COVID-19

Important COVID-19 Information



To all Patients, Parents and Carers,

We are experiencing a very challenging time and as you can imagine, the Corona Virus represents a very unique challenge to us as an orthodontic practice. We understand the anxiety from all the uncertainty that many of our patients are living through. This is completely new ground for all of us too.

We have to balance first and foremost your general health, the timing of your orthodontic treatment and our professional responsibility towards helping stop the spread of the virus by limiting movement of people to and from our practice and person to person contact.

In line with National Guidelines we have temporarily suspended all activity to protect our patients, staff and the local community from becoming infected and spreading the new COVID19 virus. All routine appointments booked until mid June 2020 have now been postponed and we are slowly working through re-appointing these patients.

EMERGENCY PATIENTS ARE ADVISED TO CONTACT NHS 111 BUT PLEASE APPRECIATE THE PRESSURE OUR NHS IS GOING THROUGH WHEN DECIDING IF YOUR PROBLEM IS URGENT OR CAN WAIT.

We are continuing to run an emergency triage phone line on 01582 769955 Mon-Fri 9am-5pm. Please call this number for emergency triage ONLY, but do not call regarding appointments - we will contact you.

The NHS / authorities have announced that certain procedures can be re-started in dental surgeries from June 8th, in accordance with certain provisions. Please realise that we are not a General Dental Practice and the terms and conditions require many changes to how you will be seen in the short term at least. We are working hard to implement these as soon as possible to protect patients and staff. This involved structural building work and procurement of PPE items currently in short supply or unavailable. We are working towards opening as soon as possible, initially to see patients who have been triaged onto the emergency list. We will contact you regarding appointments - some may need to be altered as not all procedures are currently able to be performed. This is very upsetting for us and for you, we are sure, but all orthodontic practices are experiencing the same issues.

Please follow the recommended emergency orthodontic protocols created by the British Orthodontic Society. Most orthodontic appliances can be left in situ for some months without detriment to the patient if the patient continues with the usual after care instructions – especially regarding good oral hygiene/ brushing and maintaining a low sugar diet. Please be careful with foods in your diet -avoid hard, chewy, sticky or bulky foods. Common ‘emergency’ brace problems are mostly manageable and not necessarily serious enough to need clinical intervention.



Wires digging in:

· If a thin wire, it may be possible for the patient or family member to use tweezers to replace wire in the tube or band. Or use tweezer and nail clipper/scissors to shorten the long end.

· It may be that a thin wire is the correct size but may have rotated round the teeth so that it is short on one side and long on the other. Using tweezers a pencil with a rubber on the end or a teaspoon, it may be possible to push the wire back round to prevent the long end digging in.

· If the wire is very thick and stiff, it may not be possible to cut the wire with home care instruments. If this is the case it may be necessary to cover the wire to prevent it being sharp. Relief wax/silicone may be sent to you or you can buy it online (Orthodontic Wax) Failing that using a wax covering from hard cheese or sugar free chewing gum may help.



Broken bonded retainers:

· Push back wire down towards the tooth as much as possible (Fingers or tweezers)

· Cover with best medium available (Orthodontic wax, Cheese wax or Sugar free chewing gum)

· Cut the exposed unbonded wire using tweezers and nail clippers/scissors

· Gently pull the wire to remove the whole retainer

· Advise greater use of removable retainers if present (If not please seek advice from us via email)



Lost retainers:

· Contact us by email – it may be that your unit has access to your final moulds and can make a new retainer remotely which can be posted out to you. We will contact you regarding this.

· If it not possible to get a replacement retainer you could consider ordering online a “boil in the bag” (heat mouldable) gumshield to use and wear at night to reduce the risk of relapse (unwanted tooth movement). It should be noted that these appliances aren’t specifically designed to hold teeth in position so the manufacturer cannot be held responsible for any relapse. Please contact your HCP before investing in this strategy to ensure all aspects of this compromise for retention are understood.



Gold chains:

· If the gold chain was recently placed and is now dangling down, it may be possible to cut it short. Gold is quite a soft metal and it may be possible to cut the chain using some nail scissors or nail clippers. Always hold the loose end with tweezers or similar item. If possible leave at least 5 links through the gum so it can used later by your orthodontic team.

