A dad-of-two was forced to pull out his own tooth with pliers after he was refused an emergency dental appointment because of the coronavirus lockdown, as dentists warn patients will take matters into their own hands.
Billy Taylor, 33, from Axminster in Devon, said he spent an hour working the infected gnasher out with the help of his young son as the pain had become “excruciating”.
The news comes as dental authorities have warned that more and more people may start to take “matters into their own hands” if strict Covid-19 measures mean surgeries stay shut.
Billy, an aircraft fitter, decided to perform the procedure on himself using a tool from work and a couple of shots of whisky as a sedative.
He said: “I’ve had problems with that tooth for about two years. I’ve been to the dentist over it four times. They recapped it, I’ve had a root canal.
“I had toothache running up to the Bank Holiday weekend. It was getting worse and worse. The pain was excruciating. Then, on the Tuesday after, my face was swelling and I had a migraine on that side. I think it was an abcess.
“I phoned a dentist but they weren’t very clear so I called 111. They said that I shouldn’t go in until it was restricting my breathing.
“It got really bad that night and the swelling was getting worse. I was pretty wound up. I thought: ‘Why don’t I just do it myself?’.”
Billy did some research on YouTube and searched online for any possible complications before deciding to go ahead and asked his 11-year-old son Leo to keep watch in case he passed out.
After removing the tooth the pain disappeared almost instantly but Billy said he wouldn’t recommend that anyone else try it as they may cause more damage.
The British Dental Association said dentists have been unable to work so have had ‘their hands tied behind their backs’ since the lockdown began three weeks ago.
However there are Urgent Care Centres across the UK, Birmingham Live reports.
So what can you do if you’ve got a raging toothache but your dentist is closed?
And what are the implications for the dental industry at large – as well as the care homes – in the coronavirus crisis?
Eddie Crouch – vice chairman of the British Dental Association (BDA) – has been talking to BirminghamLive about the nature of trying to cope with patients when they themselves can’t open their surgeries.
Eddie said: “It’s a really frustrating time for my colleagues in the profession.
“We are used to getting people out of trouble, not working with our hands tied behind our backs.
“I am worried about the long-term effects of all of this on my colleagues and on the profession.
“I am hoping that fairly soon we can get back to doing what we do best – and that’s looking after our patients.”
If a filling has come out, Eddie says: “Your own own dentist should be able to send you packing material for a temporary replacement.”
“But that of course means having to do it yourself.”
On the day after the Easter holidays the BDA told its members: “England continues to lag behind the other three nations in relation to setting up its network of Urgent Care Centres.
“Three weeks on from the letter of preparedness indicating a standing down of routine care and provision via the urgent care system, large parts of England are left without effective urgent care.
“We know roughly half of the 160 centres are up-and-running.
“We continue to raise our concerns about the lack of appropriate patient care with the Health Minister Jo Churchill. It is clear that she shares our frustrations over the slow progress.”
The addresses of Urgent Care Centres are not being revealed as you will need to be referred to be seen and cases will be prioritised.
How to get help
Due to the lockdown no routine dentistry is being performed at the moment, from check-ups to scale and polishing but if you have a problem, the first thing you need to do is to telephone your regular dentist as normal.
Eddie estimates most dental practices are taking calls – generally by rerouting calls from their surgeries to home.
However, some are not working that way because they are in isolation.
Your own dentist will have your medical history and be your best source of advice.
Anyone can ring any dentist – but if the one you call doesn’t have your medical history they will be much slower at responding and won’t necessarily be able to prescribe you things like analgesics (pain-relief medication) or antibiotics.
If a filling has come out, Eddie says your own own dentist should be able to send you packing material to help you to create a temporary replacement.
If in severe pain or have any of the following
Bleeding – uncontrolled intra-oral bleeding
Swellings – spreading, recurrent or continuing and/or potentially resulting in air-way management issues
Trauma – severe dental trauma injuries
Pain – severe and uncontrolled dental pain
Try to be seen by at an Urgent Dental Care Centre by calling the NHS on 111 (lines open 24/7 including Bank Holidays).
But the general advice is to always call your own dentist first.
Some things you can do to aid your condition
If you have knocked a tooth out, try to keep the tooth moist – either by keeping it inside your cheek or even in milk, but do not dry it out.
Paracetamol (or Ibuprofen if you are safe to take that) can help to reduce pain, as can ice packs or frozen vegetables pressed to your face.
Dentists also recommend swishing your mouth out with warm, salty water after any dental surgery or if in pain.
Appropriate mouthwashes can also be recommended by your dentist.
A London dentist called Dr Richard Marques also suggests a small amount of clove oil dabbed on to gums can reduce pain.
What is an Urgent Care Centre?
These are being launched to try to keep dentists safe while they do extractions.
It has taken time to set them up because of the need for a much higher degree of personal protective equipment (PPE) than a dentist would normally use.
