Answering Your Questions About Caring For Your Teeth While Sheltering In Place

Dentist treats patient
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By KCBS All News 106.9FM and 740AM

As we continue to navigate these unprecedented times, KCBS Radio is getting the answers to your questions about the coronavirus pandemic. Every morning at 9:20 a.m. Monday-Friday we're doing an "Ask An Expert" segment with a focus on a different aspect of this situation each day.

Today, we’re talking all about your teeth and dentistry with San Francisco-based dentist Dr. Cynthia Brattesani.

We’re living in strange times and in your profession, the hurly burly of daily office hours, people coming and going, problems being fixed, teeth being cleaned, X-rays being taken: all shut down.

Oh yes, it was like the light switch went off. It was incredible. We have a busy practice and no one was coming back in. However, we are staying open for emergencies and we've been very busy doing that.

So let's talk a little bit about the rules as they stand for general dentistry practice. What can you and can you not do under the shelter in place rules?

Around the week of March 16th when the mandate said to close, we closed in order to help flatten the curve. However, dental emergencies do happen and so we are considered essential in that regard. And if anybody has, for instance, some trauma, an infection or some kind of pain, broken teeth or teeth that are knocked out, then we can surely go to the office and help our patients. 

I'm curious - just a broad general question - because we're going to be moving at some point back to something approaching normal. What's the whole exposure situation like when you're in an office where people's mouths are open, you're working near their mouths and noses; how have dental practices dealt with infection prevention in the past?

So, you know, especially being in San Francisco, a generation ago, 30 years ago, we had to deal with the AIDS epidemic, and then later was hepatitis B and C that were very virulent as well as bacterial infections like TB. So we are infection control experts. We know what needs to be done to ensure the safety of our patients and our staff. We have different measures that we take, things that isolate the mouth to help exposure to help the aerosol not come out as fast, we have high level evacuation systems. And so we're very controlled. We protect the patients with glasses, we wear goggles, we have the masks that we need. So we know about that. 

Now we know this is highly virulent, so it's a little different, but we're gonna do different protocols to help. For instance, we'll give the patients pre-procedural rinses of hydrogen peroxide to help reduce the viral level in the mouth. These kinds of things. We're gonna help tremendously and we're ready for it.

Let's get some questions here, and I've heard this one from several people.

A reminder, these questions come in by email at If you're listening to this episode and you have a question about something that isn't today's topic, send those questions our way and we'll get to them in future episodes. 

How long can I delay my regular dental cleaning?

Well, we know that cleanings are very important for preventive care, and we know that's the hallmark of our profession. What we want people to know is that for now, we're going to have to delay that. We want them to do better at home in brushing their teeth for a full two minutes. Usually, people brush for only 45 seconds. Perhaps now that you have a little bit more time, maybe consider doing that after lunch as well and floss and actually use the fluoridated toothpaste. We know that dental health means overall health, and we are concerned just like you. But for now we need to help level the curve and we'll get back to it as soon as we can. So thanks for asking that. Very important.

And let me just follow up on that one. Brushing two minutes as many times a day as you can, I guess, is not a bad thing. They always tell you to floss, you should be doing that. Are there any other tips and tricks for people to keep their gums and teeth healthy in between?

Well, we want you to have a great immunity so nutritionally, we want you to reduce sugary drinks or acidic drinks. We want you to take your vitamins. And we want you to really be concerned that brushing the full two minutes helps. Understand that flossing takes care about 1/3 of the tooth surface area that brushing can’t. So you spend some time doing that and you'll be good to go.

I'm concerned about a molar that is cracked during this pandemic. I've contacted my dentist and the advice was just to file it down with a nail file, which I have already done. I'm worried that the crack could become worse over time before I can have it repaired. In addition, when I bite down while chewing food it affects the gum on the side of my cheek. Would this qualify as a dental emergency? 

In my view? Yes, it does, because things could get worse rapidly fast, so we would like to actually see the patients and place temporary material in that area, bust the areas so that it doesn't hurt the cheeks or the tongue, and we can help that and keep it at bay for as long as we need. So I would say yes. 

Okay. And going back, I'm just thinking back to being a teenager with orthodontia. And by the way, Friday morning we're gonna focus strictly on orthodontia on the Ask an Expert segment. Any tips and tricks for covering something up? I think we had beeswax back then or something like that. Is that still around?

Actually, it is. And there are some things over the counter that you can get specifically that you can use for that. But beeswax works really well. There's wax that you can get at your local pharmacy, you can place it there and it works tremendously well. We still use it too.

I have a problem with a root canal that's resulting in swelling. Have called my dentist, but so far haven't been able to get an emergency appointment. How long should I expect to wait to get in? What can I do in the meantime to deal with the issue and the pain?

You know, swelling in our view is no simple matter. You should be calling the dentist right away in order to see if you need some antibiotics or tooth extraction, or if you can have that root canal re-treated. I would highly recommend getting ahold of the dentist. Swelling could sometimes be life threatening, so it's very important that you see a dentist now.

Our Phil Matier, by the way, has had to wait five days to get in for one that's scheduled. And this does bring up a question about the care network of dental professionals you have. You have general dentists, you have periodontists, you have oral surgeons. How are you all working together during this?

Oh, we're working incredibly together. I'm so proud of my community and the collegiality. You know, the root canal specialists, the endodontists and the oral surgeons have been quite busy. They are ready at every hour of every day so call them to make sure that we can take care of our patients. 

