Dentistry amid the Covid19 outbreak, a warning

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
Dear Colleague



Please see the latest guidance below, detailing the current criteria for appointing patients at Urgent Dental Care Centres. This has been adopted across all Health Boards in Scotland.



UDCC guidance- criteria for clinic appointment:

Severe pain - not managed by pain killers, unlikely to respond to antimicrobials as the diagnosis-at-a-distance is one of acute irreversible pulpitis as opposed to apical infection.
Visible swelling, ideally confirmed by electronic means, that is progressing, or has not responded to appropriate antimicrobials
Signs of localised apical infection (TTP, intra-oral swelling etc) that has not responded to an appropriate course of antimicrobials.
Broken, painful tooth - sharp or very sensitive, temp dressing material has not worked or significant likelihood of catastrophic fracture - likely to require extraction.
Highly mobile tooth not helped by pain relief, unlikely to be helped by antimicrobials, highly likely to be a simple extraction.
Dental trauma beyond that of a painless enamel/enamel-dentine fracture.
In all cases - where there is a high chance that a single intervention is likely to relieve symptoms for an extended period



And also a set of interventions that include:



§ Extractions as an early option rather than last resort – unless the medical history contra-indicates this:

· ‘Simple’ in all cases

· Those unplanned surgical cases where there has been a failed attempt at simple extraction if expertise/symptoms/PPE permits.

· Planned surgical cases only where a surgical pathway exists

· Incisor and canine open/extirpation only, with consideration given to premolars only if:

o This tooth is in the position of a canine and

o If this tooth is critical in the retention of a ‘shortened occlusal arch’

§ "Open-to-drain" in teeth with associated swelling that are NOT already root treated (no endodontic re-treatments).

§ Additionally, in all cases where a non extraction approach is adopted, the tooth should be assessed as being both highly important and easily restorable

Teeth that have already been opened/ extirpated, and remain symptomatic/acutely infected despite also prescribing antimicrobials, should be extracted, again unless the medical history contra-indicates.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
For patients wondering why most dental practices are still not open despite what the government may have told you, this is the latest update from the British Dental Association today for practices in England:

"11:59

England: No change to practice openings

This morning’s changes to restriction regulations are causing confusion among dentists in England. It might appear that new regulations permit the reopening of dental practices in England, this is not the case.

Nothing has changed in relation to the guidance offered by the various UK administrations on the provision of dentistry.

The permitted dental care in the restrictions regulations refers to emergency-only care. The unfortunate lack of clarity in the restriction regulations is causing understandable confusion. We will keep you updated as things progress."
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer

Nemesis44UK

LE
Book Reviewer
@Fang_Farrier - I have dental pain on the left side of my face, radiating to an earache and headache on that side. I can't locate exactly where the pain is coming from, either a top molar or bottom molar. The top one is in rag order and was advised two years ago that my dentist tried to fill it, but he had no confidence in the repair, saying it would need to come out if the filling dislodged. There is a small amount of swelling and it is mostly managed with over the counter painkillers.

My question is that in your opinion, would an emergency putty as described upthread seal it off for now, until dentists are able to operate normally?

Is there a way of isolating which tooth is giving me pain?

I appreciate that you aren't my dentist and I'm not holding you to anything, just a little generalised advice would be welcomed.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
@Fang_Farrier - I have dental pain on the left side of my face, radiating to an earache and headache on that side. I can't locate exactly where the pain is coming from, either a top molar or bottom molar. The top one is in rag order and was advised two years ago that my dentist tried to fill it, but he had no confidence in the repair, saying it would need to come out if the filling dislodged. There is a small amount of swelling and it is mostly managed with over the counter painkillers.

My question is that in your opinion, would an emergency putty as described upthread seal it off for now, until dentists are able to operate normally?

Is there a way of isolating which tooth is giving me pain?

