New dental protocol advocated to allow dental practices to reopen sooner


During the past couple of months since the Covid19 lockdown, the number of dental appointments and treatments missed is staggering. Extrapolating the figures from NHS England alone[1], it is estimated that around 1.3 million adult appointments, including 4.5 million courses of treatment as well as 808,000 child appointments have so far been missed! Significantly more, if you add in numbers from the other parts of the UK.

As well as regular check-ups and treating pain, dental clinicians also undertake the vital work of mouth cancer screening. Head and neck cancers are the 8th most common cancer in the UK with incidence, increasing over the past decade by a third. In a typical six-week period nearly 1,000 cases are diagnosed [2] . Up to 88% of this type of cancer is preventable with dentists highly trained to identify susceptible patients and give preventive advice. Caught early this is a treatable cancer; caught late it has a very poor prognosis.

Taking into account these shocking numbers, you may well be thinking that this vital service, is high on the agenda for the government to reopen. The call outs that the NHS is “open for business” have become increasingly louder over the past two weeks.[3] It is not unreasonable for you to think that dentistry would be a higher priority to open than, for example, hair dressers, who it is mooted, will be among the first to open their doors under the government’s traffic light system[4] as we creep out of lockdown. And yet, this is not the case.

For those of us unfortunate enough to experience dental pain or emergency during this lockdown period, our route to care is far from easy, with the need for numerous phone calls, remote prescriptions for antibiotics that may or may not work, and for those in severe need a trip to a regional emergency hub, which were hastily put together post lockdown to treat dental emergencies, and which can be up to an hour away from home[5].

Urgent Dentalcare Centres (UDC’s) which are treating emergency patients operate with level 3 PPE and include protocols to mitigate this risk. These protocols include fully ventilating the treatment room by leaving windows open for half an hour after each patient is treated, followed by a full clean down for a further extended period of time. Given these constraints it is unsurprising that each dentist is only able to treat 4 patients per session compared to the usual 12 in normal circumstances.[6] The dental profession is clearly facing an unprecedented challenge, with millions in need of treatment unable to access sufficient care.

A better way - with a much lower risk of cross infection

A pioneering group of 150 Independent Dental Surgeons has researched and developed, what they feel is a better way to deliver dentistry to patients in need, with the aim that all those who require face to face care are able to access it sooner rather than later. Together they have spent the past six weeks of lockdown researching pioneering technologies and materials, and pooling resources to create a pathway which mitigates a 0.1% risk of cross infection to patients.

  • Pre-treatment screening 

Identify high risk to treat patients by history and temperature checks.

  • PPE 

All dental professionals working in practice to wear appropriate levels of PPE. A survey conducted by Pandora Dental amongst 4,292 dental professionals shows only 7% experienced Covid-19 symptoms prior to the lockdown, which is much lower than the general population, and can be attributed to their use of PPE.

  • Clean the mouth 

All patients to use an anti-microbial mouthwash which is 99.9% effective at killing coronaviruses as soon as they enter the dental practice.

  • Clean the air

All dental waiting rooms and dental surgeries to be fitted with clean air systems proven to effectively remove coronaviruses in the air, and ensure that airborne, droplet viruses, such as Covid-19 are neutralised before they are inhaled. This technology is used widely in clinics worldwide, and the typical time to completely change the air in a room is 5 minutes (around 25 minutes shorter that the ‘open window’ practice used by the UDC’s - meaning significantly more patients can be safely treated in a day).

  • Clean the consulting room and equipment

All dental practices are already required to thoroughly clean the consulting room and sterilise equipment between patients and sufficient time is allowed between patients to ensure this is conducted effectively. Many practices are also installing the anti-viral clean air systems in the reception and waiting areas.

  • Clean the water supply  

It is also being recommended that hypochlorous acid (which is anti-viral and anti-bacterial) is added to the water supply used in the consulting rooms. This is an agent widely used in the food industry and it is non-toxic to people, although highly effective against pathogens.

  • Minimise droplet release in the mouth

Pandora recommend rubber dam treatment is used for every patient, wherever possible.

  • Reduce any infection laden aerosol spray which is released

There are many aerosol generating procedures where the air can become laden with spray. As this can be contaminated with blood and saliva which has led to the recommendation to stop this type of procedure. However, practices have a range of high volume suction aspirator options available to deal with this problem to the extent that 99.9% of the potentially hazardous materials are safely removed. Stopping dentists, dental therapists and dental hygienists from providing these types of treatments may result in the unnecessary loss of many teeth, plus there are very many associated serious complications and concerns for the patients’ welfare which could result.

After reading the details of this new pathway developed by Pandora Dental, Professor Mike Lewis, Cardiff University, commented “I agree with all the points advocated in this protocol. This is all common sense. Let’s get back to treating patients safely, and helping our staff feel safe too.”


Dentistry in crisis


Dr Cronshaw concludes: In a recent survey of our members, it was found that each of us received between 2-4 patient calls a day who are asking for emergency dental care, which would require us to direct them to a UDC. There are 35,000 registered dentists in the UK, and if the pattern we have found is true, that would mean between 70,000-140,000 patients A DAY are in need of urgent dental care, which we are unable to give them - nor will we be able to for some time. As a profession we are keen to help all our patients and feel that the pathway we have mapped out is the clearest means by which we can achieve this safely and effectively.

We are seeking an urgent review of any proposed restrictions to dental treatment options and are speaking to The Health Minister Matt Hancock and other MPs, as well as all the health regulatory bodies.”

Morale in the profession is at rock bottom. A survey conducted by Pandora amongst 2,500 dental professionals, released on 5 May 2020 has revealed that a quarter of all dentists are planning to leave the profession as a result of concerns which have been exacerbated by the Covid-19 crisis (including stress, financial, required new protocols of PPE, and limitation on the treatments they can carry out). If these concerns are not addressed immediately there will be far fewer dentists left to treat people once practices are allowed to open.

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Image: Dr Mark Cronshaw, President of Pandora Dental







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