Getting to the dentist during a pandemic

Editor’s Note: Going anywhere during a pandemic is difficult but getting to medical appointments is even more fraught. Whether you need to get to the pediatrician, dentist, vet, internist or hospital, this five-part series from CNN Science and Wellness has you covered.

On Easter Sunday, as much of America faced another day in quarantine, a woman in Centreville, Virginia, woke up to a terrible toothache.

“I was having some pain,” she said. “With the pandemic I said, ‘I’ll just have to wait until everything’s over.’”

That Sunday, though, the pain became extreme. When she found a dentist who could see her, she learned she needed an emergency root canal.

As part of the country’s response to the Covid-19 crisis, the US Centers for Disease Control and Prevention (CDC) has recommended that dentists put off “elective procedures, surgeries and non-urgent dental visits,” allowing only emergency visits until the threat subsides.

That’s because dental work could place dentists and dental hygienists at risk for Covid-19 infection, according to the US Department of Labor’s Occupational Safety and Health Administration (OSHA).

The government agency includes dental health-care providers in the “very high exposure risk” category. Routine dental tools such as air-water syringes can send droplets of saliva through the air, potentially carrying the virus with them. Even recommended personal protective equipment (PPE), such as face shields and gowns, do not fully safeguard against infection.

The increased risk means it’s critical to take care of your teeth throughout the coronavirus pandemic, and to see providers only in case of real emergencies.

If you do experience an emergency, you’d likely see some new procedures to protect both patients and providers. Here’s what you need to know.

What is an emergency?

There’s no fixed definition of a dental emergency, said dentist Matthew Messina, the clinic director at Ohio State Upper Arlington Dentistry and a spokesperson for the American Dental Association.

Messina said issues that may require immediate care include a fractured tooth, swelling or pain that can’t be managed with over-the-counter medications.

“If someone has a little sensitivity from a small cavity,” he noted, “that would probably be postponed until after the restrictions are lifted.”

The most important thing, he said, is to start by calling your dentist, who may be able to offer care via telehealth.

“A lot of times, some really useful things can be taken care of over the phone,” he explained.

How should you care for your teeth?

If you do have a minor issue such as a cavity, Messina said you should simply care for the tooth with healthy brushing.

“It’s always best for us to reconfirm our commitments to the ‘healthy four,’” said Messina. That means brushing your teeth at least twice a day with a fluoride toothpaste, plus daily flossing and a healthy diet.

“Those things put us in the best shape to not let anything get worse,” he said.

While it’s widely known that avoiding sugary food and drink is good for your teeth in the long term, Messina said that cutting sugar, even temporarily, can help maintain good dental health while postponing regular dentist visits.

Bacteria are always present in the mouth, said Messina and eating sugar amounts to feeding them. “The bacteria metabolize sugars, and the byproduct of that is acid,” he said.

“Acid bathing the teeth is what dissolves away the enamel — the hard outer covering of the tooth — and that’s what causes cavities.”

In addition to cavities, dentists also routinely check for signs of oral cancer and other issues. If you need to put off an office visit, Messina suggested monitoring your mouth for any changes.

“If you have something in your mouth that you think is different, like a lump or bump, a white spot, a red spot, anything like that, don’t wait,” said Messina.

“If there’s something that you’re not sure is right, that’s something you want to contact your dentist about.”

What if you grind your teeth?

Another risk to your teeth during the coronavirus pandemic is teeth grinding or clenching, which can be aggravated by stress, said Messina.

“Right now we have perceived stress,” he explained. “Clenching and grinding tends to be one of the things that the body does to relieve that level of stress.”

If you notice that you’re waking up with a sore or tired jaw, you may be clenching or grinding your teeth as you sleep. If gone untreated, that can eventually result in cracked, worn-down teeth.

“One of the ways to respond to stress is to go for a walk, go for a run or do something active,” said Messina.

Another option Messina recommended to treat soreness and tension associated with grinding is to massage the sides of your face or to press a warm washcloth against jaw muscles.

How are dentists adapting to Covid-19?

When dental offices eventually reopen for routine care, they’ll be following directives from governors, state health departments and state dental boards.

In the meantime, Messina said that dentists are looking to the American Dental Association and the CDC for guidance in responding to Covid-19. If you do need to visit a dentist for urgent care, he said you’d likely see measures put in place to protect both patients and providers from Covid-19.

Those measures include social distancing, screening for Covid-19 symptoms and enhanced hygiene.

“Most offices are using efforts to socially distance the patients,” said Messina. “We want to minimize patients in a group in our reception area.” Those efforts may include having patients wait outside in cars, for example, so they can enter the office one at a time.

When the Centreville woman arrived at the dentist for an emergency root canal on Wednesday, she filled out a form that asked about potential coronavirus symptoms and exposure. In the procedure room, she said, the dentist and dental assistant wore doubled surgical masks, as well as protective gowns.

In conjunction with that additional protection, Messina noted that some offices are using CDC-recommended face shields.

When it comes to other precautions, such as respiratory hygiene and sterilization, Messina said that dental offices have practiced these measures for years.

“Our existing universal precautions provide safety for patients and healthcare providers as well,” said Messina. “Universal precautions have been the standard for dental offices since long before it became cool.”