Sandra Schoenbach Weinstein, a dentist at Westchester Prosthodontics in White Plains, N.Y., has had firsthand experience with the coronavirus that forced the United States’200,000 dentists to close their practices to all but emergency procedures in mid-March.
A few days later, she developed a low-grade fever, mild cough, dry mouth and loss of taste and smell. She has since recovered and has received the two negative tests that are required in New Rochelle to be released from quarantine. She is now back at work covering urgent appointments. “I have a different view on emergencies compared to other doctors who work on this, because I am now immune,” she says.
On April 1, the American Dental Association (ADA) recommended that dentists continue to keep their offices closed to all but urgent and emergency procedures until April 30 at the earliest. In addition to guarding against transmission of the virus, keeping dentists idle for all but the most urgent procedures helps preserve personal protective equipment, such as masks, gloves and gowns, which are desperately need on the front lines. “Many dental offices and clinics are donating their supplies of personal protective equipment to be used in hospitals that are in dire need,” says Jacqueline Haker-Bonci, a dentist with the DiBona Dental Group in Exeter, N.H.
It’s vital for dental offices to remain open to offer emergency care because it helps alleviate the burden of people with dental issues heading to hospital emergency departments that are overwhelmed with covid-19. But patients can do their part by doing their best to guard against emergencies.
What is a dental emergency?
The ADA has a full list of conditions considered dental emergencies, mostly involving infection, pain or uncontrolled bleeding. “It’s an emergency if you have swelling, an abscess, or are in terrible pain,” explains Weinstein. Biopsies and post-surgical treatment are also considered emergencies.
“Some dental emergencies are unpredictable and are related to trauma that happened years ago,” says professor Mia Geisinger, director of the Department of Periodontology at the University of Alabama at Birmingham, and chair of the ADA Council on Scientific Affairs. “There can be dying tissue inside teeth, which causes secondary infection and requires a root canal; or patients may experience facial trauma or broken facial bones, which can cause healing issues or interruption of airways. Those are clear-cut dental emergencies.”
What if you think you have an emergency?
Weinstein says if you feel any pain starting, it’s smart to rinse with salt water three times a day, because that will kill bacteria. If pain in your mouth is uncontrollable, call your dentist instead of heading to the emergency room. Your call will be answered and triaged based on the problem, and a dentist will recommend the appropriate next steps.
“Even without coming in for an appointment, we can walk through strategies over the phone,” says Weinstein. “Some dentists also invite you to send a photo of the problem, and we can help manage it that way.”
When people do need emergency appointments, there are precautions in place due to the coronavirus. The ADA has provided dentists with guidelines to ensure that the risk of potential spread of disease among patients, visitors, and staff is kept as low as possible.
If you already have tested positive for the virus, and a dental problem arises, your dentist and other medical providers will need to determine which facility is appropriate to send you to — in some cases, it might be a hospital. Because dentists use drills in saliva-filled mouths, aerosol particles come up and can land anywhere, from countertops to door handles to walls. That could make it unsafe for dentists and dental assistants to see covid-19 patients, because dental settings are not typically designed to carry out all the virus-related precautions that are in place in hospitals.
How to prevent dental emergencies
Of course, you also want to avoid causing any dental emergencies right now by watching what you eat and how you use your teeth. Both Bonci and Weinstein say that popcorn is a common culprit for dental problems. “It’s the number-one cause of emergencies that I see, because the little shell from the popcorn can wedge itself all the way down in your gum, and you’ll have a swollen gum that hurts so much,” says Weinstein.
Bonci adds that unpopped popcorn kernels can also crack teeth, as can olive pits, which might even hide in pitted olives. Cracked or chipped teeth are not always an emergency, however; it depends where the crack is, how deep it runs and how much it hurts. Sometimes you can wait for an appointment if there’s no pain.
What about chewing on ice, I asked, because it’s one of my husband’s habits (that drives me crazy). While ice-crunching is never recommended, it’s also not likely to cause a dental emergency. “When you bite something hard and you’re not expecting it, that’s when you can crack a tooth,” says Bonci. “I don’t see a lot of damage with ice because the person knows they are biting into something hard, and they chew more carefully.”
Geisinger adds that teeth should not be used as a tool, and we shouldn’t chew on nonfood items (I will be sure to tell my husband, who is also fond of munching on pen caps). “Unscrewing a cap with your teeth or biting something instead of using pliers or scissors is a bad idea,” she says.
If you are midway through dental work, and your next appointment was canceled, avoid emergencies by being careful about what you eat. “If you have a temporary in your mouth and are waiting for a permanent crown or inlay to come in, don’t eat anything super chewy. And be extra careful when flossing — floss down, and slide out,” says Weinstein.
Even though it’s a stressful time, you should try your best to keep up with your regular oral hygiene regimens, including brushing twice a day and flossing once a day. While routine dental procedures are on hold for now because the risks outweigh the benefits, Weinstein says she isn’t worried about patients missing a scheduled cleaning. “If you’re not prone to cavities, you use an electric toothbrush and floss daily, you’ll be just fine,” she says.
If you have covid-19, the same general guidelines apply for brushing and flossing. “Good oral hygiene should not change during a pandemic,” says Bonci. And if you have dry mouth as one of your symptoms, as Weinstein did, be extra vigilant. “Dry mouth can lead to rampant decay,” says Weinstein. “It’s very important to drink as much as possible, use sugarless candy or gum and rinse with fluoride.”
When there are no dental emergencies to work on, Weinstein puts her covid-19 immunity to good use by delivering groceries and supplies to sick or elderly people. “I almost feel like it’s a superpower at this moment; I can really do a lot of good by helping people.”
Correction: An earlier version of this story incorrectly said dentist Sandra Schoenbach Weinstein was tested for covid-19 on March 4. She was tested on March 6. This version has been updated.
Registered dietitian Cara Rosenbloom is president of Words to Eat By, specializing in writing, nutrition education and recipe development. She is the co-author of “Nourish: Whole Food Recipes Featuring Seeds, Nuts and Beans.”