I appreciate that you aren't my dentist and I'm not holding you to anything, just a little generalised advice would be welcomed.
I doubt a home filling kit would be much use.
Best option is to contact own dentist who will telephone triage and either arrange antibiotics or a referral to an Urgent Dental Care Centre for radiograph and probably extraction
 

Nemesis44UK

LE
Book Reviewer
I doubt a home filling kit would be much use.
Best option is to contact own dentist who will telephone triage and either arrange antibiotics or a referral to an Urgent Dental Care Centre for radiograph and probably extraction
Many thanks, much appreciated.
 

KnockKnock

Swinger
I cannot see how dentistry will ever return to what we have experienced for so many years. The air rotor with water spray to assist in tooth preparation, creates the aerosol around the mouth. Will dentists now revert to the old slow foot treadle drill? Agony!
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
I cannot see how dentistry will ever return to what we have experienced for so many years. The air rotor with water spray to assist in tooth preparation, creates the aerosol around the mouth. Will dentists now revert to the old slow foot treadle drill? Agony!
Or just use a red banded slow speed. Increases the speed on a 1:5 ratio.

Use a tungsten carbide bur

Lots of torque!
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
Even with an injection, its's the slow speed and the vibration experienced by the patient!
It's a slow speed set to high speed!

The vibration you might normally feel is because it's on a slow, slow setting with a large stainless steel but.

Quite different to a small tungsten carbide bur at very high speed.
 

4(T)

LE
Wife has had excruciating pain in one side of her face for a few days.

NHS helpline and local clinics emergency numbers (including our regular dentist) say its not an emergency; take some paracetamol.

Pain continues. Now seen to stem from an abscess presenting itself through the gum.

NHS helpline now says, yes, this is now an emergency but, unfortunately, there are no dental appointments available either now - or for the foreseeable future.

(I guess this is south England region, or however its been organised)

Wife told to go to pharmacy. Pharmacy offers paracetamol. So this is infection control in UK 2020.



Hows this for a plan? How about, when a patient has been telephone diagnosed "as a dental emergency", they are directed to a C19 priority test station (presumably a facility at a hospital). They take the test, get the answer in c.24hrs or whatever the current capability is, and, if clear, then get treated at a normal dental clinic?
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
RWife has had excruciating pain in one side of her face for a few days.

NHS helpline and local clinics emergency numbers (including our regular dentist) say its not an emergency; take some paracetamol.

Pain continues. Now seen to stem from an abscess presenting itself through the gum.

NHS helpline now says, yes, this is now an emergency but, unfortunately, there are no dental appointments available either now - or for the foreseeable future.

(I guess this is south England region, or however its been organised)

Wife told to go to pharmacy. Pharmacy offers paracetamol. So this is infection control in UK 2020.



Hows this for a plan? How about, when a patient has been telephone diagnosed "as a dental emergency", they are directed to a C19 priority test station (presumably a facility at a hospital). They take the test, get the answer in c.24hrs or whatever the current capability is, and, if clear, then get treated at a normal dental clinic?
Sorry to hear about this.

The Urgent Dental Care Centres definitekyt seem to be causing more problems South than up here, possibly volume of patients as well as various other aspects such just the different way NHS services are run.

There should be appointments available, especially if there are ongoing symptoms.

Am surprised that if an abscess has been diagnosied over the phone, that antibiotics have not been prescribed.

Our current mantra is AAA. Advice, analgesics and antimicrorobials.

I would recontact and raise a complaint, that is not unreasaonable in this situation.

There should be no need to test someone prior to attending as all the guidance is in place, we have red and green routes. But for us the decision on what is red and what is green has been turned through 90'
Originally it was based on Covid status, now it is based on what procedure we are going to undertake.

The evidence is still rather sketchy but it appears that the risks to dental teams is more based upon what you are doing rather than to whom.

However it is still a work in progress.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
I've just broken my tooth, I think an old filling (white resin) deteriorated.
My local dentist is shut, and i never registered with one since we came back to the UK.
No pain as yet, but i think it'll need looked at.

Any advice?

And before we go there, Boots size 12.
 

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