Should you worry if you can’t get a routine dental appointment because of the pandemic? Can you be your own hygienist? And what if you have an emergency? Experts answer your questions
Elle Hunt – The Guardian
Does it matter what type of brush or toothhpaste you use? Photograph: Daniel Day/Getty Images
For many of us, the routine trip to the dentist is just one of the ways in which our lives have been disrupted in 2020. The British Dental Association (BDA) estimates that, since the March lockdown, dentists in England have provided nearly 19m fewer treatments than in the same period last year.
What do you need to know about dental emergencies, and what more can you do to care for your teeth? We asked the experts.
What dentistry services are currently available?
Although some routine dental treatments are now available again, in the UK, surgeries’ operating capacity has been reduced and some are triaging patients according to their level of need and risk.
If you would like to see your dentist, it is advisable to contact them by phone or email to see if it is necessary for you to visit. For up-to-date advice on accessing dental care in the UK, see the NHS website.
What is the risk of catching coronavirus at the dentist?
Although they are assumed to be at high risk of contracting Covid-19, a recent study of nearly 2,200 US dentists found that fewer than 1% tested positive in June. Professor Damien Walmsley, scientific adviser to the BDA, says dentists’ routine attention to infection control puts them at an advantage. “It’s almost second nature to us.”
A heightened potential risk of coronavirus transmission is in the use of instruments such as dental drills or ultrasonic scalers, which create a fine mist.
How are dentists adapting?
The profession is still adapting its procedures as more becomes known about how the virus spreads. For example, some dentists have switched to handheld tools that are slower, but create less spray. “Everything’s a bit of a compromise,” says Walmsley.
Access to services is improving. In England, the “fallow time” during which a treatment room must remain empty after any aerosol-generating procedure was recently reduced from an hour to 15-20 minutes (depending on ventilation), enabling dentists to see more patients.
What can I do to care for my teeth while I can’t get to a dentist?
“The majority of dental problems are preventable,” says Walmsley. Brushing your teeth in the morning and at night, for two minutes each time, will generally be enough to prevent tooth decay and gum disease. Studies have shown, however, that people brush for an average of 43 seconds. “Four minutes a day is not a lot to ask,” says Dr Nigel Carter, the chief executive of the Oral Health Foundation.
What kind of toothpaste should I use?
Any toothpaste with fluoride will do. Not only does it help to prevent tooth decay, but it slows down the rate of progression of any existing decay. Carter is concerned by the increasing availability of “natural” toothpastes without fluoride. Water fluoridation is not widespread in the UK, “so we really do need that protection”, he says.
Is it a good idea to switch to an electric toothbrush?
What you brush with is less important than brushing. Walmsley says a manual toothbrush is just as effective as a powered one if you brush for two minutes, twice a day. Some electric toothbrushes, however, have a timer – or even an app – to help you to be more thorough. “I can say from personal experience that it’s moved me from 1.5 minutes to 2 minutes,” says Carter of his electric toothbrush.
How often should I replace my toothbrush?
Dentists recommend replacing your toothbrush or brush head every three months. Very few people do. “As a nation, we use 1.2, 1.3 heads a year,” says Carter. “There are a lot of very old, scraggy toothbrushes out there.”
Does brushing your teeth reduce your coronavirus risk?
Martin Addy, emeritus professor of dentistry at the University of Bristol, has argued that more frequent brushing should be promoted alongside hand-washing to protect against coronavirus, as the antimicrobial agents in toothpaste and mouthwash reduce mouth bacteria.
A link with brushing has not yet been substantiated, but last week a Cardiff University study found “promising signs” that mouthwash may help to kill coronavirus. Further research into how oral hygiene might factor into reducing coronavirus risk is under way.
What else can I do apart from brushing thoroughly?
If you already floss regularly, stick with it. If you have yet to make it a habit, pick up some interdental brushes, which are easier to use than string floss. Interdental cleaning is especially important if you have a history of gum disease. Do it before you brush.
