Last updated 28 May 2020
**PLEASE NOTE THE GUIDANCE SUMMARISED BELOW LARGELY RELATES TO PRACTICE PRIOR TO THE ANTICIPATED RESUMPTION OF FACE-TO-FACE PROVISION. GUIDANCE ON THE RESUMPTION OF FACE-TO-FACE PROVISION IS IN THE RETURN TO PRACTICE SECTION**
Though the lockdown is beginning to ease, the advice of the Chief Dental Officers (which the GDC requires all registrants to take into account) remains as below until resumption of care:
- Routine dental care is not to be provided
- Urgent dental needs should predominantly be managed by phone with appropriate advice and prescriptions
- Aerosol Generating Procedures should not be undertaken outside of Urgent Dental Care centres
We have also updated our categorisations of AGPs and non-AGPs, and of routine/urgent/emergency dental care, to synthesise advice from across the four nations.
- The Chief Dental Officer for England has announced a return to face-to-face NHS general dental practice on 8 June 2020. This can include both routine and urgent care (though practices are asked to prioritise urgent needs), as well as aerosol-generating procedures (subject to appropriate use of PPE, infection prevention and control protocols, and risk assessment). The CDO has also published a 'Prompt To Prepare' statement and accompanying pathway.
- The Scottish Dental Clinical Effectiveness Programme has published a Practice Recovery Toolkit, including a guide to resuming dental services, patient screening questions, patient management flowchart, re-opening checklist and template entrance notice.
- Public Health England has published A Safe Water Supply for your Team and your Patients to help dental practices reduce the potential risk of Legionella in stagnant water systems.
Henry Schein has produced a ‘bounce back’ checklist for dental practices.
Denplan is investing £2 million to provide PPE to Denplan members dentists.
The Welsh Government has published Unlocking our society and economy, which sets out a staged increased to the easing of restrictions and access to public services including elective dentistry. The All Wales Clinical Dental Leads COVID-19 Group has published the Wales De-escalation Pandemic Plan for Dentistry and COVID-19 De-escalation Standard Operating Processes for Primary Dental Care Settings in Wales.
- Updated social distancing rules now allow most people to leave home for general healthcare (previously only 'essential' medical care was deemed a reasonable excuse). The guidance in England and Scotland refers to 'any medical need', in Northern Ireland to 'seeking medical assistance', and in Wales people may visit their 'GP or local health services, including the dentist'. The relaxation does not apply to self-isolating or shielded individuals. The government has added loss or change in sense of taste or smell to the list of key Covid-19 symptoms, the NHS as a whole has started to look at a return to routine care, and the government published its UK Recovery Strategy.
- A statement from the CDO for England confirmed no resultant change to the dental advice or Standard Operating Procedure.
- The Scottish Government has published its route map through and out of the crisis, which sets out a four phase plan to return to normal dental practice.
- The General Dental Council has published a statement on treating patients in private practices, and has re-confirmed that it will not be reducing its Annual Retention Fee during the pandemic.
- The CQC has updated its advice to practices in England to say that "the decision to offer dental care services is one for the provider to take".
- The Office for National Statistics published an estimate suggesting dental professionals have among the highest potential occupational exposure to coronavirus.
- Health Education and Improvement Wales has published a Primary Care Dental Services COVID-19 Toolkit.
- The Health and Social Care Board in Northern Ireland has published Dental Care in General Dental Practice and Urgent Dental Care Centres during the COVID-19 Pandemic, and advice to dentists on remote prescribing and prescription collection arrangements.
- FGDP(UK) and the College of General Dentistry (CGDent) have convened a task group of national dental organisations and subject matter experts to agree guidance for UK general dental practices on returning to work as the coronavirus pandemic eases. In the meantime, we have added a new Return to Practice section to capture currently available resources from the UK and elsewhere.
- The Scottish Dental Clinical Effectiveness Programme has updated its guidance on Drugs for Management of Dental Problems During COVID-19 Pandemic.
- We have updated the lists of AGPs and non-AGPs to reflect recent guidance across the four nations.
- The CDO for England issued a further letter to the profession.
- The Faculty of General Dental Practice (FGDP(UK)), British Dental Association, Public Health England and the Faculty of Dental Surgery of the Royal College of Surgeons of England published an open letter calling for acceptance criteria for Urgent Dental Care centres to support responsible prescribing in line with FGDP(UK) guidance.
