next appointment.
• If the wire comes out of the silver slots on back teeth, use tweezers to gently tease it back in.
• Try to keep your tongue and fingers away, otherwise you will get ulcers and can make the problem a lot worse.
• If you have some orthodontic wax, try softening a small piece and popping onto the end of the offending bit, to cushion and protect.

Unfortunately, COVID-19 may mean that your braces will have to stay on longer than usual but when we are allowed to carry out routine appointments again, we will endeavour to offer you a priority slot.

You need urgent dental advice if you have:

• A severely-broken tooth (new occurrence), or tooth that has been knocked out
• Toothache that is preventing sleeping and eating, combined with swelling or fever that is not manageable with pain killers

You need to call 111 or go straight to A&E if you have:

• Facial swelling extending to the eye, neck or floor of mouth, affecting your vision, breathing or preventing your mouth opening more than 2 finger widths
• Bleeding following an extraction that does not stop after 20 minutes of solid pressure with gauze
• Bleeding due to trauma resulting in loss of consciousness, double vision or vomiting

If you need further advice or help, please call the practice for further information on 01270 876026.

With all our best wishes for your safety and health at this difficult time, Aliya, Michael, Lauren and Ally xxx

(The Team at Lawton Dental Care)