The PAINFUL TRUTH about dentistry in LOCKDOWN
Emergency centres overwhelmed, many left in agony untreated . . . and some yanking out their own teeth
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.
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.
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.
scotland is set to have its own road map to the easing of restrictions published on thursday. But similarly, there is no announcement yet on when dentists will resume normal practice. so far, a total of 56 urgent care centres have been set up in scotland.
lesley was told by her dentist to buy a temporary toothfilling 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.
‘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.’ 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 reimplant 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.’
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 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 also warn 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 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 spokesman tells Good Health: ‘We continue to discuss with Public Health England and the dental profession the next steps forward.’
Professor Walmsley wants to see the return of dentistry under safe conditions for all.
‘Most dentists are desperate to get back to work,’ he says.
What’s more, untold thousands of patients are desperate to see them.