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Providing self care advice to patients

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Providing self care advice to patients

There is frequently a need for dental practice staff to advise patients on how to manage their symptoms prior to seeing a dentist. The following sections provide advice on managing a range of common conditions for which self care might be beneficial to the patient.

Patients who are waiting for dental appointments might require basic advice on the effective management of their dental pain.

Before providing a patient with advice on analgesia, it is essential to first establish what pain relief they have already taken, particularly paracetamol, to check for possible overdose. Overdose with paracetamol is dangerous because it can cause liver damage that is sometimes not apparent for 4–6 days and can be fatal. Paracetamol is present in many over-the-counter preparations and all paracetamol-containing medications that the patient has taken should be identified. For more information on paracetamol overdose see Management of Acute Dental Problems or the British National Formulary. 

Assess whether the patient has exceeded the recommended dose of pain relief medication, and if signs of overdose advise the patient to seek emergency medical assessment.

Give the patient the following advice on the use of self care measures.

  • Avoid stimuli that trigger or worsen the pain, such as hot or cold foods or cold air.
  • Holding cooled water or crushed ice around the tooth can help some types of dental pain.
  • Severe pain from the mouth or teeth sometimes feels worse when lying flat; therefore, try lying propped up as this might ease the pain.
  • Use painkillers that have successfully provided pain relief for you in the past without adverse effects (e.g. ibuprofen and/or paracetamol), but do not exceed the maximum daily dose.
  • Avoid taking aspirin or ibuprofen as a painkiller if there is bleeding.
  • Always follow the directions on the painkiller information leaflet for dosage and advice on precautions with some medical conditions.

Advise the patient to call back if the advice provided proves inadequate to manage their dental pain.

Information for patients about painkillers including paracetamol and ibuprofen is available via the NHS Inform website.

If there is uncertainty regarding appropriate analgesia, the patient should be advised to seek advice from a community pharmacist, particularly in the context of existing medical conditions or medications.

Note that patients in Scotland can access analgesia, topical anaesthetics and mouthwashes, which may be helpful to manage pain from oral conditions, via the NHS Pharmacy First Scotland service. This is available at community pharmacies that dispense NHS prescriptions.

Depending on the nature of the injury, patients who have experienced trauma to their mouth might require urgent or emergency dental care. Dental trauma exposing the pulp or dentine, or resulting in teeth that have moved requires an urgent appointment with a dentist. For an avulsed (knocked out) permanent tooth, prior to seeing a dentist, advice on immediate reimplantation or storage of the tooth to preserve the living cells on the root should be provided. 

For broken or fractured teeth, determine whether the pulp/dentine has been exposed by asking the patient if the teeth are sensitive or painful. If they are, arrange an urgent appointment with a dentist to help avoid pulpal infection. 

  • If the pulp/dentine has not been exposed, advise the patient that this does not require urgent care but that a non-urgent appointment might be necessary to restore aesthetics or to remove sharp edges.

For teeth that have moved, arrange an urgent appointment with a dentist for assessment.

For an avulsed (knocked out) adult tooth, advise immediate reimplantation of the tooth, if feasible, as follows:

  • handle the tooth by its crown (the white part), avoid touching the root
  • if the tooth is dirty, rinse it gently in milk, saline or in the patient's saliva
  • immediately reimplant the tooth in its original position in the jaw and then bite gently on a clean handkerchief or gauze to hold it in position
    • if available, a mouthguard, bleaching tray or bandage made from folded tin foil can be used to hold the tooth in place until the patient can be seen by a dentist

If reimplantation is not feasible, advise the patient to immediately place the tooth in milk, saliva (e.g. after spitting into a container) or saline for transportation to the dentist.

Arrange for the patient to see a dentist as an emergency case as soon as possible (irrespective of whether the tooth has been reimplanted or not). 

For an avulsed (knocked out) primary tooth, advise the patient/carer that the tooth should not be reimplanted and arrange a non-urgent appointment. If there are other concerns, for example possible intrusion of tooth (i.e. the tooth cannot be located and may have been completely pushed back into the gum) or safeguarding concerns, arrange an urgent appointment.

In all cases, provide advice on the management of pain, if required (see Pain advice section above).

Patients who have had extractions during the past week might require basic advice on the management of bleeding from the extraction area.

Ascertain whether the patient is currently taking anticoagulant or antiplatelet medication (i.e. ‘blood thinners’ such as dabigatran, apixaban, rivaroxaban, edoxaban, warfarin, aspirin, clopidogrel, prasugrel, ticagrelor).

Give the patient the following advice on the use of self care measures to stop the bleeding:

  • place a rolled-up piece of cotton or gauze swab moistened with saline or water over the socket and bite firmly on it
  • maintain the pressure for 20 minutes before checking whether the bleeding has stopped 
  • if the bleeding stops, avoid drinking alcohol, smoking or exercising for 24 hours, keep head raised if possible and avoid disturbing the blood clot

For patients taking anticoagulant or antiplatelet medication, advise the patient to re-contact the practice for an emergency appointment if these self care measures do not control the bleeding, or call NHS24/111 (Tel: 111) if unable to contact the practice.

For patients who are not taking anticoagulant or antiplatelet medication, advise the patient that if the bleeding fails to stop or restarts, to repeat pressure once more, and re-contact the practice for an emergency appointment if these self care measures do not control the bleeding, or call NHS24/111 (Tel: 111) if unable to contact the practice.