- The European Society of Clinical Microbiology and Infectious Diseases has published Guidance for managing Legionella in dental practices during the COVID-19 pandemic.
- The definitions of routine, urgent and emergency dental care have been updated to encompass protocols in Wales and Northern Ireland.
- We have updated the section on remote prescribing and advice to highlight the fact that faxed prescriptions are not legally valid.
- The Acting CDO for Northern Ireland has published further details of Financial Support to GDS and an accompanying FAQ, an update on redeployment and updated Covid-19 FAQs.
- The British Orthodontic Society has published an Orthodontic Services Initial Recovery Protocol , a table of AGPs and non-AGPs in orthodontics, an AGPs in orthodontics discussion document, guides to PPE and decontamination for AGPs and non-AGPs, and a series of documents in preparation for the immediate post-lockdown phase.
- The Medical and Dental Defence Union of Scotland has published Covid-related employment law advice.
- Members of the Faculty of General Dental Practice (UK) or the Faculty of Dental Surgery of the Royal College of Surgeons of England who are based in the UK or Ireland can now access mental health and wellbeing support from a trained counsellor by calling 020 7869 6221.
- The dental faculties of the Royal Colleges of UK and Ireland have co-hosted further Covid-19 webinars, which are available to watch here. The next webinar, Health & Wellbeing, will take place at 6pm on Tuesday 2 June (register here).
- The NHS Practitioner Health Programme has expanded its service during the pandemic, with 24/7 support available by texting NHSPH to 85258 or calling 0300 131 7000. We have also added a link to its extensive range of online wellbeing resources.
- The NHS Looking After You Too service is offering primary dental care professionals either employed by, or contracted to work on behalf of the NHS, free one-to-one coaching support.
- Members of the British Association of Dental Nurses can now access a health e-hub and confidential helpline.
- The Dental Defence Union has made its online learning resources available to non-members free of charge during the pandemic.
- Dentists Provident is offering its members the opportunity to suspend their cover during the pandemic.
Further details are below.
Return to Practice
FGDP(UK) and the College of General Dentistry (CGDent) have convened a task group of national dental organisations and subject matter experts to agree guidance for UK general dental practices on returning to work as the coronavirus pandemic eases.
The Chief Dental Officer for England has announced a return to face-to-face NHS general dental practice on 8 June 2020. This can include both routine and urgent care (though practices are asked to prioritise urgent needs), as well as aerosol-generating procedures (subject to appropriate use of PPE, infection prevention and control protocols, and risk assessment by the practice). The CDO has also published a 'Prompt To Prepare' statement and accompanying pathway.
- Phase 1: Increase care offered at emergency dental hubs as practices prepare to open.
- Phase 2a: Dental practices open to offer patients non-AGP urgent care. Urgent care centres take referrals for AGPs.
- Phase 2b: Dental practices begin to offer patients non-AGP routine care. Urgent care centres take referrals for AGPs.
- Phase 3: Limited reintroduction of AGPs in dental practices.
Phase 1 is due to begin on 28 May, with other phases subject to three-weekly review of the threat posed by coronavirus in Scotland.
The Scottish Dental Clinical Effectiveness Programme has published a Practice Recovery Toolkit, including a guide to resuming dental services, patient screening questions, patient management flowchart, re-opening checklist and template entrance notice.
The Welsh Government has published Unlocking our society and economy, which sets out a traffic light guide to moving out of lockdown which envisages increasing access to elective dentistry once the decision has been taken to move from the current 'red' phase to the 'amber' phase, followed by full access to services subject to physical distancing and additional precautions. Accompanying this, the All Wales Clinical Dental Leads COVID-19 Group has published the Wales De-escalation Pandemic Plan for Dentistry and COVID-19 De-escalation Standard Operating Processes for Primary Dental Care Settings in Wales.
Public Health England has published A Safe Water Supply for your Team and your Patients to help dental practices reduce the potential risk of Legionella in stagnant water systems.
A General Dental Services Re-establishment Working Group has begun work in Northern Ireland.
The British Dental Association and 16 other NHS trades unions are calling on governments and employers to meet the nine points in its return-to-work blueprint.
