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The grim new face of a visit to the dentist

by Corina Stansbury (2020-06-20)


British dental surgeries finally reopened yesterday — but we can't hope for anything like the service that we knew before the pandemic, dentists are warning.

Patients must expect only very limited treatments, such as emergency repairs, as well as long queues for appointments and spiralling bills for non-NHS care.

And that's if your local surgery actually reopens.

Around half of English dentists say they are remaining shut this week because they don't yet have the required personal protective equipment (PPE) and other anti-viral precautions in place.

All routine UK dental care was suspended 11 weeks ago to help stem the spread of coronavirus.

Since then, only emergency treatment has been available at some 550 Urgent Dental Care 'hubs'.

However, as Good Health has reported previously, many patients have been unable to get any treatment during the lockdown and have been left in agony.

British dental surgeries finally reopened yesterday — but we can't hope for anything like the service that we knew before the pandemic, dentists are warning

The Government last week told practices that they could reopen from yesterday — but only if they introduce stringent safety measures.

But many of the UK's 10,000 dental practices say they weren't given enough warning and still lack the necessary PPE to treat patients safely.

To help them, the Department of Health and Social Care has said: 'We are working around the clock to make sure staff have the PPE they need, and we have made further supplies available to the dental sector this week.'

Mick Armstrong, chair of the British Dental Association (BDA), warns: 'Anyone expecting dentistry to magically return this week will find only a skeleton service.'

So what does this mean for you?

IS IT LIKELY MY DENTIST WILL BE REOPENING?

A poll for the BDA of more than 2,000 UK dental practices shows that only around half will reopen this week.

More than 80 per cent of the practices polled say they expect to reopen 'to some level' by the end of June.

The BDA reports that six in ten of its members do not yet have the necessary PPE to resume delivering face-to-face care.
Dentists also complain that they've had only days to meet the new regulations on safe practice and staff training laid out in a 62-page government document that was issued on Thursday last week.

The Government last week told practices that they could reopen from yesterday — but only if they introduce stringent safety measures

HOW WILL I BE NOTIFIED IF MY PRACTICE IS OPEN?

There's no official method for notification. Many dentists will use email, text and social media to tell patients they are reopening, says Dr Mark Cronshaw, president of Pandora, the UK Association of Independent Dental Surgeons.

But not all surgeries will be up to speed on this.

The Department of Health says patients should simply phone their practice — though many surgeries won't yet be able to say when they'll be reopening.

Orthodontists are also allowed to reopen this week, though again, patients may need to check.

WILL I GET AN APPOINTMENT?

The service being offered will be very limited, not least because surgeries will have to spend 30-60 minutes decontaminating rooms and equipment after each patient.

All the surfaces inside the surgery must be treated using an antiviral chemical, hypochlorous acid.

While most UK practices used to see 30 patients a day, Dr Cronshaw says that typical dentists may now manage ten to 12 at best.

The BDA is even less optimistic.
In its poll, 60 per cent of members predicted their practice will operate at only a quarter of its pre-coronavirus capacity: perhaps eight patients or fewer a day.

Lockdown has left some 800,000 people in the UK with untreated dental needs.

On top of this, the BDA anticipates that only a tiny fraction of the nearly 40 million courses of treatment delivered by NHS in England last year will be possible under current conditions.

DO I HAVE TO TAKE A COVID-19 TEST FIRST?

No, official Department of Health (DoH) advice is that you don't have to have been tested.

But it adds: 'If you experience any of the symptoms of Covid-19, then please do not visit the practice in person. All patients should initially contact their dentist by phone.'

If you need urgent dental care and are an infection risk for Covid-19, you will be referred to an Urgent Dental Care hub to see if you can be treated safely there.

The Department of Health says that treatments on offer will vary from practice to practice, depending on staff and equipment available.

Many patients will still be offered just advice over the phone. Only those needing urgent care will be invited in for treatment

WHAT IF I SIMPLY WANT A CHECK-UP?

There's no point ringing to request a routine check-up, says the BDA.
Dentists will screen treatment requests and treat only those most in need of deliverable help — a process called triage.

The Department of Health says that treatments on offer will vary from practice to practice, depending on staff and equipment available.

Many patients will still be offered just advice over the phone. Only those needing urgent care will be invited in for treatment.

Dr Cronshaw told Good Health that at his Isle of Wight surgery, they 'expect to be back to routine check-ups in a few weeks' time'.

WILL SOME TYPES OF WORK BE BANNED?

There are no bans as such, but strict new rules mean many surgeries won't be able to offer treatments involving drilling or anything that might cause potentially virus-carrying droplets to spray from the patient's mouth.

These so-called aerosol generating procedures (AGPs) should be avoided wherever possible, because they carry a strong risk of transmitting infection to staff and can only be performed if the surgery has high-level PPE, such as respirator masks and fluid-resistant gowns.

Seven in ten practices won't be able to offer AGPs immediately upon reopening, says the BDA.

WILL I PAY MORE FOR TREATMENT?

The Department of Health says there will be no change to charges on the NHS treatment list.

However, it has no control over charges for private dentistry.

Dr Cronshaw says that the costs involved in dentistry will inevitably rise, and some of this will be passed on to patients who have procedures done privately. For example, procedures involving AGPs will involve up to £30 worth of PPE being used, he says.

The BDA warns that the cost of such equipment has spiralled, with prices for boxes of simple masks rocketing from £5 to £50.

So it seems inevitable that many surgeries will be keen to see patients go private to cover their increased PPE costs.

The Department of Health says that patients will be required only to follow normal rules on social distancing until you are in the dental chair.

Dr Cronshaw suggests, however, that some practices may ask you to drive to the surgery and wait in your car until your dentist becomes available

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MUST I WEAR A MASK IN A WAITING ROOM?

The Department of Health says that patients will be required only to follow normal rules on social distancing until you are in the dental chair.

Dr Cronshaw suggests, however, that some practices may ask you to drive to the surgery and wait in your car until your dentist becomes available.

'On arrival, many practices will check patients with a contactless thermometer to make sure they are not running a temperature,' he says.
'Some practices may then have the patient use a disinfectant mouthwash, and wash their hands under supervision with anti-microbial handwash.'

WHAT CHANGES WILL I SEE?

The chief dental officer for England has asked dentists to change some aspects of their surgeries before reopening.

Chairs in waiting rooms should be two metres apart, while receptionists may be behind a plastic shield.

Dental teams will be wearing PPE that includes a surgical gown if a filling is planned.

During procedures, Dr Cronshaw says he will be wearing glasses and a mask over his nose and mouth, as well as a protective visor.

As far as possible, you will be asked to pay using a contactless method.

Meanwhile, behind the scenes, all practice staff should be screened daily for Covid-19, perhaps with a temperature check.

AND IF MY DENTIST IS NOT REOPENING?

Even if your practice is not reopening soon, the DoH says they should continue to offer the remote triage advice service that's been in place since lockdown began. Your surgery may refer you to an Urgent Dental Care hubs for emergency care.

While English, Welsh and Northern Irish dentistry is restarting this week, dentists in Scotland will reopen later. The BDA suggests that it 'will be some time this month'. If you do not have a regular dentist, call NHS 111 or use the NHS 111 online service.

Dr Cronshaw recommends that if you're in urgent need but still can't get help, call some local practices: 'All dentists are very aware of the distress suffered by patients in trouble and will do their very best to help.'

Sadly, six in ten BDA members fear they won't be able to stay financially afloat.

Only 8 per cent say they feel confident they can survive the impacts of spiralling treatment costs and plummeting appointment numbers.