The painful truth about dentistry in lockdown
The painful truth about dentistry in lockdown: Emergency centres are overwhelmed, many patients are left in agony untreated… and some are even yanking out their own teeth
- Dentist surgeries are not allowed to open at the moment because of coronavirus
- Around 600,000 patients have needed urgent dental treatment for problems
- Dentistry was not mentioned in the guidance of how lockdown will be eased
- Here’s how to help people impacted by Covid-19
Lesley Platts, an NHS occupational therapist who is managing hard-pressed care services in London, is suffering an additional burden — a nasty toothache that her dentist won’t touch.
Her dentist isn’t being difficult — it is because they are under lockdown and banned from physically seeing patients.
Lesley, 50, is one of around 600,000 patients who have needed urgent dental treatment for problems such as infections and broken teeth in the UK since all routine dental treatment was stopped and practices were ordered to close under the coronavirus lockdown on March 23.
Last week the Government published guidance on how lockdown restrictions across England are going to start being lifted. But it did not mention dentistry.
Instead, the office of the chief dental officer in England declared that there will be ‘no change yet’ in the suspension of normal dental care.
Local authorities have worked to set up limited dental care centres to offer urgent treatment for severe toothache that does not respond to painkillers, abscesses and fractured teeth, which accounts for 10 per cent of all dental care.
Lesley Platts, an NHS occupational therapist who is managing hard-pressed care services in London, is suffering an additional burden — a nasty toothache that her dentist won’t touch
Patients can be treated at a centre if they have been referred by their dentist. A total of 165 were planned but many have been slow to open. This is not least because they have been ‘blighted’ by problems setting up, as well as shortages of protective equipment, says Ashley Dé, head of communications at the British Dental Association.
And some are struggling to cope with demand. Around 300,000 people a month need urgent dental care, according to NHS data, but only eight patients per surgery per day can be treated in a fully functioning urgent dental care centre because treatment rooms and equipment need to be disinfected between patients.
This has left Lesley among countless numbers of patients who are unable to get treatment. There has been a rush of people posting stories on social media about how they have taken matters into their own hands, with some pulling out painful teeth, while others are trying to patch up damage with temporary fillings sourced online.
Lesley’s problem began a month ago, when a hole appeared next to a filling in a molar in her upper-jaw.
The mother-of-two, from Oxfordshire, initially felt a searing pain that struck when she bit on food. Soon, she was in such agony that she could not sleep.
Last week the Government published guidance on how lockdown restrictions across England are going to start being lifted. But it did not mention dentistry
As an NHS worker, Lesley was only too aware of the pressures on services. She waited for four days before contacting her dentist in the hope the pain might subside.
‘In the end, I rang my dentist and then sought further advice from two others,’ says Lesley. ‘But they all told me the same thing — that they weren’t allowed to see me, and that the emergency dental service that was supposed to cover for them was not yet operating.’
There are currently serious gaps in dental provision across Britain. This leaves some patients with few options other than putting up with it or taking matters into their own hands.
Lesley was told by her dentist to buy a temporary tooth-filling repair kit online. These typically cost around £10 and include dental cement and an applicator. ‘I tried a number of online sellers but they had all sold out,’ she says.
The alternative, her dentist said, was to visit A&E, where the only thing they would do is pull out her problem tooth. This is not only an extreme solution to needing a filling but goes against modern dental practice of preserving teeth whenever possible.
Lesley is anxious to keep the molar. A friend kindly sent her an emergency dental repair kit that they had bought a year ago to carry while travelling. But Lesley feels extremely wary.
She says: ‘The packaging carries a warning that if you fail to clean the tooth properly before applying the filling, then you may get an abscess forming behind it. I don’t feel confident that I could make my mouth sterile and feel too concerned to use the kit. Given the lack of dental provision, the last thing I want to do is make my problem even worse.’ Lesley is left in limbo — and still in pain.
Damien Walmsley, a professor of restorative dentistry at Birmingham University and scientific adviser to the British Dental Association, says that dental practices are limited in the help they can offer patients suffering with decay, infections or injuries.
They can advise patients over the phone to use aspirin, paracetamol or ibuprofen. Alternatively, they can prescribe antibiotics.
Around 300,000 people a month need urgent dental care, according to NHS data (file image)
‘With infected teeth, antibiotics are often not that useful,’ he says. ‘There is hardly any blood supply to the root of the tooth, where the abscess is sitting on nerves and pressurising them. This means that very little antibiotic is carried there. Patients should instead do their best to get into an urgent dental care unit, if possible.’
