By Dr. Rebekkah Merrell
As this coronavirus situation has unfolded, all of us – your dentist, the dental staff, and our patients – have been faced with questions about how to lead our daily lives while being told we must stay at home. And we’ve all felt how uncomfortable and frustrating the uncertainty and restrictions can be. My staff and I have seen that those feelings are magnified when your health, or that of a family member, is the cause of that uncertainty.
We’re now getting numerous questions every day from our dental patients about handling their dental appointments and needs since the stay-at-home measures went into place. We hope that by sharing the answers to the most common questions that you’ll feel more confident in dealing with your dental health during this time.
Is my dental office open?
We are currently open and seeing emergency patients. On March 16, the American Dental Association issued guidelines advising dentists nationwide to postpone elective procedures for three weeks until April 6. This was recently extended until April 30, and there is a chance that date may be extended again. To find out, you may call our office: 828.251.2426
Dental offices are allowed to see patients who are having an emergency. At Asheville Smiles Cosmetic & Family Dentistry, we’re staffing the phones as we should be while we are all sheltering in place. So, don’t worry if you should run into a problem – we can and will provide emergency care. We also have video conferencing available with your dentist. This is called teledentistry and allows the patient and dentist to have a consultation to assess your problem without you needing to come into the office. After the consultation, the dentist can determine what the appropriate next steps may be. A fee may be associated with teledentistry calls, but this isn’t always the case.
What is considered a dental emergency?
Dental emergencies, according to the American Dental Association, “are potentially life-threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection.”
What constitutes an emergency is actually pretty simple – it’s about pain or trauma. Some common dental emergencies include:
- Severe dental pain (most people think of this as a “toothache”)
- Pain from a wisdom tooth
- Post-operative pain from a dental surgery or procedure
- An abscess or localized pain and swelling
- A broken tooth resulting in pain or cutting your tongue or cheek
- A tooth being knocked out
- Dental treatment if a temporary crown or bridge is lost, broken, or causing gum irritation
Other emergency dental care includes extensive decay or defective fillings that cause pain, removal of stitches, denture adjustments for radiation/oncology patients, denture adjustments or repairs to address difficulty chewing, replacing a temporary filling on a tooth with a root canal if you are experiencing pain, and snipping or adjusting an orthodontic wire or appliance that is cutting your lips or cheeks.
The ADA has a terrific website for patients called mouthhealthy.org where you can download their guide to help decide if you’re having a dental emergency.
What about my dental checkup that’s scheduled?
This will be one of the few times that you’ll hear a dentist advise that you avoid your six-month checkup. But routine hygiene and cleaning appointments are considered elective procedures. A more complete list of elective or non-emergency dental procedures includes:
- Initial examinations (including x-rays)
- Periodic (six-month) checkups (also including x-rays)
- Routine dental cleanings and other preventive therapies
- Orthodontic procedures other than those to address a problem (e.g., pain, infection, trauma)
- Extraction of teeth that do not hurt (like having your wisdom teeth pulled)
- Fillings on cavities that aren’t causing pain
- Aesthetic dental procedures (such as whitening)
Make no mistake — six-month exams are still very important. As soon as the crisis passes let’s get that hygiene appointment rescheduled for you.
What happens when I get to the dental office with an emergency?
We have protocols put in place in accordance with the CDC guidelines and American Dental Association. We are maintaining social distancing protocols. All patients are asked to wait in their car verse the waiting room. Patient should call or text our office at 828.251.2426 upon arrival at their dental appointment. Appointments are being spaced out to limit overlap in appointments.
Patients are asked to use hand sanitizer upon arrival at their appointment.
You may be asked to swish with Peroxyl mouth rinse for 60 seconds prior to starting dental treatment.
The office is disinfected after each patient leaves each room with additional sanitation measures. Public restrooms are disinfected after every use.
Staff is wearing addition personal protective equipment.
Your safety and reducing the possible spread of the virus between patients is of the utmost importance.
For this reason, additional screening measures when scheduling appointments and upon your arrival at your appointment are being taken.
Your dentist and our staff will ask questions, and for everyone’s safety you’ll want to answer honestly. These questions may include:
- Have you had symptoms commonly associated with COVID-19? (common symptoms include fever, shortness of breath, dry cough, runny nose, sore throat, or diarrhea)
- Within the past 14 days have you travelled by airplane?
