As this coronavirus situation has unfolded, all of us have been faced with questions about how to lead our daily lives while being told, we must stay at home. We’ve all felt how uncomfortable and frustrating the uncertainty and restrictions can be. My staff and I have seen that those feelings are magnified when your health, or that of a family member, is the cause of that uncertainty.
We’re now getting numerous questions every day from our dental patients about handling their dental appointments, and needs, since the stay-at-home measures went into place. We hope that by sharing the answers to the most common questions that you’ll feel more confident in dealing with your dental health during this time.
Are we open?
The short answer is “yes,” but only for dental emergencies. On March 16, the American Dental Association issued guidelines advising dentists nationwide to postpone elective procedures for three
weeks (until April 6). Our state is asking that we continue this until at least May 8th. Not only will this help limit exposure to and transmission of the virus for patients and staff, but it also helps preserve and extend the supply of personal protective equipment that is needed in both hospitals and dental offices. Dental offices are allowed to see patients who are having an emergency. Right now, we are staffing the phones while we are all sheltering in place. So, don’t worry if you should run into a problem – we can and will provide emergency care. You may be asked to video conference with us first – a technology called teledentistry, which allows the patient and dentist to have a consultation to assess your problem without you needing to come into the office. After the meeting, we can determine what the appropriate next steps may be. We expect these guidelines to change… and then change again. So, please call us, and we can update on the current protocol.
What is a dental emergency?
Dental emergencies, according to the American Dental Association, “are potentially life-threatening and require immediate treatment to stop ongoing tissue bleeding, or to alleviate severe pain or infection.” What constitutes an emergency is pretty simple – it’s about pain or trauma. Some common dental emergencies include:
• Severe dental pain (most people think of this as a “toothache”)
• Pain from a wisdom tooth
• Post-operative pain from dental surgery or procedure
• An abscess or localized pain and swelling
• A broken tooth resulting in pain or cutting your tongue or cheek
• A knocked-out tooth
• Dental treatment if a temporary crown or bridge is lost, broken, or causing gum irritation
Other allowed emergency dental care includes extensive decay or defective fillings that cause pain. Removal of stitches, denture adjustments for radiation/oncology patients, denture adjustments, or
repairs to address difficulty chewing, replacing a temporary filling on a tooth with a root canal also are allowed. Loose and traumatic orthodontic wires or appliances that are causing pain also qualify. The ADA has a terrific website for patients called mouthhealthy.org, where you can download their guide to help decide if you have a dental emergency.
What if I have already scheduled a checkup?
This will be one of the few times where you’ll hear a dentist advise you to avoid your six-month checkup. However, routine hygiene and cleaning appointments are considered elective procedures. This is a basic list of elective or non-emergency dental procedures:
• Initial examinations (including x-rays)
• Periodic (six-month) checkups (also including x-rays)
• Routine dental cleanings and other preventive therapies
• Orthodontic procedures other than those to address a problem (e.g., pain, infection, trauma)
• Extraction of teeth that do not hurt (like having your wisdom teeth pulled)
• Fillings on cavities that aren’t causing pain • Aesthetic dental procedures (such as whitening)
Make no mistake — six-month exams are still essential. As soon as the crisis passes, let’s get that hygiene appointment rescheduled for you.
What happens when I get to the dental office with an emergency?
When you call for your appointment, we will ask a few questions to make sure that it is safe to care for you. We will also let you know the changes to our regular visit. We may request, for instance, that you stay in the car, and we will text or call you when it is appropriate to enter the office. We may have you sign a Patient Request for Treatment, Representations, and Consent document. Everything that we are currently doing is with your safety in mind. The questions that we will ask might include:
• Have you had symptoms commonly associated with COVID-19?
(For example: fever, shortness of breath, dry cough, runny nose, or sore throat)
• Within the past 14 days, have you traveled by airplane?
• Within the past 14 days, have you been at a gathering of 10 or more persons?
• Within the past 14 days, have you had close contact with a person who has been confirmed
positive or suspected to be positive for COVID-19?
If we are comfortable with the answers to the screening questions and your condition does need emergency attention, then we will do our best to render the appropriate treatment. That means that
even if you have what might qualify as an emergency, the dentist will evaluate if a procedure can be delayed for 30 days. This judgment would be based on assuring that waiting won’t cause you undue harm or pain. An example is a lost or broken filling where a temporary filling can be quickly and easily placed, allowing you to return in the future for the more involved final filling.
What safety measures will the office take if I have to come in for emergency treatment?
As health-care providers, we are trained on the CDC guidelines for infection control and using the appropriate personal protective equipment (PPE) such as masks and gloves. We continue to update our education and training to ensure your safety. We will do everything, including a referral to a different dental center, if indicated, to ensure your safety and our safety.
If I’m missing my checkup, should I do anything differently?
Make sure you are brushing and flossing. Do everything that we advise you to do regularly. It’s never been more important to do the best job possible to maintain your oral health. Since many of us will have extra time on our hands, make sure you brush at least twice a day for two minutes. If you feel like you want to take additional steps to protect your hygiene during this time, here are a few ideas:
1) Use a powered toothbrush.
2) Use an irrigation device like a water flosser.
3) Use interdental “pics” or the like to compliment your flossing.
4) FLOSS! If you don’t currently floss, it’s an excellent opportunity to start. You have the extra time, and
once you’re in the habit, you’ll like the extra clean feeling while also strengthening your gums!
If my child or I am in orthodontic treatment, will missing appointments cause harm?
The simple answer is “No.” Your teeth will just stop moving at some point. Once elective procedures are allowed again, treatment can easily be restarted, and your teeth will start moving from right where they left off. If you have aligners, you may be able to have a teledentistry consultation with us, and we may, if appropriate, send you your next set of aligners. Otherwise, continue to use your current aligner. Even though your teeth will generally stop moving after a week or two in the same aligner, it will act as a retainer holding the teeth in place until you can get in for your next aligner. The most important thing is to keep your teeth clean with brushing, flossing, and avoid sweets, especially between meals. Stay home, stay safe, and know that we’re here for you.
During this time, when we are all asked to stay home unless there is a dental emergency, which means pain or trauma, most of you will be just fine. Concentrate on excellent basic home hygiene. You can be secure that your dental health will likely be fine. If you’re still confused or unclear as to whether you need to be seen in the office, email us or call us. (Contact details are on our website at www.portofinodental.org or call us at 239-482-8806. We are here for you, as are our dental colleagues all over the country, and, for that matter, the entire world right now.
Stay safe and healthy!
Dr. Ricardo S. Bocanegra