So feel free to, if you can't find a dentist to see you right away, call your local dental society, that would be like San Francisco, San Mateo, Alameda, and we can get you a dentist right away.

That leads to our next question: how can somebody who doesn't have a regular dentist get care if they have an emergency right now?

Yeah, that works really well. The dental society is used to answering those kinds of questions throughout the year. And, of course, with pandemic they are on the money to get to you right now.

When I go to the dentist for cleaning, they're always checking my teeth and checking my gums. Is there anything I can do at home right now to kind of keep up on that?

Yes, we've said before on what they have to do to keep their teeth clean. No worries. When we when we're able to see you, we’ll be able to do some preventive things that will help going forward. Just make sure that you’re cleaning your teeth twice a day at least and flossing and using a flouridated toothpaste. And if you want to use the rinses that you like to feel more comfortable, those kind of things will really help you and keep you clean.

Is there any sort of telemedicine being done in dentistry? I saw my general doctor the other day over Zoom. Can I do that with my dentist?

Absolutely. A lot of dentists have set up teledentistry. I did some just yesterday. We’re able to use teledentistry in a great way because we can do a virtual exam and look on the screen. For instance, a patient was very concerned if she had any swelling, and I was able to do a virtual exam, it works tremendously well.

You know, part of dentistry is the relationship. It's touching the patients and seeing the patient close up. So using virtual and this technology boy, that's been amazing. It's been a great help. 

Is there anything you might recommend in terms of being prepared for an appointment like that? Any tips or tricks for using your smartphone to get a photo or video, for example?

Yes, absolutely. I'm so impressed with patients today, using that technology to send even photos beforehand. Or actually, I can use the teledentistry app and I'd be able to snap a picture, and be able to enlarge it like so I can see. Definitely, any kind of pictures you can give with your smartphone before teledentistry, boy, that really helps.

Should someone with a dental emergency go to the emergency room to get faster treatment?

You know, emergency rooms have never been equipped adequately to help with dental emergencies because they really can't address the underlying problem. It takes a lot of different materials and techniques. Oftentimes they will give you maybe some antibiotics or some painkillers, and that can help that first but it's not really taking care of the underlying problem. 

Also, we want to try to eliminate too many visits to the emergency room right now because they're busy with other matters and we don't want patients to be exposed to the COVID-19. So we would ask you not to seek care at the emergency rooms but call a dental office.

We've mentioned pain a few times. So maybe a broad question there is, how should people who are waiting to get that emergency treatment manage pain?

Okay, so at first we'd have to look at your medical history in order to really figure it out. But it does help to take some Advil. Ibuprofen works the best on dental pain.

But I would ask you to ask your dentist to make sure, because there certain medical conditions that can't take Advil and they are certain mixtures of doses that we can give you to really help you. Oftentimes when you call a dentist, they might even prescribe an antibiotic if you're not allergic to it. And what it does - it doesn't cure the issue - but it will help alleviate pain and possible infection as far as inflammation is concerned. So really talk to your dentist. We have some great ideas for you.

Why hasn't the state or dental association secured some of the millions of N95 masks made available for the hospitals and others for dentists and oral surgeons so they could do more treatment during this time?

Well, I'm so glad you asked a few weeks ago in mid-March, we actually confirmed with the state emergency stockpile to get us some masks. We actually secured 1,000,000 3M N95 masks that were actually expired, but it was gonna help as a stopgap measure for our members to deliver care and then have someone when we opened. Well, it turned out at that point the state actually stopped the delivery and asked for them back. And we were extremely disappointed, as you can imagine. 

Now, having said that, we've gotten some since then through our dental societies that have been able to give it specialists. And so we're hoping that things will get better as we go on. The bottom line is that we know that the healthcare frontline workers need them and we need to save lives, and we understand. It’s just that as you could imagine, we're ready to open and we need that material as well.

This comes from a questioner who says he is a 1099 self-employed dentist working at a corporate dental office. In other words, considered an independent contractor, not a business owner. Had applied for the $10,000 SBA grant for certain things and had intended to apply for the Paycheck Protection Program, then found out he couldn't because he doesn't have any established relationship with banks as a business person. Ended up only getting a few hundred dollars in the first program. Any thoughts as to help people managing this from a business perspective?

I'm glad you asked. This is really complicated, and I'm not an expert in accounting. So the most that I can tell you is that some people have received PPO grants, some have gotten the EIDL grants, but some have not. And we know that this economic impact has been devastating for dentists and then subsequently for patients because we need those monies in order to keep the lights on. 

So we are really hoping that the federal and state relief efforts are going to come about because some have gotten them, some have not. We're really hoping that something like that will happen. If you look up and down the state, most dental offices are small businesses, so we are feeling the pain like other small businesses in the state and we need this so that we can take care of our patients.

While I've got you on that topic, the people who work in the dental offices as hygienists - are they typically employees or contractors? How does that work?

You know hygienists are typically employees of the practice. They're the ones that really help us  with our rest of our staff to really ensure the safety of patients and deliver care. And it's so unfortunate that a lot of dental practices have had to have their hygienists and assistants let go or furloughed at this time. We're just hoping to get back soon, get those loans and really be able to go back to dentistry.

Any thoughts, anything I should have covered that you want to pass on?

I wanted the audience to know that patients are really important to us. We're ready when we have to go back to the office. We understand that overall health means dental health, so we're ready for you as soon as you come in.