- Within the past 14 days have you been in close proximity (less than six feet) at a gathering of 10 or more persons?
- Within the past 14 days have you had close contact with a person who has been confirmed positive or suspected to be positive for COVID-19?
In some cases, you may be required to sign a Patient Request for Treatment, Representations and Consent document. As your dentist, we will also monitor the health of their staff in order to limit possible exposure to the virus.
If we feel comfortable with the answers to the screening questions and your condition does need emergency attention, then we will render the appropriate treatment.
Even if you have what might qualify as an emergency, the dentist will evaluate if a procedure can be delayed for 30 days. This judgment would be based on assuring that waiting won’t cause you undue harm or pain. An example is a lost or broken filling where a temporary filling can be quickly and easily placed, allowing you to return in the future for the more involved final filling.
What safety measures will the office take if I have to come in for an emergency treatment?
As health-care providers, dentists and their teams are trained on the CDC guidelines for infection control and using the appropriate personal protective equipment (PPE) such as mask and gloves. If for some reason an office doesn’t have appropriate PPE available, they’ll refer you to another dental professional for your emergency treatment. (In our office we don’t anticipate that happening and as of now we have a good supply of PPE.) If we do need to provide emergency treatment, we’ll attempt to minimize the use of equipment that creates airborne spray. This is a precautionary measure to limit the potential spread of the virus since any patient could be positive but undiagnosed and not yet exhibiting symptoms.
The Asheville Smiles team has been trained in the latest ways to minimize the possibility of transmitting the virus.
If my child or I am in orthodontic treatment, will missing appointments cause harm?
The simple answer is “No.” Your teeth will just stop moving at some point. Once elective procedures are allowed again, treatment can easily be restarted, and your teeth will start moving from right where they left off. If you have aligners you may be able to have a teledentistry consultation and the dentist may possibly send you your next set of aligners. Otherwise, continue to use your current aligner. Even though your teeth will generally stop moving after a week or two in the same aligner, it will act as a retainer holding the teeth in place until you can be seen for your next aligner.
If I’m missing my checkup should I do anything differently?
Make sure you are brushing and flossing. Do everything as you would normally. It’s never been more important to do the best job possible to maintain your oral health.
Since many of us will have extra time on our hands, make sure you brush at least twice a day for two minutes.
If you feel like you want to take extra steps to protect your hygiene during this time, here are a few ideas:
1) Use an electric toothbrush. We recommend and sell Sonicare Electric Toothbrushes at our Office.
2) Use an irrigation device or floss. We love our Waterpik’s and Sonicare AirFlossers.
3) Use your favorite mouth wash. We recommend not using alcohol based mouth rinses. Instead, try a fluoride based mouth rinse. We use Oxyfresh Cavity Protection or Act. If you’re anti-fluoride, no worries. Try any mouth rinse that is alcohol free.
4) Floss – if you don’t currently floss it’s a great opportunity to start. You have the extra time and once you’re in the habit you’ll like the extra clean feeling while also strengthening your gums! We also love our essential oil floss, COCOFLOSS that we use at all your hygiene appointments.
5) If you are cavity prone, you may want to try Prevident 5000 toothpaste. It is a prescription toothpaste, so call our office to ask about it.
6) Don’t forget to brush your tongue and top of your mouth. This helps get rid of bacteria and yeast that can stay on the tongue and roof of your mouth.
7) Lastly, if you haven’t changed your brush head or toothbrush in awhile, it’s time to get a new brush or brush head. We recommend new toothbrushes or brush heads every 3 months or after you have been sick.
Stay home, stay safe, and know that we’re here for you
During this time that we’re all asked to stay home unless there is a dental emergency, which means pain or trauma, with basic home hygiene you can be comfortable that your dental health will be fine. If you’re still confused or unclear as to whether you need to be seen in the office, email us or call us. Contact details are on our website at www.ashevillesmiles.com. My staff and the dentists are here for you, as are our dental colleagues for patients all over the country and the world for that matter.
During this time and for the foreseeable future, there will be a lot of things that may seem different in the dental office, but as soon as the virus is under control and it is safe to return for normal dental treatment, we’ll be happy to welcome you back!
Stay safe and healthy!
Dr. Rebekkah Merrell and the Asheville Smiles Team: Angela, Lauren, Mario, and Morgan