The General Dental Council has published a statement on treating patients in private practices, and the CQC has updated its advice to practices in England to say that "the decision to offer dental care services is one for the provider to take... we will assess the extent to which providers are providing an appropriate level of safety [with reference to] prevailing guidance".
Cochrane Oral Health has published Recommendations for the re-opening of dental services: a rapid review of international sources.
The American Dental Association has published a Return to Work Interim Guidance Toolkit, covering pre-appointment screening, patient registration, reception area preparation, a chairside checklist, staff protection and a supplies shopping list. The US Center for Disease Control and Prevention (CDC) has also published Interim Infection Prevention and Control Guidance for Dental Settings during the COVID-19 Response.
The Australian Dental Association has published a series of guides to re-opening practices and practising dentistry during COVID-19.
New Zealand's Ministry of Health has published updated guidelines for oral health services.
Ireland's Health Protection Surveillance Centre has published COVID-19 Guidance on Managing Infection Related Risks in Dental Service.
Henry Schein has produced a ‘bounce back’ checklist for dental practices.
The British Orthodontic Society has published a series of documents in preparation for the immediate post-lockdown phase, encompassing planning, re-opening, cross-infection control, IT and remote working, patient communication, pre-attendance screening, workforce management, finances and resources for patients.
The European Federation of Periodontology has published suggestions for the management of a dental clinic during the Covid-19 pandemic.
The newly-formed British Association of Private Dentistry has published a Return to Practice position paper.
The Alpha-Omega Dental Fraternity published an open letter to the profession entitled Returning to Dental Practice: Realistic considerations, Practical solutions.
Dental Directory has published a checklist for re-opening a dental practice after longer than one week.
The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) has published Guidance for managing Legionella in dental practices during the COVID-19 pandemic.
Denplan is investing £2 million to provide PPE to Denplan members dentists.
Telephone triage and assessment
NHS practices throughout the UK are expected to make arrangements for patients with urgent dental needs to be triaged and assessed over the phone by a dentist during normal business hours. National protocols covering remote urgent dental care provision are available for England, Scotland, Wales and Northern Ireland.
The recognised triage protocol in all four nations is the Scottish Dental Clinical Effectiveness Programme's guidance on the Management of Acute Dental Problems during the COVID-19 Pandemic.
Dentists should familiarise themselves with the GDC’s principles for good practice in remote consultations and prescribing, the key element of which in the current context is risk assessment. The British Dental Association has published advice on risk assessments during the COVID-19 pandemic (this is only available to its members).
The official advice to NHS practices in Wales and Northern Ireland allows for face to face assessments if strictly necessary (and subject to the clinical discretion of the dentist), using standard PPE, as long as patients are asymptomatic and have a pre-agreed appointment following an initial assessment by phone. COVID-19 symptoms now include a loss or change in sense of taste or smell, in addition to a new and continuous cough or a temperature of at least 37.8 degrees.
The advice given by the CDO for Scotland is that no face to face assessment should take place outside of designated Urgent Dental Care centres.
In England, the fourth letter of preparedness published on 15 April said that in the absence of a designated local Urgent Dental Care service, a dental practice may undertake non-AGP face-to-face dental assessment with Level 2 PPE and in accordance with the Standard Operating Procedure for Urgent Dental Care. However Urgent Dental Care centres should now be established throughout England.
Remote prescribing and advice
Following triage and assessment, patients should be offered self-care advice by the dentist as necessary.
Appropriate prescriptions for analgesics and/or antimicrobials can be made by phone under the emergency supply provisions of the Human Medicines Regulations 2012, through which pharmacists can supply a medicine provided the dentist undertakes to provide a physical prescription within 72 hours. Neither photos of prescriptions nor faxed prescriptions are legally valid, but may be accepted by prior agreement pending provision of the hard copy. Dental prescribers experiencing difficulty in obtaining emergency supply of medicines from local pharmacies should contact their NHS Local Area Team and LDC as a matter of urgency.
Prescribing by phone should comply with the GDC’s principles for good practice in remote consultations and prescribing.
The Health and Social Care Board in Northern Ireland has issued advice to dentists on remote prescribing and prescription collection arrangements.
Antimicrobials should continue to be prescribed in a responsible manner and only where clinically indicated, and dentists should consult FGDP(UK)’s Antimicrobial Prescribing for General Dental Practitioners guidance.