Lesley may be wise to avoid trying her home-filling kit, says Professor Walmsley. ‘I would find it very difficult to put a filling in my own tooth,’ he says.
‘There is a danger that you could put chemical filler in the wrong place and cover your gums, causing an ulcer. The chemicals involved in the filling may also cause painful contact dermatitis if they come into contact with the gum.’
As for doing other DIY dentistry such as extracting your own teeth, Professor Walmsley has this simple advice: Don’t do it. ‘There are too many vital structures such as nerves and tissues around the face for people to do anything safely themselves,’ he stresses.
There are, however, a few things we can do to fix emergencies ourselves, he adds. ‘If you have knocked out a tooth, you can try to put it straight back into the socket and it may re-implant itself with the surrounding tissues growing back. If you can’t do that but have access to an emergency dental service, put the tooth in a cup of milk, to preserve it healthily enough to be re-implanted.
‘If you have lost a crown, you may be lucky enough to find that it clips back on. You can also use denture adhesive from pharmacies to stick it back on, though this is a temporary fix.’
EXTRACTION WAS THE ONLY WAY
Housewife Angela Wood, 49, lives in Sheffield with her husband, John, 48, a software engineer. The couple have two children aged 16 and 19. She says:
It’s bad enough that I’ve had a healthy tooth taken out. What’s worse is that I’m still in terrible pain.
Just after lockdown began, I developed a throbbing in the bottom left side of my mouth. I phoned my dentist. They couldn’t see me and told me to take painkillers.
But over the following three weeks, the pain got so bad I couldn’t concentrate on even the simplest of tasks. Hearing my distress, my dentist referred me to an emergency treatment centre.
There, I was told that, although I could have an X-ray, the only procedure being offered was extraction. (Dentists can’t use their drills because the aerosol spray it produces may spread the virus.)
I was told the X-ray suggested I may have an infection near a crown and was given a five-day course of antibiotics. But the drugs didn’t help. Two days later, I called the centre in despair. The dentist said he couldn’t say with any certainty what the problem was. Most likely it was an infection that, under normal circumstances, would need root canal treatment. But the only treatment he could offer was extraction.
Within days of having the tooth out, I had developed sensitivity in my upper-left teeth. Now, two weeks later, if I have anything hot or cold it’s excruciatingly painful.
The emergency dentist suggested taking out the tooth next to the one he had removed, as it could also have an infection. I was horrified.
I’m in a miserable no man’s land. I can’t believe dentistry has been reduced to this.
Attempting to use super glue is an absolute no-no, adds Professor Walmsley. ‘Super glue is rendered useless inside your mouth by all the moisture there. It makes the glue swell and, as a result, it soon becomes unstuck,’ he says. ‘But it can do a lot of harm, such as sticking together fingers and lips.’
Even those who do get to see a dentist are offered only limited help. In fact, the British Dental Association says that even the emergency centres can offer only a limited range of treatments, and patients with repairable teeth are often told that the only option is to have them pulled out.
Dr Keith Burns, who runs a private dentistry practice in London that has been closed under lockdown, says this problem is becoming distressingly common.
‘Every week I hear from patients having teeth taken out at urgent dental care units that would have been saved easily in a normal dental practice,’ he told Good Health.
‘I am talking to patients who are having a terrible time.
‘One has fractured a molar, which has become painfully infected. I prescribed two courses of antibiotics in an attempt to help. In the end, it had to be extracted at an urgent dental care unit. I could have saved that tooth by going into it and clearing the infection.
‘I also have patients who were given temporary dental bridges that I haven’t been allowed to replace in time. Instead, the bridges are now broken. One lady patient just isn’t able to eat using any of her back teeth. All of this is just the tip of the iceberg.’
Practitioners are also warning that thousands of cases of head and neck cancers that often get spotted during routine check-ups may now be going undiagnosed in the UK.
These cancers are the eighth most common cancer in Britain.
In a normal six-week period, nearly 1,000 cases are diagnosed by dentists, according to figures from the Oral Health Foundation. The tumours are treatable if caught early but have a very poor prognosis when they are spotted late.
A Department of Health and Social Care spokesperson tells Good Health: ‘We continue to discuss with Public Health England and the dental profession the next steps forward, taking into account the risk of infection and consequent need for personal protective equipment.’
Professor Walmsley wants to see the return of dentistry under safe conditions for both practitioners and patients.
‘Most dentists are desperate to get back to work,’ he says.
What’s more, untold thousands of patients are desperate to see them.
COULD CLINICS CLOSE DOWN?
The extended lockdown on dental practices threatens a further serious long-term impact — the loss of thousands of UK dental practices. Government rules on compensation have left nearly all of them without financial support.
