I Have a Dental Emergency, but I'm Scared to Visit the Dentist Due to COVID-19. What Do I Do?

A toothache struck at the worst possible time. How to navigate dental care in the time of COVID-19?

The COVID-19 pandemic has affected all of us in a significant way.  Whether you know someone who has contracted COVID-19, or you could not work and suffered a lost of income, or you are suddenly responsible for homeschooling your children because schools are closed, this pandemic has surely been stressful for all of us.

 The last thing you want to deal with during this mess that we know as COVID-19 is a dental emergency.  You need to see a dentist.  But is it safe to see a dentist right now?  Is my dentist even open right now?  Could I get an appointment?  

 It’s OK to be Afraid Right Now

We are all trying to be strong right now.  We are all doing our best to put on a happy face and stay productive and eat right and get the right amount of sleep we need.

 But fear is striking us in all kinds of different ways, and it’s OK to be afraid, especially when you are faced with an unthinkable dilemma like a debilitating toothache.  We all want to stay well and healthy, but life rarely goes as planned, and we all have to be prepared to deal with that.

 We Are Open Starting May 19, 2020

First of all, our dental clinic in Richmond, BC is open for normal office hours Tuesday to Saturday 9am-5pm.  We will be happy to see you or provide a consult over the phone.

 Enhanced Safety Measures

Here are some precautions we are taking to keep our clients and staff safe:

• We are maintaining social distancing and reducing the number of people we see.

• We are screening our staff and patients daily for potential COVID-19 symptoms. Anyone who has even the mildest suspicion that they may be sick are asked to stay at home.

• Every person that enters the building will be asked to wash their hands with soap and water.  Hand sanitizer is also available, but a 20-second handwashing with soap and water is the most effective way of removing germs.

• Increased disinfection measures for all high contact surfaces: everything including the door handles, sink, pens, and pin-pads are disinfected after EVERY person touches it.

• Enhanced personal protective equipment including N95 mask, face shield, safety glasses and surgical gowns.

• Air filtration with UV disinfection to remove dust and germs from the air.

Dental Procedures During the Time of COVID-19 Stay the Same

Your dental procedures stay the same during COVID-19.  In fact, the time you spend in our dental office will likely be shorter because we will try to complete all insurance forms and medical questionnaire prior to your arrival.  We will also try to get as many details as possible over the phone about your dental needs prior to your arrival, so that we can prepare the right instruments for your visit.  

If you have a dental emergency, please call us first at 604-277-3533. You should not put off a serious dental infection.  We want to help and want to assure you that we take the highest precautions possible to keep our clients safe.  We will be happy to chat over the phone with you about whether you need to come in right away or in some cases our dentists can provide a consult over the phone.  

Preventing Dental Emergencies in the Time of COVID-19

Dental offices in Richmond, BC have been mandated to close by the British Columbia Ministry of Health and College of Dental Surgeons of British Columbia.  It will be difficult to find a dentist to address your dental concerns during the current COVID-19 pandemic. Therefore, it is important for you to take good care of your teeth.  This article will focus on how you can prevent dental emergencies during this pandemic.

Other than an accident, there are only three basic ways people have problems with their teeth.  Two are infections and one is mechanical.  The infections are tooth decay/cavities and gum disease.  Only a licensed dentist can diagnose either infection.

Chewing is a mechanical process that creates hundreds of pounds of pressure per square inch.  This pressure, when not in harmony, causes worn, broken and loose teeth and requires a highly skilled dentist to help distribute the pressure so teeth are not harmed. 

I will discuss each entity to help you keep your teeth as healthy as possible until COVID-19 is no longer a serious threat.  I promise to be very frank, open and honest.  Now is the time for all people to start taking responsibility for their own health including diet, exercise and self-help.  If you don’t clean your teeth properly, there are going to be negative consequences.  If you are overweight, there will be negative consequences and the list goes on and on.  Most health issues are common sense when you stop and think.

Tooth Decay Prevention

It is important to understand the decay process first.  Food debris left on teeth feed bacteria which produce powerful acids.  The acid eats through the enamel until it reaches the tender dentin.  The bacteria then eat away at the dentin somewhat like flesh eating bacteria eat skin.  Left unchecked, the bacteria enter the nerve and once in the nerve, they enter the circulatory system and have free reign to go to every organ in the body.  The infected nerve can be considered acute or chronic.  Acute means pain; chronic means no pain in everyday language.  Pain or no pain, the infection is real.

Obviously, it is better to have a cavity-free mouth to start with.  Common sense dictates that clean teeth don’t rot!  I recommend brushing your teeth with an electric toothbrush for 2 minutes after breakfast and before bedtime.  Brushing cleans only 70% of teeth surfaces.  It doesn’t clean where the teeth contact each other.  Yes, that means flossing in between all teeth before bedtime.  I have no fear of ever having decay if I keep them perfectly clean.

Gum Disease

Gum disease is obviously in the gums and not the teeth.  It is caused by different bacteria than decay.  This particular group of pathogenic bacteria are also fed by food that remains on the junction of teeth and gums.  It first starts out as gingivitis meaning only the gums are infected.  It then progresses into the bone and eats the bone away.  Because the bacteria have invaded living tissue and bone, they too are free to travel through the entire circulatory system causing havoc including weakening the entire immune system that’s so critical right now.