This states that the prescribing of antibiotics for toothache, including acute pulpitis, is inappropriate as they are of no clinical benefit in managing dental pain. Analgesics can provide pain relief prior to provision of definitive treatment, and recommended drug regimens for dental pain relief in adults and children can be found here.
While non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be prescribed, paracetamol is as effective for dental pain in most cases, and the government has advised on a precautionary basis that patients with suspected or confirmed COVID-19 take paracetamol in preference.
The guidance notes that antimicrobials may be appropriate where patients present with an acute dental infection for which definitive treatment has to be delayed because of a need to refer for specialist services due to an inability to establish drainage. It may therefore be appropriate to prescribe antimicrobials based on a provisional diagnosis, conducted remotely, of a swelling associated with an acute dental infection.
’Shielded’ / ‘clinically extremely vulnerable’ patients, who are those with these conditions, have been advised by the government not to leave home at all, so may need support for the delivery of prescriptions. Patients can register for shielding support as follows:
- England: register online or call 0800 028 8327
- Scotland: contact their local authority (details here) or call 0800 111 4000 (operates Monday to Friday, 9am to 5pm)
- Northern Ireland: email email@example.com, call 0808 802 0020 or text ‘ACTION’ to 81025
- Wales: patients are asked to first seek help from family, friends, carers or others in their community, or request help from voluntary organisations, before contacting their local authority
Ideally, any patient prescribed antimicrobials should be referred for definitive treatment in an urgent care setting to avoid repeat prescribing of antimicrobials. However, as there is insufficient urgent dental care capacity to treat all dental patients who have been prescribed antimicrobials, dentists are expected to follow the SDCEP guidance on the Management of Acute Dental Problems during the COVID-19 Pandemic, which recommends arranging follow-up to establish whether symptoms have improved or worsened. SDCEP has supplemented this with updated guidance on drugs for the management of dental problems during the COVID-19 pandemic.
FGDP(UK), together with the British Dental Association, Public Health England and the Faculty of Dental Surgery of the Royal College of Surgeons of England, have published an open letter calling for acceptance criteria for Urgent Dental Care centres to support responsible prescribing in line with FGDP(UK) guidance.
Urgent care arrangements
The official advice in England and Scotland is that no face to face care should take place outside of designated Urgent Dental Care centres, to which patients with urgent needs which cannot be provided remotely should be referred. Over 400 Urgent Dental Care centres are now established throughout the UK, and referrals should identify those patients who are shielded. The SOP in England states that conditions provided for by local Urgent Dental Care centres are likely to include, but are not limited to:
- Life-threatening emergencies, e.g. airway restriction or breathing/swallowing difficulties due to facial swelling
- Trauma including facial/oral laceration and/or dentoalveolar injuries, e.g. avulsion of a permanent tooth
- Oro-facial swelling that is significant and worsening
- Post-extraction bleeding that the patient cannot control with local measures
- Dental conditions that have resulted in acute and severe systemic illness
- Severe dental and facial pain: that is, pain that cannot be controlled by the patient following self-help advice
- Fractured teeth or tooth with pulpal exposure
- Dental and soft tissue infections without a systemic effect
- Suspected oral cancer
- Oro-dental conditions that are likely to exacerbate systemic medical conditions
In Wales and Northern Ireland, general dental practices can continue delivering urgent care where necessary using standard PPE, following triage/assessment by phone and an examination, subject to the clinical discretion of the dentist, if it does not involve an aerosol generating procedure, and if the patient is asymptomatic for COVID-19. Patients unable to be seen in general dental practice should be referred to an Urgent Dental Care Centre.
The British Orthodontic Society has published a guide to orthodontic emergency centres.
Volunteering and redeployment
General dental practitioners throughout the UK have been asked to volunteer to be redeployed to support the NHS COVID-19 response. While many are staffing Urgent Dental Care centres, others are supporting NHS 111 or working in hospitals, care homes and elsewhere.
The GDC supports the redeployment of dentists, including to undertake task beyond their usual scope of practice, but still requires them to ensure they are trained, competent and indemnified for the tasks they undertake. Under the Coronavirus Act 2020, the NHS provides indemnity for work undertaken while redeployed, but dental professionals are advised nonetheless to notify their usual indemnity provider of the roles they will be performing.