According to the British Dental Association, dentists are among the only businesses on the High Street that are not offered full relief from having to pay business rates.
‘Private practice accounts for more than half of the £7.8 billion spent each year on dentistry, and much of that money is used to subsidise NHS work,’ says Ashley Dé, of the British Dental Association. ‘If private dentistry is left to collapse — which looks very possible at present — this will have a disastrous effect on the overall provision of care to patients.’
Government figures from last year indicate that more than 1.4 million adult patients had tried and failed to access dental care.
Such concerns have led more than 1,000 private dental practices in the UK and Ireland to set up the lobbying organisation Pandora Dental.
Dr Mark Cronshaw, a dental surgeon and president of Pandora, says: ‘The earliest that dental practices could resume normal service appears to be early July — the same time as hairdressers.’
Children’s oral health is in crisis, too
By Julie Cook
He was giggling when I saw it — a large tooth poking out over the top of a milk tooth. I stopped my son Alex, 11, mid-laugh and asked him to open his mouth wider. ‘Ah yes,’ I said. ‘An adult tooth is growing over your baby tooth. We’ll call the dentist.’
Only, of course, in that split second I’d forgotten: we couldn’t call the dentist. Since the lockdown, practices have been shut.
Alex still has to lose all his milk molars and some other teeth. He is late for his age group — usually, milk molars have fallen out by the age of ten-and-a-half — and we have been warned he may need them removed if they don’t make way for the adult teeth soon.
Now an adult tooth is bearing down on a milk tooth that is stubbornly refusing to budge, forcing the adult tooth out at an angle and pressing on the baby tooth.
‘It hurts badly in the gum,’ Alex told me. I called our dentist to be told that they are only doing emergency sessions over the phone. Children’s check-ups would have to wait.
As well as the pain and overcrowding, my son also regularly has fluoride painted on his teeth to protect them from cavities. With the most recent appointment cancelled, he will miss out on this, too.
Every year nearly 60,000 children have to be admitted to hospital to have teeth extracted under general anaesthetic, mainly due to tooth decay, according to NHS Digital
Meanwhile, a friend’s teenage daughter, who has braces, has been unable to see her orthodontist for her check-up and tightening because of Covid-19.
‘It will probably set her back by months,’ her mother said.
Another friend has a child with several fillings who now has toothache. But their dentist remains closed.
Fortunately, our problems are not as bad as many others.
Every year nearly 60,000 children have to be admitted to hospital to have teeth extracted under general anaesthetic, mainly due to tooth decay, according to NHS Digital.
Regular dental visits to check for cavities and give children fluoride treatments to strengthen enamel are vital for many — so, if dentists can’t see children at a higher risk of dental cavities, will we see an increased need for extraction and other NHS treatment?
The reason dentists had to close is because dentistry is considered to be one of the high-risk professions in terms of spreading the virus, which could happen through aerosols and droplets during invasive procedures, says Dr Claire Stevens, a consultant in paediatric dentistry at Manchester University NHS Trust and spokesperson for the British Society of Paediatric Dentistry.
‘Dentists can’t do a check-up without getting very close to patients,’ she says. There is a risk of transmission to dentist, dental nurse and patient.
When it comes to decay, she says, most children will be fine. ‘Lockdown is unlikely to have a huge impact in terms of children’s oral health because decay happens over months, not weeks,’ she explains.
As for children with braces, Dr Stevens says: ‘Lockdown will mean many can’t be seen in person by their orthodontist and may need to wear braces for longer. But wearing a brace for an extra six weeks is still preferable to spreading coronavirus. There is a low risk to children in delaying adjustments for braces.’
However, she concedes that lockdown may cause families to lapse into unhealthy dental habits.
‘In nearly all cases, dental decay is preventable,’ says Dr Stevens.
‘We are urging parents to maintain a strict oral health routine, especially during lockdown, which includes avoiding or limiting sugary drinks and snacks, and having tap water or milk in between meals. Encouraging your child to brush twice a day, for two minutes, and not to rinse out fluoride toothpaste after use are also good things you can do.’
My own dentist has said they will not be reopening until June at the earliest. But Dr Stevens stresses that for emergencies and severe pain, children can still get dental care. ‘We have not stopped treating emergency cases,’ she says.
‘We are still here if a child has severe pain or for dental trauma. We continue to see a lot of trauma possibly because children in lockdown are enjoying playing outside.
‘I have treated injuries where children have fallen off trampolines or gone over their bike handlebars.
‘The first point of call is your own dentist, who can do an assessment via video call and refer you to an emergency clinic if your child has severe pain or dental trauma.’
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