Clean gums do not get infected!  Healthy gums grow into the roots of the teeth and seal out any type of bacterial invasion.  If you have healthy gums and follow the above regimen, your gums should remain healthy.

If your gums bleed when you brush or floss, you have gum disease!  Until this virus crisis is over, traditional dentistry will not be able to help you as dental cleanings are not recommended during this pandemic.  Using the above regimen is the only thing you can do right now.  

Important:  When gums bleed on brushing, the toothbrush turns red and there is blood in the sink during rinsing.  The natural thinking would be to leave the area alone.  However, the truth is contrary to this natural thinking.  Wherever there is bleeding, that area needs to be aggressively cleaned with an electric tooth brush, floss and a Waterpic type of appliance.  The goal is to mechanically remove the bacteria that causes the infection.  In no way does this compare with the effectiveness of a professional dental cleaning, but it is best thing you can do at home.

The Bite

Clean teeth have no effect on the way the teeth come together.  Good bite or bad bite, the only advice I have is the Mantra; “lips together, teeth apart.” Clenching destroys teeth and can cause TMJ/TMD.  It only makes sense to not clench.

The bottom line is to keep your and your children’s teeth perfectly clean which only takes a couple of minutes after eating.  Now is the time to get into the habit.  Once you get used to having perfectly clean teeth, you can never go back to the old neglectful way.

Summary of Good Oral Hygiene Regimen:

• Use an electric toothbrush

• Brush for two minutes each time, clean all surfaces of all teeth

• Brush after breakfast and before bedtime

• Floss once daily before bedtime

• When gums bleed on brushing, do not stop brushing! Instead, Brush, floss and use Waterpik or Soft Picks to make the area as clean as possible.

How to Brush Children's Teeth

"When should I start brushing my baby's teeth?"

You should clean your baby's mouth even before your child has teeth. Use a clean damp washcloth to wipe your baby's gums daily. This routine gets you and your baby into the habit of keeping the mouth clean, and it gives baby teeth a clean place to come into.

As soon as the first tooth emerges, parents should start brushing their children's teeth.

"How to brush my child's teeth?"

This position is very effective in brushing your children's teeth

• Lie your baby in a comfortable place

• Make sure you can see into your baby's mouth

• Use a soft baby toothbrush

• Apply a small amount (the size of a grain of rice) of fluoridated toothpaste on the toothbrush. 

• Brush your baby's teeth. Make sure you clean all the surfaces of their teeth. 

• If your baby is too young to spit out toothpaste, use a clean damp washcloth to wipe off the toothpaste.

• Floss between teeth as soon as two teeth touch together. Floss sticks may be easier to use on children.

• Brush your child's teeth twice a day: in the morning and just before bed. Floss once a day.

"When can kids brush their own teeth?"

Children lack the coordination and dexterity to brush their teeth properly until about the age of eight. Remember if you child cannot write his or her name they cannot clean their teeth effectively. 

Children under 3 years of age should have their teeth brushed by an adult.

Children from 3 to 8 years of age should be assisted by an adult in brushing their teeth. If your child wants to brush his or her own teeth, you can let them brush first and then you can brush their teeth again after to make sure they are clean.

"When should my child start seeing the dentist?"

The Canadian Dental Association recommends the assessment of infants, by a dentist, within 6 months of the eruption of the first tooth or by one year of age. The goal is to have your child visit the dentist before there is a problem with his or her teeth. In most cases, a dental exam every six months will let your child's dentist catch small problems early.

Do I Need My Wisdom Teeth Out?

"My Dentist recommended extracting my wisdom teeth, but they are not hurting me. Do I really need to have my wisdom teeth removed?"

We hear the above question fairly often. I hope the following information will be useful to you in helping decide what to do with your wisdom teeth.

Your wisdom teeth do not need to be removed if they are:

• Healthy
• Fully erupted (fully grown in)
• Positioned properly to bite with the opposing teeth
• Positioned so that all surfaces can be cleaned sufficiently daily

Healthy wisdom teeth (*) positioned aesthetically and functionally. 

For the wisdom teeth to erupt and align properly there must be sufficient room in the back of the jaw. It is very rare to see someone with all 32 teeth in the mouth. The above images show someone with wisdom teeth that are optimally aligned and functional. 

Examples of Wisdom Teeth Problems

Sometimes wisdom teeth only partially emerge through the gums. Other times, they are completely hidden. Wisdom teeth that fail to erupt properly become impacted, or trapped, in the jaw bone. 

The partially impacted wisdom teeth create a passageway for food and bacteria, which can cause

• Decay of the wisdom teeth
• Pain and infection of the gums around the wisdom teeth
• Damage to adjacent teeth

Impacted wisdom tooth 

Wisdom tooth causing damage to the neighboring tooth. 

According to the American Dental Association, wisdom teeth removal may be necessary if you experience changes in your mouth, such as:

• Pain
• Repeated infection of gums surrounding the lower last tooth
• Cysts
• Tumors
• Damage to nearby teeth
• Gum disease
• Extensive tooth decay

Wisdom teeth can cause damage long before your experience symptoms. The damage can be irreversible, as shown in the image above. The best way of prevention is to take a panoramic x-ray to check for the growth and orientation of the wisdom teeth. If the wisdom teeth are positioned in a problematic way, your dentist may recommend removing them before they start to cause damage to the surrounding tissue.

The decision to remove wisdom teeth can be complex. Talk to your dentist about the position and the health of your wisdom teeth and what's best for your situation.