My Tooth Hurts. My Dentist's Office Is Closed. Now What?

Here's what to do for dental care during the pandemic
An empty dental chair in an exam room. Even if your dentist’s office is closed for routine business, you can and should still find care for certain problems.
Even if your dentist’s office is closed for routine business, you can and should still find care for certain problems. Photo: ingimage
April 10, 2020

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If you had an appointment on your calendar to get your teeth cleaned or a cavity filled around now, it’s most likely been rescheduled because of COVID-19. And while some folks may be secretly grateful for a reprieve from the dentist, some oral-health issues shouldn’t be postponed, and some are outright emergencies. How do you know the difference?

The American Dental Association (ADA) recommends that dental offices only treat emergencies at this time, and some states and municipalities have mandated that, as well. These measures protect both patients and oral health-care professionals, as dental procedures can pose distinctive risks for COVID-19 transmission. A significant concern is the creation of aerosols—fine particles or liquid droplets suspended in the air—by drills, air and water syringes, and other pieces of dental equipment.

“Dentists are required, ethically, to provide emergency care,” said Associate Dean Mary-Jane Hanlon, president-elect of the Massachusetts Dental Society. Photo: Kelvin MaMary-Jane Hanlon, D97, associate dean for clinical affairs at Tufts School of Dental Medicine and president-elect of the Massachusetts Dental Society, assures the public that dentists may open their offices for emergency treatment, or, in some cases, refer patients to other facilities. “Dentists are required, ethically, to provide emergency care,” she said. How to provide that care safely and efficiently in the face of this highly contagious airborne virus is now dentistry’s focus.

Fortunately, most dental procedures can be delayed short-term without great risk, and as uncomfortable as it may be, mild or intermittent pain is usually not a sign of immediate danger. “It’s the pain that wakes you up in the middle of the night that’s sometimes worrisome,” Hanlon said. “If it throbs, that’s worrisome.”

Here, Hanlon answers some of the questions you may have about seeking dental care during the pandemic.

My dentist’s office is closed, and I think I might have a problem. What should I do?

Mary-Jane Hanlon: Call your family dentist first. They are supposed to be triaging patients and will recommend next steps. It’s always best to just call your dentist first.

If I have an emergency, will I be able to see my usual dentist?

Some dentists may be in the medically compromised group—that’s anyone, for example, over age sixty or with underlying medical conditions such as respiratory disorders, asthma, or diabetes—and they have been told they should not be seeing patients. If that’s the case, your dentist will refer you to colleagues who can help.

What sort of things will the dentist want to know?

The dentist will ask about swelling or pain: Does it hurt when you bite down? Do you still feel pain after you bite down and let go? Different symptoms can indicate different problems— whether it’s a cracked tooth or an infection, for example.

What about taking over-the-counter pain relievers or other medications?

At the start of the pandemic, there was some concern to avoid non-steroidal anti-inflammatory drugs, like ibuprofen or naproxen (sold as Advil, Motrin or Aleve). However, that has yet to be substantiated. The current recommendation is if you need something to bring down swelling, take the anti-inflammatory as directed, but be very cautious of the dosage. Acetaminophen (sold as Tylenol) can quell pain, but it will not take swelling down, so it may not be as helpful. It will, however, take some of the pain away or to a more tolerable level. 

Dentists can also prescribe antibiotics to treat or ward off infection. Typically, a dentist would want to take an X-ray before prescribing antibiotics, but a recent ADA advisory allows prescribing without an X-ray under the current circumstances.

What else can I do?

Rinsing with warm salt water, or using ice or heat, can also help. Patients should make sure to check with their dentist or pharmacist whether anything they try, including any over-the-counter medications they take, could interact with other medications they may be taking. Keep the problem area really clean; don’t chew in the area bothering you if at all possible.

I’ve recently had a dental procedure, such as a root canal, and I’m supposed to go back for a follow-up appointment.

Follow your post-operative instructions, and check with your dentist. According to the ADA, situations that may require an in-person follow up are changing a dressing or removing stitches.

What’s the best way to try and avoid a dental emergency?

Brush your teeth after you eat, floss daily, and make sure you’re taking extra-good care so you don’t run into problems right now. The thing you can do to best serve all of us is be able to stay at home.
 

The ADA offers the following recommendations:

Dental care you can reschedule for another time

  • Regular visits for exams, cleanings and x-rays
  • Regular visits for braces
  • Removal of teeth that aren’t painful
  • Treatment of cavities that aren’t painful
  • Tooth whitening

Dental care that you should have taken care of by a dentist at this time

  • Bleeding that doesn’t stop
  • Painful swelling in or around your mouth
  • Pain in a tooth, teeth, or jawbone
  • Gum infection with pain or swelling
  • After surgery treatment (dressing change, stitch removal)
  • Broken or knocked out tooth
  • Denture adjustment for people receiving radiation or other treatment for cancer
  • Snipping or adjusting wire of braces that hurts your cheek or gums
  • Biopsy of abnormal tissue

For more information, see www.mouthhealthy.org.

Helen Ragovin can be reached at helene.ragovin@tufts.edu.