Eddie said: “Other parts of the health service were prioritised above dentistry – even the Dental Hospital went from full services to none so patients are being triaged over the phone.
“That means for people with infections, swellings and abscesses, they will be prescribed antibiotics from their local pharmacy.
“If they still have a problem after two weeks, they can be referred to one of the Urgent Dental Care Centres.”
From decay… to delay
We all know that dentists are on the front line when it comes to fighting tooth decay but given that abscesses can be fatal, their biggest enemy now is time delay.
In order for dentists to work in an Urgent Care Centre, they need to be fully equipped with PPE and FFP3 – a respiratory face mask that has to be fitted properly.
One of the other factors which has caused delays setting up the centres has been a shortage of people who can ensure such masks are fitted correctly.
The centres are being created in practices with multiple surgery rooms so the dentists can keep working while the rooms are rotated.
This is because even after one patient has been seen it will take the rest of the hour at least for that room to be declared safe for another patient to be seen.
The risk is that Covid-19 would be present in aerosol spray and the room has to be thoroughly cleaned after each patient’s treatment.
Eddie estimates the time taken to make each room ready for another patient to typically be from 35 to 40 minutes.
Patients going to Urgent Care Centres are being told to wait outside – inside their car if that is how they have arrived.
They are also told to expect to have to leave as soon as possible following a procedure.
Eddie says one of the lessons from Wuhan in China where Covid-19 was first declared was that ear, nose and throat surgeons were particularly at risk from being ‘overloaded’ with the virus after being in close proximity with multiple patients.
Even in February, British dentists were trying to get more PPE supplies, but with China supplying 55 per cent of the world’s output shortages developed when the country stopped exporting.
Dentists ‘want to work’
Eddie says sitting at home triaging patients is not what dentists want to be doing – even in a pandemic.
“It’s been a really frustrating time for my colleagues in the profession,” he says.
“We are used to getting people out of trouble, not working with our hands tied behind our backs.
“My colleagues are keen to get going to help patients but they also know that every precaution must be taken.
“We don’t want to infect a patient otherwise a dentist wouldn’t be able to look at himself.
“At the end of the day we are talking about teeth, not saving lives.”
The care home time bomb
The coronavirus pandemic took on a sinister new twist last week when it was revealed just how many care homes were being decimated.
The Office for National Statistics (ONS) says more than 217 people with Covid-19 had died in care homes in England and Wales up to April 3, but the numbers are rising and some homes have lost more than a dozen residents to the disease.
While the numbers of coronavirus deaths released by the Department of Health only include those who have succumbed in hospital, it’s has been reported that Covid-19 has now hit 13.5% of the UK’s 11,300 care homes.
So it’s feared the true death toll is being considerably under reported.
Eddie says that at the turn of the century, many elderly people living in care homes no longer had their own teeth.
Now they often do and are also presenting with different types of problems, such as implants.
Eddie says: “Various projects have been ongoing to try to improved dental care in care homes and people would normally be seen by salary dental services and community dental services.
“Dental health tends to deteriorate rapidly once people are in care homes.
“A patient now might have to be transferred to the Urgent Care Centre unit because we are not treating people in surgeries.”
Eddie says because dentists are closed they have supplied some PPE to care homes.
The future of dentistry
Should the lockdown last for three months or more, Eddie fears some practices could go under which would add to the pressure of trying to see patients in general – or of patients trying to see a dentist which ever way you prefer to look at it.
He says because NHS funding hasn’t even kept pace with inflation for four years, practices have been relying on private income more than ever to survive.
Eddie says NHS England had apologised for some ‘confusing’ information about what dentists could and could not do re furloughing staff.
But higher earning dentists still faced major issues with everything from their self-employed statue to business rates and a lack of support from banks.
The best news was the possibility of delaying income tax payments.
But Eddie warns: “If this continues for more than three months, many practices will be in serious jeopardy of actually having to close.
“Patients would then start to struggle to see a dentist and that will put an incredible strain on the NHS when (the pandemic) is over and it will take a long time for them to be seen.
“Then there are dental laboratories which have gone over a cliff edge in terms of no work coming out.
“Hygienists and therapists are often self-employed, too.”
Dentists saw the pandemic coming
Like lots of people in the medical professions, dentists had had a pandemic at the back of their minds for a decade after issues like Sars arose.
Eddie says the industry thought that because of Brexit issues, that a lot of PPE had been stockpiled.
“One big problem came when China suddenly stopped exporting because it makes 55 per cent of the world’s PPE.
“If the government is right when it says we have stocks, then getting it out has been a problem because there is a shortage.
“I am hoping that fairly soon we can get back to doing what we do best – and that’s looking after our patients.
“Most people will have a good dentist and they will value that service.
“But it would really pain me if some of my long-established colleagues are not there going forward.”
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