Coronavirus recommendations from the dentist.

In the midst of Coronavirus spreading, we at Smile Plus Dentistry have been monitoring this situation very closely for the past two months. As health care providers during a pandemic we will continue with the relief of pain and management of infection for our patients in order to keep them out of hospitals and emergency departments.

As the spread of COVID-19 continues we have received several questions from our patients:

Should I go to the dentist if I’m having pain?

Remember, social distancing is key to controlling the spread of the coronavirus. Also, the key to your optimal health is to make sure you don’t end up with dental infections.  As we have had first-hand experience in seeing patients suffer due to letting infections play out, we suggest all our patients visit the dentist if they experience pain,  swelling or discomfort. Presently, dentists across the US have been advised to see only those patients with dental emergencies and infections.

  • Wisdom tooth pain/infection (your mouth might not open fully or you may experience a bad taste in your mouth)
  • Root Canal Treatment (RCT) to treat pain
  • Severe, throbbing pain in your jaw
  • Infection of the face with intra-oral or extra-oral swelling
  • Trauma to the teeth or jaw
  • Denture adjustment for radiation and oncology patients
  • Denture adjustments or repairs when you can’t chew
  • Severe dental pain from pulpal inflammation
  • Pericoronitis or third-molar pain (gum inflammation around wisdom teeth)
  • Dry socket or post extraction pain and inflammation
  • Abscess or localized bacterial infection resulting in localized pain and swelling
  • Tooth fracture resulting in pain or causing soft tissue trauma
  • Dental trauma with loose teeth or tooth loss
  • Dental restoration or crown cementation if the temporary crown is lost, broken or causing gingival irritation.
  • Extensive caries or defective restorations causing pain
  • Suture removal
  • Replacing a temporary filling on RCT access openings in patients experiencing pain
  • Snipping or adjustments of an orthodontic wire
  • Appliances piercing or irritating the soft tissues of the mouth.

IF YOU HAVE A DENTAL EMERGENCY OR AREUNABLE TO GO TO THE DENTIST, WE ARE SCHEDULING PHONE CALLS AND VIDEO CONFERENCES WITH OUR DENTISTS

ORAL HYGIENE MEASURES

Is Oral hygiene necessary to fight the coronavirus?

The oral cavity is a potentially high risk area for the coronavirus and the virus has a high infectious susceptibility to oral epithelial cells. Coronavirus infects cells below the voice box, in the airways and deep in the lungs, unlike flu viruses which start with your nose and throat. Other than via tiny particles inhaled in air, coronavirus reaches those cells via fluid in the nose or throat that sneaks past your voice box (this is called aspiration) and slides down your windpipe, or trachea. Keeping your mouth and throat clear of infectious pathogens throughout the day and before you sleep at night (when most aspiration usually occurs) is paramount right now.

What oral hygiene measures can I take to decrease my personal exposure to coronavirus?

Oral Hygiene:

– Brush and floss your teeth, swish and spit and gargle twice with an antiseptic mouthwash. Since 2019-nCoV is vulnerable to oxidation, a mouth rinse containing oxidative agents such as 1% hydrogen peroxide or 0.2% povidone is recommended.

-Tongue cleaning may play an important role, as it has been reported that ACE2 is the main host cell receptor of 2019-nCoV and plays a crucial role in entry of virus into the cell to cause final infection.  As recent studies show there is a high expression of ACE2 receptors (highly enriched) in epithelial cells of the tongue.

General Hygiene:

Stop touching your face. The eyes, nose and mouth, are all entry portals for the new coronavirus and many other germs. Wash your hands and face well with soap and warm water, including a quarter-inch into each nostril. Then gently blow your nose. DON’T use those irrigating devices, like neti pots, that might force viruses further inside! Soap helps lift germs from the surface of the skin, but it’s the scrubbing that gets germs off hands. Hand sanitizer is a good alternative, but it must have at least 60 percent alcohol to be effective according to the CDC. Move away from people breathing in your face, avoid close, indoor gatherings of people and stand some feet away even when outside.

