DENTISTS up and down the country had to shut their doors as the nation went into lockdown – leaving some attempting DIY procedures.
But from June 8, dental practices will be allowed to resume treating patients as the government gradually begins to ease restrictions.
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Many dentists have been outraged that they had been forced to close at all with some questioning why they were not deemed to be essential workers.
During the coronavirus pandemic, people have only been able to receive emergency dental care at a handful of centres – and many have only been able to offer extractions.
So far the UK government has released no precise guidance as to how practices should operate under the “new normal”.
Guidelines have however been produced internationally which may give an indicator as to how things could look.
A group, led by Professors Jan Clarkson and Craig Ramsay from Cochrane Oral Health, conducted a rapid review based on data from 17 other countries who have proposals in place as to what the new normal will be.
From temperature screening to waiting outside, here’s how your next dentist appointment may go…
Preparing to reopen
First of all, before a practice can reopen, staff will need to undergo training which will focus on how to stop the spread of contamination.
To be able to ensure patients and staff can keep a safe 2m distance, surgeries will likely run at a reduced capacity – possibly as low as 50 per cent.
This will also allow for extra cleaning precautions to take place.
So, these physical changes will have to be set out before a practice can safely open.
Before your appointment
Before your appointment, patients will be called to be made aware of social distancing measures, sanitiser stations and may be asked to wear a mask.
Catherine Tannahill, director of clinical dentistry at Portman Dental Care has been working on how to update procedures over the last few weeks in order to minimise the spread of Covid-19 and to keep staff safe.
“Before visiting the practice all patients will be called and briefed on the new procedures in place, so they will know exactly what to expect.
“We may also require them to complete and return a new medical history form digitally ahead of their appointment.”
On the day of your appointment
People will be encouraged to have used the toilet, brushed their teeth and are well hydrated before leaving the house for their appointment.
Once patients arrive at the practice, they may be asked to wait outside before coming in for their appointment.
The dos and don’ts of caring for your teeth during lockdown
With many people unable to seek urgent dental care, what can you do to make sure you don’t need to make a trip to the emergency care centre?
Catherine Tannahill, director of clinical dentistry at Portman Dental Care said there are many things you can do to make sure you look after your oral health during lockdown.
- Eat low alkali food and drinks: doing this after meals helps balance the acidic effects of sugary foods
- Wait to brush your teeth: after eating you should wait one hour before brushing your teeth to avoid enamel damage
- Have sugar free gum: chewing gum helps you produce saliva which helps your mouth stay clean and your teeth strong
- Eat your veggies: eat foods that are good for your teeth like celery and carrots
- Eat too much fruit: fruits are strong in acidic sugars, you should eat as part of a meal and not as a snack
- Crunch ice: crunching ice can cause microbreaks in your teeth
- Avoid fizzy drinks: fizzy drinks are high in sugar and it’s best to avoid them while dental practices are closed
- Avoid sticky foods: things like caramel and toffee can loosen brace wires and fillings
Ms Tannahill continued: “We would also ask that people come to appointments alone where possible and to bring as minimal personal belongings as possible with them.
“Patients will need to call the practice upon their arrival and either have to remain in their car or stand outside, practising the social distancing recommendations, until one of the team members unlocks the practice door and invites them in.”
The doors to the practice are likely to remain locked until staff are ready for your appointment.
Entering the practice
Patients who are waiting outside will be called when it’s time to enter the practice.
There’s likely to be temperature checks on the door and people will be asked to verbally declare whether they have coronavirus symptoms or not.
Once inside, patients may be given a mask if they’re not already wearing one and made to wash their hands.
Waiting rooms are likely to be out of bounds and items such as magazines, TV remotes, water coolers and toys will be removed.
There will be markers on the floor – just like in supermarkets – to indicate 2m distances, but it’s understood most practices will ask people to wait outside until their appointment and will go straight to the treatment room.
Reception staff will sit behind a perspex screen for added protection and people will be asked to use contactless payment where possible.
