DIY dentistry is filling a gap while clinics stay closed
Desperate measures are being taken to get relief from tooth pain, but should surgeries have been shut down, asks Luke Mintz
Billy Taylor swigged a couple of shots of whisky to calm his nerves before yanking his own tooth out. The 33-year-old had been suffering “excruciating” pain for weeks due to an infected tooth, which had caused the whole left side of his face to swell up. “Every half an hour it was getting bigger,” said Taylor, an aircraft fitter from Axminster, Devon. “I looked like the Elephant Man.”
The dental clinics in his area had all shut their doors because of the pandemic, so Taylor called the NHS on 111, hoping to book a slot at one of the emergency dental hubs hastily set up by the NHS.
But he was told that he could not come in unless the infection was restricting his breathing.
So Taylor took matters into his own hands: after the whisky, he placed an ice pack on his face until he could not feel his gums. He then enlisted the help of his 11-year-old son, Leo, who used Taylor’s work tools to tug on the tooth for an hour and a half, until it came out. He said the pain subsided “instantly”, although he was left with some bruising on his cheek.
Reports suggest that an alarming number of people are now resorting to “DIY dentistry”, as the closure of most of the UK’S 12,000 dental clinics throws millions of patients into a confusing limbo.
Nearly all routine dental treatment across the UK was cancelled in late March, following advice from the chief dental officers of each of the UK’S four nations that there was too high a risk of patients giving coronavirus to staff, or vice versa.
Policymakers were particularly worried about the use of aerosolgenerating machines, like ultrasonic scalers, which are thought to carry a high risk of transmission when used on an infected patient, because they can spray coronavirus particles into the room’s atmosphere, where they might linger for hours.
Seven weeks later, there is still no sign that the NHS is looking to restart routine care.
But the decision was controversial. Julie Deverick, president of the British Society of Dental Hygiene & Therapy and a practising dental hygienist, says the viral load of coronavirus in aerosol machines isn’t as high as previously thought, and other European countries have kept most of their dental clinics open.
Instead, patients here are triaged over the phone – a small number are referred to an emergency hub for treatment, but most are just given advice over the phone, or prescribed antibiotics or painkillers over email. The hubs are generally only carrying out basic procedures like extractions. Those with a loose or missing filling, bleeding gums, or a minor infection are very unlikely to get an appointment.
Dentists complain that the NHS was too slow to get these hubs up and running, particularly in England, leaving a long backlog of cases. Mick Armstrong, chairman of the British Dental Association, has blamed a “dragging of heels in government”, which has left “thousands of practices unclear if they have a future”.
Deverick says she has heard of patients who cannot get a filling and so have been forced to get their tooth extracted just to stop the pain. Those who do not want an
Patients are using chewing gum to fill cavities after their fillings come loose
extraction are instead being prescribed repeated rounds of antibiotics; one patient received three back-to-back prescriptions – “that’s not good, we’re trying to reduce the use of antibiotics”.
As for Taylor et al, Deverick adds that feeling forced to remove one’s own teeth “is horrendous”.
Chris Dean, a dentist for several decades who is now managing director of the Dental Law Partnership, says his law firm receives around 40 messages a day from worried patients. Patients are using chewing gum to fill cavities after their fillings come loose, he says, or supergluing their veneers back on. Others are using wire-cutters to remove braces.
Some patients are being advised to buy over-the-counter home dentistry kits, which provide a putty material from which patients can fashion their own fillings. But Dean says that in the first few weeks of lockdown he could not find a single kit in any shops.
Now, some are available in high street pharmacies.
But patients should think carefully before trying anything at home. “No dentist would advise taking your own teeth out. Call your dentist and see if you can access the urgent service,” says
Dean. “If you can’t, then temporary filling materials and temporary cements are now available.
“Do not use superglue, do not take pliers to your mouth. In extremis, accept that you might be missing a crown for a bit.
“There are people falling between the gaps here, whose problems are not sufficiently life-threatening to warrant attendance at the urgent dental care centres. And you may say, ‘Well, that’s Covid for you, tough’, but these people are in pain. I think we can do better.”
Deverick is also worried that the sudden drop in routine dental appointments might mean that red flags go ignored, saying: “Whenever you see a dentist or a hygienist, they check for oral cancer.” For those now waiting months with abnormalities they don’t recognise, “what’s going to happen to them?” she asks.
Experts stress that now is a more
important time than ever to maintain excellent oral hygiene.
“People need to brush their teeth really, really carefully during Covid,” says Dean. “Twice a day, and perhaps three times a day, and you need to use little brushes between the teeth, and a fluoride mouthwash.
“Be careful with food – if you’ve got a lot of crowns and bridgework then don’t eat toffees. You can’t rely on the dental service right now.”
Deverick is optimistic, still, that coronavirus could produce some positive changes for the industry. The rise in phone and video consultations has shown them more efficient methods, she says, although she thinks the bulk of their work, like checking for bleeds, will always require an in-person consultation.
“[But] this lockdown has certainly opened everybody’s eyes to what’s available,” she reasons.