What else should I be mindful of?
“Being conscious of what you’re eating and when is also vital for a healthy mouth,” says Nyree Whitley, group clinical director for the the dental care provider mydentist. Many people have been consuming more sugar and alcohol during the pandemic, which is detrimental to oral health over a prolonged period. Whitley suggests limiting snacks and consuming sugar only as part of a meal.
My gums bleed after brushing and flossing. Should I be worried?
People can be put off by this, especially when starting a new oral care regimen, but Carter’s advice is to persevere. “It’s not an indication you’re brushing too hard: it probably means you haven’t been brushing well enough.” The bleeding indicates some level of gum disease, and will probably stop as your gums become healthier.
Whitley says that dentists reported patients’ gum disease had got worse in the months between the first lockdown and practices reopening mid-year: “It’s a good reminder of just how quickly gum disease can worsen.”
Can I replicate a professional hygienist’s clean at home?
This is “straying into DIY dentistry,” says Walmsley. Even with his expertise, he knows better than to attempt dentistry on himself. “You could easily get yourself into trouble,” he says. If there is visible plaque or tartar (calcified plaque) around the necks of your teeth, talk to your dentist about the possibility of booking in for a scale and polish.
I think I am grinding my teeth. What can I do?
This has reportedly become more prevalent during the pandemic, due to rising stress levels. If you know you are inclined to clench your jaw while concentrating or stressed during the day, becoming aware of it may be enough to break the habit, says Carter.
Sleep grinding, known as bruxism, is harder to tackle. You may not even know you do it unless you share a bed, but it can cause sleeplessness, facial pain and headaches. Your dentist will be able to tell if you are doing your teeth any damage, and suggest possible treatments.
How do I tell if I have a dental emergency?
Chipping a tooth, without any associated pain, is generally not an emergency, says Walmsley. If you have broken or lost a filling, crown or veneer, you can get an emergency repair kit from a chemist to tide you over until you can speak to your dentist. Toothache may be eased with paracetamol or ibuprofen.
“An urgent dental need could include facial swelling extending to the eye or neck, bleeding after an extraction that doesn’t stop, toothache that prevents eating or sleeping, or trauma that results in bleeding or fracturing,” says Whitley. In the UK, call your dentist on their emergency line, or call 111.
I have knocked out a tooth. What do I do?
This is also high priority: a knocked-out adult tooth can usually be reimplanted if a dentist can get to it quickly. “The longer the tooth is out of the mouth, the higher the chance is the body will reject it,” says Walmsley.
Holding the tooth by the crown, not the root, try to put it back into the hole in the gum. Bite down gently on a clean cloth to hold it in place. If the tooth does not go in easily, put it in a container of milk or saliva (adults could also hold it inside their cheek). “Don’t wash it under the tap – you want to keep all the little cells and bits of body around it,” says Walmsley. If you cannot find the tooth, still seek emergency care.
What else should I look out for?
The symptoms of mouth cancer can be “annoying but manageable”, warns Whitley, who suspects that, because people’s perception is that they have only a minor problem, they “are simply putting off getting help”. If you have mouth ulcers that do not heal within several weeks or unexplained, persistent lumps in the mouth or lymph glands (in the neck), contact your dentist or doctor.
I usually see my dentist twice a year. How concerned should I be by this break?
“For people who have been going on a regular basis and having little more than an examination, scale and polish, there’s really nothing to worry about,” says Carter. The profession has been seeking to extend the interval between check-ups for those healthier patients for the past 15 years as the rate of decay has reduced.
You should talk to your dentist about how often you need to see them, taking into account your patient history, says Carter. If you have good oral hygiene, you may need to go only once every two to three years. If your regimen is lacking, now is an ideal time to improve it, he says. The dentist is “not the repair shop that does everything for you – you’ve got to be in charge of your own oral health”.