Helping our dental patients through the coronavirus crisis By Dr. Barksdale
As this coronavirus situation has unfolded, all of us – your dentist, the dental staff, and our patients – have been faced with questions about how to lead our daily lives while being told we must stay at home. And we have all felt how uncomfortable and frustrating the uncertainty and restrictions can be. My staff and I have seen that those feelings are magnified when your health, or that of a family member, is the cause of that uncertainty. Is my nearby dental office open?
We are now getting numerous questions every day from our dental patients about handling their dental appointments and needs since the stay-at-home measures went into place. We hope that by sharing the answers to the most common questions you will feel more confident in dealing with your dental health during this time.
Most likely your local dental office is open only for dental emergencies. On March 16, the American Dental Association issued guidelines advising dentists nationwide to postpone elective procedures for three weeks until April 6. This was recently extended until April 30, and there is a chance that date may be extended again. To find out, you may call our office. At William Penn Dentistry, we have chosen to follow strict OSHA, CDC and ADA guidelines. Not only will this help limit exposure to and transmission of the virus for patients and staff, but it also helps preserve and extend the supply of personal protective equipment that is desperately needed in both hospitals and dental offices. What is considered a dental emergency?
Dental offices can see patients who are having an emergency. At William Penn Dentistry, we are staffing the phones as we should be while we are all sheltering in place. So, do not worry if you should run into a problem – we can and will provide emergency care. You may be asked to video conference with your dentist. This is called tele dentistry which allows the patient and dentist to have a consultation to assess your problem without the patient needing to come into the office. After the consultation, the dentist can determine what the appropriate next steps may be.
Dental emergencies, according to the American Dental Association, “are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection.”
What constitutes an emergency is simple – it is about pain or trauma. Some common dental emergencies include:
- Severe dental pain (most people think of this as a “toothache”)
- Pain from a wisdom tooth
- Post-operative pain from a dental surgery or procedure
- An abscess or localized pain and swelling
- A broken tooth resulting in pain or cutting your tongue or cheek
- A tooth being knocked out
- Dental treatment if a temporary crown or bridge is lost, broken, or causing gum irritation
Other emergency dental care includes extensive decay or defective fillings that cause pain, removal of stitches, denture adjustments for radiation/oncology patients, denture adjustments or repairs to address difficulty chewing, replacing a temporary filling on a tooth with a root canal if you are experiencing pain, and snipping or adjusting an orthodontic wire or appliance that is cutting your lips or cheeks. What about my dental checkup that is scheduled?
The ADA has a terrific website for patients called mouthhealthy.org where you can download their guide to help decide if you are having a dental emergency.
This will be one of the few times that you will hear a dentist advise that you avoid your six-month checkup. Routine hygiene and cleaning appointments are considered to be elective procedures. A more complete list of elective or non-emergency dental procedures includes:
- Initial examinations (including x-rays)
- Periodic (six-month) checkups (also including x-rays)
- Routine dental cleanings and other preventive therapies
- Orthodontic procedures other than those to address a problem (e.g., pain, infection, trauma)
- Extraction of teeth that do not hurt (like having your wisdom teeth pulled)
- Fillings on cavities that are not causing pain
- Aesthetic dental procedures (such as whitening)
Make no mistake — six-month exams are still especially important. As soon as the crisis passes, let us get that hygiene appointment rescheduled for you. What happens when I get to the dental office with an emergency?
This may vary based on the protocols put in place by any individual dental office to maintain social distancing.
Some offices may request that you stay in the car and will text or call you when it is appropriate to enter the office. Others may space appointments so that no two patients should ever encounter each other. Either way, your safety and reducing the possible spread of the virus between patients is of the utmost importance. Dentists or their staff will ask questions, and for everyone’s safety you will want to answer honestly. These questions may include:
- Have you had symptoms commonly associated with COVID-19? (common symptoms include fever, shortness of breath, body aches, dry cough, runny nose, or sore throat)
- Within the past 14 days have you travelled by airplane?
- Within the past 14 days have you been in close proximity (less than six feet) at a gathering of 10 or more persons?
- Within the past 14 days have you had close contact with a person who has been confirmed positive or suspected to be positive for COVID-19?
In some cases, you may be required to sign a Patient Request for Treatment, Representations and Consent document. In others, just speaking with the dentist may be enough. Our office will also monitor the health of our staff in order to limit possible exposure to the virus. What safety measures will the office take if I must come in for an emergency treatment?
If the office is comfortable with the answers to the screening questions, and your condition does need emergency attention, then someone will render the appropriate treatment.
Even if you have what might qualify as an emergency, the dentist will evaluate if a procedure can be delayed for 30 days. This judgment would be based on assuring that waiting will not cause you undue harm or pain. An example is a lost or broken filling where a temporary filling can be quickly and easily placed, allowing you to return in the future for the more involved final filling.
As health-care providers, dentists and their teams are trained on the CDC guidelines for infection control and using the appropriate personal protective equipment (PPE) such as mask and gloves. If for some reason an office does not have appropriate PPE available, they will refer you to another dental professional for your emergency treatment. (In our office we do not anticipate that happening, and as of now we have a good supply of PPE.) If we do need to provide emergency treatment, we will attempt to minimize the use of equipment that creates airborne spray. This is a precautionary measure to limit the potential spread of the virus since any patient could be positive but undiagnosed and not yet exhibiting symptoms. (asymptomatic) If I am missing my checkup should I do anything differently?
The William Penn Dentistry team has been trained in the latest ways to minimize the possibility of transmitting the virus. Extra cleaning and disinfection protocols you have implemented in in response to the coronavirus. In our office we are requiring every patient to use hand sanitizer upon entering. We are disinfecting every doorknob and countertop. From the front desk to the treatment rooms, everything is wiped down between patient visits, and also at the end of each day. We are going the extra mile to make sure every inch of the treatment areas and equipment are disinfected.
Make sure you are brushing and flossing. Do everything as you would normally. It has never been more important to do the best job possible to maintain your oral health.
Since many of us will have extra time on our hands, make sure you brush at least twice a day for two minutes.
If you feel like you want to take extra steps to protect your hygiene during this time, here are a few ideas:
If my child or I am in orthodontic treatment, will missing appointments cause harm?
- Use a powered toothbrush. My favorite brand is Sonicare.
- Use an irrigation device.
- Use your favorite mouth wash with fluoride.
- Floss – if you do not currently floss this is a perfect time to start. You have the extra time and once you are in the habit, you will like the extra clean feeling while also strengthening your gums.
The simple answer is “No.” Your teeth will just stop moving at some point. Once elective procedures are allowed again, treatment can easily be restarted, and your teeth will start moving from right where they left off. If you have aligners, you may be able to have a tele dentistry consultation and the dentist may possibly send you your next set of aligners. Otherwise, continue to use your current aligner. Even though your teeth will generally stop moving after a week or two in the same aligner, it will act as a retainer holding the teeth in place until you can be seen for your next aligner. Stay home, stay safe, and know that we are here for you
During this time when we are all asked to stay home unless there is a dental emergency, which means pain or trauma, with basic home hygiene you can be comfortable that your dental health will be fine. If you are still confused or unclear as to whether you need to be seen in the office, email us or call us. My staff and the dentists are here for you, as are our dental colleagues for patients all over the country and the world for that matter. Stay safe and healthy!
During this time there will be a lot of things that may seem different in the dental office, but as soon as the virus is under control and it is safe to return for normal dental treatment, we’ll be happy to welcome you back!