Pjcs dental-emergency-covid #دحاتم_البيطار #timodentist
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- Dental practices are currently closed, so patients may present to pharmacies with dental problems. Urgent dental care can be accessed through contacting one's own dentist, local health board, or NHS 111 if unregistered. - Pharmacies can provide advice on interim management of dental issues like toothache, lost fillings, mouth ulcers and more by recommending pain relief, diet changes, oral hygiene techniques and when to seek urgent dental care. - Detailed guidance is given on advising patients on self-care for specific dental problems, when referral is needed, and cautioning those who may be at higher risk like those who are pregnant, diabetic or experiencing concurrent symptoms.
Pjcs dental-emergency-covid #دحاتم_البيطار #timodentist
- 1. The current situation As a result of the COVID-19 pandemic, all dental surgeries are now closed and the provision of all routine, non-urgent dental care has been stopped until further notice. As a result, patients may present more frequently to community pharmacy with their dental problems. Access to urgent dental care Patients should be advised that urgent dental care services have been established across the UK and that initial access to remote primary care dental triage and assessment is via two paths: l By contacting their own dentist and/or local health board if they are registered with a dental practice; or l By contacting NHS 111 if they are not registered with a practice. Following remote assessment, a decision will be made as per local protocols on whether a referral or access to urgent dental care is required. Dental emergencies and pharmacy The summary of self-care advice and important considerations (see overleaf) can be used by pharmacy teams to counsel patients on interim management for the following dental problems: Toothache Fractured or chipped tooth Lost fillings or crowns Mouth ulcers Bleeding or sore gums Sensitive teeth Teething Managing dental emergencies in response to COVID-19 RAPID RELIEF • REPAIR & PROTECT • COMPLETE PROTECTION l Gather information using the WWHAM (Who? What? How? Action? Medicines?) questioning approach; l Avoid the scripted nature of these questions by talking to the patient and including them in the conversation. Repeat back your understanding for confirmation; l Listen carefully to the patient — they will often provide you with answers to some of the questions before you ask them. l Brush twice daily, using small circular motions, ensuring coverage of all surfaces of the teeth and where teeth meet the gums. It is important to also brush the tongue; l Use a toothpaste with at least 1,450ppm of fluoride for children aged 3+ and adults; l Spit out after brushing and do not rinse, to maintain fluoride concentration; l Dentures should be cleaned daily and not worn overnight; l Use interdental aids daily (e.g. interdental brushes or floss) to clean in-between teeth. For detailed information see: http://bit.ly/PJDental1 GlaxoSmithKline, manufacturer of Corsodyl and Sensodyne, provided financial support in the production of this content. The Pharmaceutical Journal retains sole editorial responsibility. Promotion: PM-UK-CSYL-20-00078 The Pharmaceutical Journal, May 2020, online. doi: 10.1211/PJ.2020.20207974 ADVICE FOR MAINTAINING ORAL HYGIENE CONSULTATION TIPS
- 2. Dental emergencies: interim self-care and management advice through pharmacy Sources: NHS Health Education England. Managing dental and oral presentations in community pharmacy. Available at: https://psnc.org.uk/communitypharmacyss/wp-content/uploads/sites/121/2017/11/Pharmacy-Dental-Fact-Sheets- Final-290917.pdf (accessed May 2020); Public Health England. Delivering better oral health toolkit. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention (accessed May 2020); National Institute for Health and Care Excellence. Oral health promotion in general dental practice. Available at: https://www.nice.org.uk/guidance/ng30 (accessed May 2020); Scottish Dental Clinical Effectiveness Programme. Guidance prevention and management of dental decay in children. Available at: https://www.scottishdental.org/sdcep-prevention-and-management-of-dental-caries-in-children-2nd-ed (accessed May 2020); Scottish Dental Clinical Effectiveness Programme. Management of acute dental problems during COVID-19 pandemic. Available at: http://www.sdcep.org.uk/wp-content/uploads/2020/03/SDCEP-MADP-COVID-19-guide-300320.pdf (accessed May 2020); National Institute for Health and Care Excellence Guideline GG160. Fever in under 5s: assessment and initial management. Available at: https://www.nice.org.uk/guidance/cg160 (accessed May 2020) Product Information