Dental Emergencies During the COVID-19 Pandemic

The COVID-19 pandemic has created uncertainty and major changes to our daily lives, including our oral health and dental care. Tennessee, like many other states, is under a shelter in place order. The governor has executed executive orders limiting dental care to emergency-based care until at least April 30, 2020. These orders are intended to preserve personal protective equipment (PPE) like gloves and masks while also minimizing the spread of the deadly coronavirus. Dentists, dental assistants, and auxiliary staff are highly susceptible to COVID-19, because we work in the oral cavity and generate aerosol—the primary means of spread for the virus. The mandates issued by the state and Governor Bill Lee are consistent with the recommendation made by the American Dental Association (ADA), urging dentists across the country to suspend all routine dental care until at least April 30th.

We’ve had several offices and patients call to ask what constitutes a dental emergency. The ADA defines dental emergencies as “potentially life-threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection.” Some signs indicating that you may be experiencing a dental emergency include:

Bleeding that doesn’t stop
Pain or swelling in or around your mouth
Tooth or jaw pain
Broken or knocked-out tooth
Gum infection with pain and swelling

The ADA has also elaborated a second set of symptoms they classify as URGENT. Patients MAY require early intervention by their dentist and/or a dental specialists for the following symptoms:

Severe dental pain caused by pulpal inflammation
Third-molar pain
Tooth fractures with pain or resulting in soft tissue trauma
Post-op complications such as dry socket
Abscess or localized bacterial infection with swelling
Dental trauma that results in a lost tooth
Lost or broken temporary restoration or if a restoration is irritating the gum tissue
Cavities or decay that cause pain

These guidelines attempt to capture what can and should be treated but do not include all possible emergencies. If you are experiencing pain or a suspected dental emergency, we strongly encourage you to reach out to your general dentist, who may refer you to a specialist.

With regard to endodontics and root canals, the following conditions would be considered neither an emergency nor urgent:

Routine consultations and x-rays for patients who are asymptomatic
Cavities approaching the pulp without the presence of symptoms
Teeth with asymptomatic radiolucencies (shadows at the root end on x-rays)
Teeth with draining sinus tracts (pimples or bumps on the gum) that are asymptomatic

It’s important to note that, while the above conditions may be asymptomatic initially, they may progress with onset of severe pain and/or swelling. In these worsening circumstances, treatment may be advised.

As we continue to monitor the mandates from the government and the ADA, we will pass along relevant information to our patients and referring offices. However, we encourage everyone to check with the Centers for Disease Control (CDC), state, and local governments for the latest recommendations and guidelines.