Toothache during lockdown: what to do and what not to do

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    The COVID-19 pandemic and the subsequent lockdown have hit oral health in many more ways. But, it has not been talked about much. Of course, we have bigger issues to worry about. Remember that all dentists have postponed elective procedures and will carry out only emergency treatments until further notice.

     Maintaining good oral hygiene is always a key step towards preventing any dental pain. You may be able to minimize incidence of dental pain if you follow these simple procedures:

    Brush twice daily:

    The layer of plaque deposits in every 12 hours, thus, brushing twice helps removing it. Plaque has millions of bacteria, it can cause decay of teeth & gum problems.

    Brush thoroughly

    You should spend at least 2- 3 minutes on brushing. Take your time, moving the toothbrush in gentle motions to remove plaque.

    Use fluoride toothpaste:

    Fluoride is absorbed into the enamel and helps to repair it by replenishing the lost calcium and phosphorous required keeping your teeth hard.

    Floss your teeth daily:

    Flossing helps clean in-between the teeth. If you don’t floss, you’re at risk for two major dental issues in your mouth: Gingivitis and cavities between your teeth

    Limit sugary and acidic food:

    Bacteria in mouth use sugar from food and drinks to produce acids that dissolve and damage the teeth. These cause tooth decay.

    Avoid sticky foods: 

    “Sticky foods” like hard candies and lollipops provide long-lasting sources of sugar. These are also linked to tooth decay.

    Drink lots of water: 

    Water helps keep your mouth clean and fight dry mouth. Water flushes food and residue that cavity-causing bacteria are looking for. It also dilutes the acids produced by the bacteria.

    Most of us keep on top of our dental hygiene, that’s not much of a problem for now. But, if something goes wrong you start to feel toothache as the most common symptom.

    If you have any type of swelling, severe pain or feel increasingly unwell contact a helpline number and ask for immediate appointment. Some cases when left untreated may develop into a potentially life-threatening situation. Below are most common symptoms you may face and the solutions to them:

    Severe tooth pain: 

    Contact your dentist who should be able to diagnose the reason for the pain, and arrange antibiotics or stronger pain killers. You can take over-the-counter painkillers (500mg paracetamol or 400mg Ibuprofen) for the time being. (Ibuprofen should only be taken if not exhibiting COVID symptoms).

    General toothache:

    Take painkillers if you need them, and maintain good oral hygiene by brushing twice daily with fluoridated toothpaste. Reduce sugary snacks to ensure the decay doesn’t get any worse.

    Bleeding gums: 

    This is usually the result of gingivitis or gum disease, and your gums continue to bleed until the oral hygiene improves. This sometimes, may present as toothache. Brush your teeth twice a day, spending extra time on areas that bleed, and use interdental brushes or floss to clean in between the teeth.

    Tooth sensitivity: 

    It is usually a result of receding gums, large fillings, broken or dislodged fillings or decay. Using of hard bristle brush, improper and prolonged brushing may also result in sensitive tooth. It can also be induced by frequently consuming acidic foods or liquids.

    One can use desensitizing toothpaste twice daily for about 21 days and wait for the response. Maintain good oral hygiene and reduce sugar in your diet to prevent any decay from getting worse. Contact your dentist for dislodged restorations or cavities if too large.

    Broken tooth: 

    If in pain call dental help line number. If you think this tooth needs to be extracted because it is in two pieces, you can visit dentist after you take an appointment. Small fine cracks are not much to worry about during this pandemic.

    Broken filling/ filling has fallen off:

    If a simple clean filling has dropped out with no pain then it’s not an emergency. Definitely contact dental help line number if there is severe pain.

    Wisdom tooth pain: 

    This is usually a dull aching pain, but can be sharp at times. It is not usually made worse by changes in temperature or contact with food, but may feel better after cleaning the area well. This will get better with improved cleaning with a long-handled inter dental or single tufted brush which you can buy from pharmacy.

    A warm saline rinse is very good for disinfecting the area, and you can also dip the interdental brush in it before cleaning in the gum around the wisdom tooth. If the pain is very severe and it is affecting your ability to open your mouth wide enough to reach it, then you may need antibiotics which will be prescribed by your dentist.

    Avoiding Potential Emergencies:

    The best way to prevent dental emergencies is to stay proactive in your oral hygiene and have routine check-ups, for now it can be self-screening.

    Dos and Don’ts

    1. Always do practice good oral hygiene.
    2. Docheck if there is a food particle or other debris wedged alongside the tooth leading to pain. If so, try flossing around the tooth.
    3. Don’t use a sharp object in the mouth as it may aggravate your pain.
    4. Do rinse your mouth with warm saline water to see if the pain subsides. Apply Ice pack (cold compressions) in case of swelling.
    5. Do use OTC medications such as Acetaminophen or Ibuprofen for general dental pain.
    6. Don’t use clove oil, alum or slaked lime, these have potential to cause chemical burn.
    7. Do schedule an online consultation with your dentist if the toothache is severe, increases while lying down, or worsens with hot food.
    8. Don’t use fingernails and safety pins to remove food lodged between the teeth. Do use dental floss and interdental brushes. 
    9. Don’t use mouthwashes unnecessarily, unless prescribed by a dentist. They are known to cause chemical burns.
    10. Do use antibiotics only when prescribed by a dentist. Antibiotic resistance is a clear and present danger.
    11. Don’t use antibiotics from leftover strips.
    12. Don’tchew ice, popcorn kernels and hard candy, all of which can crack a tooth.
    13. Don’t use your teeth, to cut or tear things; it may lead to a chipped tooth.A simple tip –do use scissors.

    Oral health professionals and most of the dental procedures are categorized as high risk profession and procedures during this pandemic. It’s always better to avoid visiting dentist unless it’s a dire emergency (Progressive swelling, uncontrollable bleeding, orofacial trauma and severe excruciating pain not relieved by over the counter painkillers). So, it is always advised to follow simple home remedies so that “You stay at home for us, we stay at work for you”.

    Dr. Abhinaya Luitel
    Government Consultant,
    Department of Oral Medicine and Radiology
    BPKIHS, Dharan, Nepal

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