Patients may even be asked to use their own pens if they need to sign forms and if not a pen will only be able to be used once, it’s understood.
If a patient needs the toilet once inside they should only do so with the permission of staff, as the area will need to be deep cleaned.
Before patients enter the treatment room, they will be asked to leave their coat and bag in a box provided.
They will then be asked to wash their hands once again and depending on the treatment, patients may be asked to swill with a hydrogen peroxide solution for one minute.
Dental staff will be in full personal protective equipment (PPE) as they will be working within the safe social distancing recommendations.
Once the procedure is over, patients will be asked to sanitise their hands once more before leaving the treatment room.
The entire room will then have to be cleaned and disinfected before seeing the next patient.
It’s thought appointments will have a 20-30 minute gap to allow time to safely sanitise between appointments.
The report states: “Patients’ appointments should be spread between 20-30 minutes to allow for enough time to disinfect all areas and avoid cross-infection between patients in waiting rooms.”
Dental PPE problems
One of the main reason dental practitioners have not been allowed to return to work is due to a lack of PPE.
Many of the tools used by dentists, such as drills, can spray germs widely so adequate protection is vital.
Face masks can cost anything from £5-£200 and NHS England says FFP3 face masks are needed for all aerosol-generating procedures.
One dentist said a lot of practices are rushing to get PPE orders in order to allow time for fit testing.
While the cost of most PPE has soared, protective gloves have also doubled in price from some suppliers.
Not all staff will have to wear gloves – receptionists will only have to wear surgical face masks.
Despite this, the use of PPE is different in every area and some hospitals in London have been using two sets of gloves for protection.
Other forms of PPE include disposable gowns and these can range between £5-£15.
NHS England states that clinicians should wear disposable plastic aprons for non Aerosol Generating Procedures (AGPs).
While the advice varied for patients who were suspected to have Covid, the general consensus of the report what that clinicians needed to wear a higher level of PPE than usual in order to protect themselves.
Ms Tannahill added: “As dentists we obviously can’t carry out social distancing when performing routine check-ups and treatments, so the teams will be in full PPE gear and minimal colleagues will be in the treatment rooms, which will then be fully cleaned and disinfected after each patient.
“This means that there will be longer waiting times between patients, and so practices will be on a reduced number of patients that they are able to see in a day. Therefore, patients who are vulnerable or are in need of urgent dental care will be prioritised in the first instance once we re-open.”
When it comes to the sort of kit dentists will need to reopen, PPE is at the top of the list. But other items have also been suggested that may help make things run a bit smoother.
While there have been no studies showing that air purifiers help stop the spread of the virus and some have said the costs are so low that many dentists may get them just to show their patients that they are doing all they can.
Dentist Neel Kothari told Dentistry Online: “There are a few glaringly obvious issues with air purifiers.
“Firstly, we as clinicians will always be between the patient and the unit. Secondly, there is a distinct lack of evidence demonstrating effectiveness and finally, if needed, what standard do we require?
“Could we end up spending a lot of money only to be told they need to be upgraded?
“However, to many dentists the costs of the units are a relatively inexpensive way to demonstrate to their patients that they are doing everything they can to ensure safety.”
This is while other parts of kit such as suction systems could set practices back over £2,500 – and it’s an amount many may not be able to afford after being shut for such a long time.
The systems are used to reduce the amount of aerosol used and could be a quick solution for many practices.
Cleaning and waste management
While it’s clear every business that reopens after the lockdown will have to adhere to a stricter cleaning regime, it’s unclear as to how this will actually be implemented.
The report stated that most countries were no longer using the spittoon in dental procedures.
In order to avoid viral cross contamination it was also suggested that paperwork and other items in the office be kept to a minimum.
It was also recommended that practitioners switch between treatment rooms in order for sufficient time to be given to disinfect each room to a high standard.
Common contact areas such as handles should be covered.
The report also stated: “The door of the surgery must remain closed to prevent viral spread. One guidance document expands on this to state all drawers and cabinets should also remain closed”.
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