Corsodyl 0.2% Mouthwash (Alcohol Free). Active Ingredient: Chlorhexidine digluconate Indications: Plaque inhibition; gingivitis; maintenance of oral hygiene; post periodontalsurgery or treatment; aphthous ulceration; oral candida. Legal category: GSL. Licence Holder: GlaxoSmithKline Consumer Healthcare, Brentford, TW8 9GS, U.K. Information about this product, including adverse reactions, precautions, contra-indications and method of use can be found at: https://www.medicines.org.uk/emc/medicine/23034 Trade marks are owned by or licensed to the GSK group of companies. MANAGEMENT ADVICE CAUTIONS AND WHEN TO REFER TOOTHACHE http://bit.ly/PJDental2 l Provide analgesia (paracetamol and ibuprofen) if required; l Implement a soft diet and avoid pain triggers (e.g. hot or cold drinks and food); l If sensitive, recommend desensitising toothpaste and soft toothbrush; l For cuts or abrasions in the mouth, recommend chlorhexidine mouthwash, saltwater or anaesthetic mouthwashes/gels to prevent infection and aid oral hygiene (see advice overleaf); l A chipped tooth may be sealed using a temporary filling kit. l If caused by trauma, enquire if patient has experienced any vomiting or loss of consciousness. If yes, the patient should urgently attend A&E; l Ifmildtraumaandpatientcanself-manage theircondition,advisethatifpainbecomes severeanduncontrollable, preventing sleepingoreating,theywillneedtoseekurgent dentalcareservices. http://bit.ly/PJDental2 FRACTURED OR CHIPPED TOOTH l Provide analgesia (paracetamol and ibuprofen) if required; l Implement a soft diet and avoid pain triggers (e.g. hot or cold drinks and food); l If sensitive, recommend desensitising toothpaste and soft toothbrush; l For cuts or abrasions in the mouth, recommend chlorhexidine mouthwash, saltwater or anaesthetic mouthwashes/gels to prevent infection and aid oral hygiene (see advice overleaf); l A chipped tooth may be sealed using a temporary filling kit. l Ifcausedbytrauma,enquireifpatient hasexperiencedanyvomitingorlossof consciousness.Ifyes,thepatientshould urgentlyattendA&E; l If mild trauma and patient can self-manage their condition, advise that if pain becomes severe and uncontrollable, preventing sleeping or eating, they will need to seek urgent dental care services. http://bit.ly/PJDental2 LOST FILLINGS OR CROWN l Provide analgesia (paracetamol and ibuprofen) if required; l The crown (if stable) can be re-cemented with a temporary crown cement kit or the remaining tooth sealed with a temporary filling kit; l If sensitive, recommend the use of a desensitising toothpaste and soft toothbrush. l Owingtoriskofpain,swellingandinfection, advisepatienttoseekurgentdentalcare servicesimmediately. http://bit.ly/PJDental3 MOUTH ULCERS l Emphasise oral hygiene advice alongside the use of mouthwashes (e.g. chlorhexidine during and two days after healing has occurred); l Local pain relief using topical gels (e.g. benzydamine hydrochloride); l Avoiding pain triggers (e.g. spicy foods and smoking). l Urgentdentalassessmentisrequiredforany non-healing,non-painfululcerpresentfortwo weeksormore,thathasnoobviousrepeat traumatothearea; l Patientswithregularmouthulcersshouldbe referredtotheirGPforinvestigation. http://bit.ly/PJDental2 SENSITIVE TEETH l Short, sharp pain can be triggered by hot, cold, sweet or acidic foods. Recommend desensitising toothpaste to temporarily relieve pain and avoidance of triggers; l Provide oral hygiene advice (see box overleaf). l Ifsymptomsarepersistentandcannotbe self-managed,recommendseekingdental adviceforeliminationofothercauses. http://bit.ly/PJDental5 TEETHING l Teething begins around age 6 months (varies between 3 months and 12 months of age). Adult teeth begin to erupt around the age of 6 years; l Explain that symptoms related to teething are self-limiting; l As children can experience pain in the mouth during teething, affecting sleeping and eating; l Ensure the child is adequately hydrated; l Sugar free liquid paracetamol or ibuprofen can relieve pain and pyrexia; l Pureed food, cool liquids and teething aids can be helpful, but regular pureed sweet food (e.g. fruit purees) can lead to tooth decay. l Beawareoftheriskofseriousillnessinchildren withfeverrefertoNICEGuidelineCG160; l Ifyouhaveanyconcernsastothechild’s generalhealth,contactGPorNHS111. BLEEDING OR SORE GUMS l Emphasise oral hygiene advice (see overleaf); l If bleeding is frequent and there is a bad taste or bad smell, rinse with a chlorhexidine mouthwash (not for children <7 years); l Smoking contributes to gum disease, so recommend smoking cessation if appropriate. l Gumscanbleedmoreifpregnantordiabetic; l Recommendseekingdentaladvicefor eliminationofothercausesespeciallyif concurrentfeverorulceration. http://bit.ly/PJDental4