DENTAL OFFICE PRECAUTIONS

As a dental practice working in close quarters with the patients over so many years, we have developed heightened measures for sterilization and disinfection. Infection control procedures are actions taken in health care settings to prevent the spread of disease. The Centers for Disease Control and Prevention has recommendations for dental office infection control. We care about your safety and work hard to prevent the spread of infection.

WHAT PRECAUTIONS WE HAVE TAKEN TO PREVENT THE SPREAD OF CORONAVIRUS:

  1. We are using EPA-registered, hospital-grade disinfectant on frequently-touched surfaces or objects throughout the office. Surfaces such as door handles, chairs, desks and bathrooms are cleaned and disinfected often during the day.
  2. We have removed magazines, reading materials, toys and other objects that may be touched by others and which are not easily disinfected
  3. Signage in treatment rooms instructs patients on standard recommendations for respiratory etiquette and social distancing.
  4. We have conducted an inventory of Personal Protective Equipment and have made sure that we are stocked with N-95 masks, surgical gloves, gowns etc.
  5. We request that patients not bring companions to their appointment, except for instances where the patient requires assistance.
  6. We have requested our team members who are experiencing flu-like illness to not come to work. Our team members are also self-monitoring by remaining alert to any respiratory symptoms

PRE – SCREENING PHONE CALL:

  1. If you have a toothache or if you have any dental emergency give us a call  at 717-730-0999. We will be asking you few basic COVID screening questions and then dental-related questions. This is to find out if the problem can be taken care by prescribing medicines. This way, we minimize the risk of disease transmission.
  2. We are recommending that only asymptomatic patients who have tested negative for COVID-19 infection or recovered patients (after 2 weeks since resolution of signs and symptoms) be seen at our office. What this means is that if you are experiencing any flu-like symptoms you are better off going first to your primary care physician or emergency care.

DURING DENTAL CARE:

  1. Upon arrival we ask you to directly proceed to the treatment room prepared for you. This way you will be seated in sterile and disinfected room where appropriate social distancing guideline will  be followed. We ask you not to sit in our reception area.
  2. Our dental health care professional team follows strict universal precautions. This means we follow infection prevention practices for all patient care, regardless of the suspected or confirmed infection status of the patient. This includes hand hygiene, use of Personal Protective Equipment, respiratory etiquette, sharps safety and keeping sterile instruments and devices, clean and disinfected environmental surfaces.
  3. Since the virus may be vulnerable to oxidation, we are asking patients to use a 1.5% hydrogen peroxide mouth rinse prior to their doing oral evaluation.
  4. We will measure your body temperature and ask you to fill out our COVID-19 questionnaire.
  5. We may take extraoral radiographs as an alternative to intraoral radiographs, as intra-oral radiographs can stimulate coughing.

AFTER YOUR APPOINTMENT :

  1. In light of current the controversy regarding whether ibuprofen should be used for patients with COVID-19 infection, we are recommending that you avoid using Ibuprofen. Instead, Acetaminophen (Tylenol) or Naproxen (Aleve) can be used.
  2. All disposable equipment is discarded after each use. All non-disposable equipment is sterilized and disinfected according to manufacturer’s instructions.
  3. We are using EPA-registered, hospital-grade disinfectant on frequently touched surfaces or objects as indicated on the product’s label.  Surfaces such as door handles, chairs, desks and bathrooms are cleaned and disinfected frequently.
  4. FOR OUR TEAM MEMBERS: Upon arriving home we are asking our dental health care professionals to take off their shoes, remove and wash clothing (separately from other household residents) and immediately shower.

SCHEDULE A TELEDENTISTRY CONSULTATION

During the present time, we are trying our best to help prevent the spread of infection. The ADA® (American Dental Association) and many other state dental associations have recommended that dentists see patients who have an emergency or possible infections.

We have instituted a platform where dental patients can schedule a phone call or video conference with our dentists to explain their dental problem. We can recommend if their condition is severe enough for them to come in for their dental problem.

If the dental emergency involves a potential infection, we can prescribe medicines to alleviate the patient’s dental pain.

If the problem cannot be managed by medicines alone, we can help find a dentist that’s available near your zip code and help set up an appointment.

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