· If you have a none dissolvable coloured stitch discuss with your HPC about the feasibility of removing it at home using nail scissors to prevent a minor infection in the gum.



Aligner therapy:

· If your current aligner is in good order keep wearing it as much as possible

· If your current aligner is broken or ill fitting, step back to your previous aligner

· If neither option is open to you, email us for advice. It may be possible to have a new aligner at the correct stage made for you and sent out to you, or with advice from your HPC a ‘boil in the bag’ (heat mouldable) gum shield to use and wear at night to reduce the risk of relapse (unwanted tooth movement). It should be noted that these appliances aren’t specifically designed to hold teeth in position so the manufacturer cannot be held responsible for any relapse. Please contact your HCP before investing in this strategy to ensure all aspects of this compromise for retention are understood



Bracket off:

(This is not urgent unless it is causing trauma to the soft tissues)

· It may be possible to guide you on how to remove the bracket from the wire via video if it is causing trauma.

· It may be the possible to leave the bracket if it is not causing any problems at present. Consider using orthodontic wax if it is rubbing your lip/ cheek.



Elastic bands:

At this time if you run low or out of elastics your HPC may either send you some more out via the post or advise cessation or night wear only.



Molar band off:

· If band is very loose we may be able to talk you through removal of the band and trimming of the wire depending upon your stage of treatment.

· It may also be also be the case that we advise you to leave the band in place. If this occurs please ensure you adhere to good oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.



Band off quadhelix, TPA, LA:

· Discuss with your HPC about the nature of the looseness and take advice accordingly.

· Push band back onto tooth if it will locate and ensure you adhere to good oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.



Removable/functional appliances

· Check for comfort and retention

· If unsure about how much to continue to wear the appliance discuss via email

· If there is a fractured clasp or acrylic continue to wear if possible.



Seperators:

· These should be removed at the earliest opportunity – Attempt removal with dental floss but *do not poke in with a pin, paper clip or wooden tooth pick*



Lost module(s):

· No action required – try and make the wire where the module has been lost secure with orthodontic wax, cheese wax or sugar free chewing gum.



Lost spring:

· No treatment required



Fractured/frayed power chain:

· Accept situation– most powerchain will denature in 4-6 weeks and become passive

· Remove powerchain with tweezers if necessary

· Cut frayed end as short as possible to improve comfort



Exposed end of wire tie - long ligature or short ligature

· Re-tuck sharp end under wire/bracket using tea spoon or tweezers

· Remove wire if broken with tweezers if possible

· Cut fayed end as short as possible to improve comfort with nail cutters or scissors

· Cover for comfort using Ortho wax, Cheese wax, Sugar free chewing gum



We would suggest that you maintain an optimal level of oral hygiene, use your interdental brushes/floss and continue to brush your teeth after meals, to prevent any gum inflammation. We would also suggest that you avoid foods that may cause your braces, removable appliances, aligners, retainers and all other orthodontic appliances to break. We realise that this for many of you will be an inconvenience and as such we apologise, but at this stage of the COVID19 outbreak our emphasis has to be on keeping you and your loved ones safe, keeping our team healthy and doing our best to reduce person to person contact and travel.

We are available to answer any questions you can still contact us by email as these is monitored regularly. We aim to respond within 24hrs to all emails. Below are suggested protocols to follow when you attend an acute orthodontic emergency appointment at your local dental urgent care units:

· When entering the practice, please use the hand sanitisers provided and if required, allow the team to take your temperature. If your temperature is over 37.5, they will not be able to see you and will advise you to follow NHS self-isolation advice of minimum 7 days.

· Remain 2 meters away from ALL other persons where possible and at least 1 meter away from reception desk.

· Avoid touching unnecessary surfaces, your eyes, nose or mouth if your hands have not been cleaned.

Please do not attend if you or someone in your household has:

· Been recommended to self-isolate

· A high temperature

· A new persistent cough

· Been in contact with a confirmed or suspected carrier of COVID19.

We would like to again send our apologies for the inconvenience but we need to work together so that we overcome this difficult time in humanity.

STAY SAFE

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