HOUSTON – To protect dental professionals, preserve resources, and expand available hospital capacity during the COVID-19 pandemic, Governor Abbott and numerous organizations have recommended that non-emergency and elective dental procedures be postponed for the next several weeks.
More recently, the Centers for Disease Control and Prevention (CDC) issued Interim Infection Prevention and Control Guidance for Dental Settings that further reinforces that elective procedures, surgeries, and non-urgent dental visits be postponed.
Why is this important? Most treatment provided by dental professionals produces aerosols. While the primary mode of transmission for COVID-19 is still thought to be by larger respiratory droplets, dental procedures are considered high risk for spreading the virus. Additionally, all dental procedures require the use of personal protective equipment (PPE), with varying levels of masks and respirators needed for different types of procedures.
So, what should someone who has an urgent dental issue do during the COVID-19 pandemic? The American Dental Association (ADA) has provided examples of elective versus urgent and emergent treatment. Dentists are advised to defer non-urgent care but continue to see patients for acute dental issues, keeping those patients out of emergency rooms.
That said, life-threatening emergencies, such as maxillofacial trauma, uncontrolled bleeding from the mouth, or facial swelling that crosses the midline or impacts breathing or speaking, will continue to be treated by oral and maxillofacial surgeons in a hospital setting.
What is urgent?
The following are examples of urgent dental conditions requiring prompt treatment, but usually not a trip to the ER:
- Severe tooth pain (“toothache”) – This condition is typically due to inflammation of the tooth’s pulp (nerve inside the tooth) and is most commonly caused by decay, whether it be the first cavity in the tooth or under an existing filling or crown.
- Abscess (infection) resulting in localized pain and swelling – Severe decay is again the likely cause, leading to death of the tooth’s pulp (nerve). Swelling may be limited to a “gum boil” on the gums, or in more severe cases, significant swelling of the face or jaw.
- Fracture of tooth or restoration (filling, crown) resulting in pain and/or causing soft tissue trauma – When the biting surface and/or side of a tooth chips or breaks, the tooth may become sensitive and/or the sharp edge may cut into the gums, tongue or cheek.
- Dental trauma resulting in avulsion (tooth knocked out) or luxation (tooth present but loose) – This is typically due to an accident, such as automobile, athletic event, etc., where part of the tooth is fractured, pushed in, knocked loose or completely knocked out. Patients suffering these conditions often need to be seen immediately, especially in the case of an avulsed (knocked out) tooth. In some instances, the injury may extend beyond the teeth, to jaw or facial fractures.
- Loss of temporary or permanent restoration (filling, crown, bridge) – Loss of the existing filling or crown can result in sensitivity, gum irritation or (after a period of days/weeks) even shifting of other teeth.
- Pericoronitis – A condition involving inflammation of the gums surrounding a tooth, typically a third molar (wisdom tooth). This condition most often occurs in partially erupted (not fully visible) molars that have a flap of gum tissue partially covering the tooth.
- Postoperative osteitis (“dry socket”) following tooth extraction – Typically appearing three to four days following an extraction, dry sockets requiring frequent, if not daily, dressing changes.
- Need for biopsy of abnormal tissue – Mouth sores or patches on the tongue, lips, cheeks or gums that do not resolve on their own are examples of abnormal tissue that may require an oral biopsy, where a sample of the tissue is removed and analyzed by an oral pathology laboratory.
Other conditions that may require prompt dental care during this time include removing sutures (stitches), adjusting dentures that are irritating, broken or malfunctioning, especially for cancer patients undergoing chemotherapy or radiation; and trimming broken or twisted orthodontic wires or appliances to avoid piercing or ulcerating the gums, lips or tongue.
Patients who do have to go in for treatment should be prepared to answer screening questions and have their temperature checked. Friends or family members may be asked to wait outside.
Making the call
So, to summarize: Patients with non-urgent dental needs during the COVID-19 crisis are advised to wait until restrictions on dental care are lifted.
Patients with urgent dental needs should contact their dental professionals to see what can be done for interim relief. This might include avoiding certain types of foods, taking pain medications or antibiotics, or using an over-the-counter temporary filling or cement, available at drugstores.
Anyone who doesn’t have a dentist, or who has questions, may call UTHealth School of Dentistry’s new Dental Information Hotline, 713-486-4000, Option 1. Staff will take calls between 8 a.m. and 5 p.m. Monday through Friday. Information also is posted on the school’s website.