by Steven Gray, DDS

Dental practices could never have prepared for the level of disruption brought about by COVID-19. Within weeks, dental practices across the country went from being fully operational to completely shutting their doors. The American Dental Association and other healthcare experts advised that all but the most urgent dental treatments be delayed. Ultimately, Governor Whitmer placed temporary restrictions on all non-essential medical and dental procedures.

The majority of dental procedures create airborne droplets, thus inherently carrying a high risk of disease transmission from a patient potentially infected with a virus to the health care team. This has left many patients wondering what they can do if they have a dental emergency. Of course, the first and best step is to call your regular dental office. While almost every office is currently closed physically, many are still taking phone calls and are able to triage patients’ needs by a phone call or video visit.

While there are hopes that dental offices will be able to re-open for non-emergency treatment soon, that is dependent on the governor’s actions and individual offices’ comfort levels in returning to work. For the time being, here are some common dental emergencies and general approaches in addressing each of them.

Pain - Although pain levels are highly subjective, it is often a sign of an issue with the nerve of the tooth.  In particular, pain that is spontaneous (pain arising without a stimulus) and pain that lingers (lasts more than 15-30 seconds) are particularly concerning.  Swelling, throbbing and radiating pain are also worrying symptoms.  These are often evident that the nerve tissue has been damaged in an irreversible way and will likely need a root canal to alleviate the pain.  During this stay-at-home order, dentists may recommend a round of antibiotics in order to reduce the infection responsible for the pain.  In comparison, pain that goes away in just a few seconds, and is reactive to hot, cold or chewing may be signs of a reversible cavity that can be fixed with a filling.  These situations can likely wait for dental offices to re-open to address these problems.

Sensitivity - Sensitivity to hot, cold, sweets or breathing in cool air is common for patients with gum recession. When the gums recede and the roots of a tooth are exposed patients will typically experience some degree of sensitivity. Sensitivity may be reduced by brushing gently with a sensitivity toothpaste and spitting out the paste without rinsing. Tooth grinding can also cause this type of sensitivity. Sinus congestion during this allergy season can also cause abnormal feelings on teeth and are not necessarily cavity-related.

Broken tooth/filling - The treatment necessary for a broken filling or tooth can vary based on where the break or fracture occurs and the pain and sensitivity level a patient is experiencing. Fractures can be somewhat superficial (crack 1), deeper below the gums (crack 2), into the nerve tissues (crack 3) or completely down the root (crack 4). If a patient isn’t experiencing much pain, a short-term solution is to pick up some temporary filling material from a local pharmacy and attempt to fill the missing space with the product. Roll up the material into a sausage-like shape, place it into the missing space as best possible with a wet finger and pack it in using a wet Q-Tip to do the final packing. Try to keep the material at or below the tooth’s natural shape and contour. Leaving excessive material could create a “high bite” situation, which could lead to pain. A crack into the nerve or down the root would require more extensive care.

Jaw/muscle issues -Some patients experience sore muscles or joints. Many times, these patients know they are a daytime or nighttime clencher/grinder (bruxer) and may already have a bite splint they wear at night. For the time being, a management strategy is to rest the muscles (eat soft foods, don’t talk on the phone and don’t chew gum), use warm compresses in 15-20 minute increments, gently massage the tissues and take a low dose anti-inflammatory (400 milligrams of ibuprofen every four to six hours or 220 milligrams of naproxen every 12 hours). Of course, consult a physician if there are concerns about taking these medications.