Advice from Local Dentist on Treatment During Lockdown

What to do if you have an urgent dental problem

There has been a lot of confusion, anxiety and distress for patients who have urgent dental problems at this time. Long-time Chiswick dentist Dr Mike Clarke, senior partner at West London Dental Centres and Chair of the LDC Confederation (representing almost 3000 dentists across Greater London) explains the official pathway for patients at this difficult time.

On 25 March the Chief Dental Officer for England announced the postponement of routine dentistry in dental practices in order to protect patients, dental teams and the wider community from potential infection transmission. That is, no face to face appointments could be offered until further notice.

This was followed by a series of protocols designed to provide an interim arrangement for patients who needed urgent assistance. All dentists in England should follow these protocols, whether NHS or private practices. The first stage is the AAA protocol at the practice level:

• Advice
• Analgesia
• Antibiotics (if appropriate)

Patients needing help should therefore telephone their dental practice directly during normal hours, to speak to the receptionist. In this initial triage, if necessary, the patient may wish to speak with a dentist directly. As a result of that telephone consultation with a dentist, depending on what the provisional diagnosis indicated a prescription would then be issued electronically and sent to a local pharmacist. This may include antibiotics for a dental infection, but please be aware that if there are no clinical signs of infection then antibiotics would not help. In those cases, advice regarding painkillers may be the only option at that stage.

Once a prescription has been provided, after a period of approximately 48 hours to allow the antibiotics to start to take effect, there could be another telephone review by the practice dentist. If necessary, further different antibiotics may be prescribed. If, however, after following this initial triage stage the dentist felt that direct treatment was urgent, then the dentist would assist the patient to follow the London dental triage protocols to one of the designated urgent dental care hubs across London that have been established by the NHS England (London Region) team. This would be via the 111 service. However, patients should be aware that the 111 service is also currently dealing with an enormous number of calls daily for help. That initial 111 telephone service would require further triage before an appointment might be offered.

Patients who do not have a regular dentist may also try to contact a dental practice locally for help, or if that is not possible, then call 111.

Similarly, if a patient calls outside of the normal practice hours, although some practices have extended their telephone triage service if this is not possible, the correct protocol then would be to call 111. Most practices will have further helpful information available on their websites.

It is important for patients to understand what is considered urgent, and what is considered to be an emergency. The Faculty of General Dental Practice has provided guidance in this respect, as follows:

Urgent care includes:

• Dental and soft tissue infections remaining locally within the mouth
• Severe dental or facial pain that could not be controlled following self-help advice by the dentist
• Badly fractured teeth with exposure of the nerves

Dental Emergencies include:

• Facial trauma, including a permanent tooth having been knocked out
• Significant swelling of tissues in the mouth and/or face that is becoming worse
• Bleeding from an extraction site that the patient cannot control
• Dental conditions causing more systemic illness, for example a raised temperature related to a dental infection
• Dental conditions that are likely to exacerbate existing serious medical conditions

Dental emergencies are therefore those conditions that would be considered to be in need of immediate attention, and that could have a serious immediate effect on the patient’s general health. As for medical emergencies, the patient should seek help at the local A&E hospital service. In extreme cases, this may be via telephone 999.

Going forward after lockdown, once dental practices are allowed to reopen, the safety of patients and dental teams will be of the highest priority. This means that normal working practices may need to be modified for some time, but the dental profession will be guided by the best up to date information and guidance available from the NHS authorities and other professional bodies.

May 3, 2020