NHS England’s publication, Deploying the clinical dental workforce to support the NHS clinical delivery plan for COVID-19, maps the skills of different members of the dental team to roles in which they might be redeployed, indicating what training, if any, would be necessary to fulfil them.
However recruitment of dental volunteers has been on hold in England since the end of April following receipt of over 22,000 applications. If and when it is resumed, those willing to be redeployed should complete this online form. Recruitment of NHS Volunteer Responders to work in community support roles has also stopped following receipt of over 750,000 applications.
In Northern Ireland, the redeployment: availability declarations are being processed and a redeployment update was issued to NHS practices in May. The Department of Health previously published its approach to redeployment.
Communications from the CDOs
Recent communications to dental practices from the Chief Dental Officers for England, Scotland and Wales, and the Acting Chief Dental Officer for Northern Ireland, are below:
28 May - Resumption of dental practice
01 May - Update letter
08 April - Redeployment
25 March - Preparedness letter (issue 3)
20 March - Preparedness letter (issue 2)
06 March - Preparedness letter (issue 1)
27 February - Standard Operating Procedure for Primary Care (since withdrawn)
12 February - Interim advice for primary care (since withdrawn)
09 April - Redeployment
30 March - Enhanced financial support
23 March - Cessation of routine dental care
22 April - Redeployment
03 April - Red alert phase escalation
26 March - Financial support
23 March - Red alert
17 March - Amber alert
01 May - Dental Care in General Dental Practice and Urgent Dental Care Centres during the COVID-19 Pandemic (since updated)
30 April - Financial Support to GDS
30 April - FAQ on GDS Financial Support
29 April - Prescribing, Collection and Remote Options
28 April - Redeployment: Availability Declaration
27 April - Updated Covid-19 FAQs
20 April - Clinical negligence indemnity for GDPs
03 April - Financial support to General Dental Services
28 March - Further update on COVID-19 preparation
26 March - Complaints handling
20 March - Financial support to General Dental Services
16 March - Practice preparations
05 March - Practice preparations
27 February - Face Mask Shortage
Routine vs urgent vs emergency care
Definitions of routine, urgent and emergency care are provided in the NHS England commissioning standard for urgent dental care, SDCEP guidance on emergency dental care, Red Alert advice issued in Wales and Northern Ireland's Guidance for the provision of General Dental Services during the COVID-19 Pandemic. These are synthesised as far as possible below, but dentists may wish to consult official local definitions using the links provided.
Routine dental problems are those for which self-help advice and/or access to treatment within seven days would normally be required, and include:
- Mild or moderate pain: that is, pain not associated with an urgent care condition and that responds to pain-relief measures
- Minor dental trauma
- Post-extraction bleeding that the patient is able to control using self-help measures
- Loose or displaced crowns, bridges or veneers
- Fractured or loose-fitting dentures and other appliances
- Fractured posts
- Fractured, loose or displaced fillings
- Treatments normally associated with routine dental care
- Bleeding gums
The SDCEP guidance suggests that approximately 25% of ‘emergency’ phone calls are likely to fall into its ‘advice, self-help and routine care’ category.
Urgent dental problems are those which result in severe or worsening pain which is unresponsive to analgesia, or could lead to a significant deterioration in a patient's oral healthare, and/or for which self-help and access to treatment within 24 hours would normally be required. These include:
- Dental and soft-tissue infections without a systemic effect
- Severe dental and facial pain: that is, pain that cannot be controlled by the patient following self-help advice
- Oro-facial swelling that is not significant and worsening, does not involve the eyelid or neck, and does not affect swallowing or breathing
- Fractured teeth or tooth with pulpal exposure
- Simple trauma affecting adult tooth involving the dentine or pulp or luxation/avulsion of permanent tooth
- Suspected oral cancer
The SDCEP guidance suggests that approximately 75% of ‘emergency’ phone calls are likely to fall into the ‘urgent care’ category.
Dental emergencies are those conditions that pose a significant threat to a patient's general health unless prompt treatment is provided, and require contact with a dentist within an hour. These include:
- Trauma including facial/oral laceration and/or dentoalveolar injuries, for example avulsion of a permanent tooth
- Oro-facial swelling that is significant and worsening
- Swelling involving the eyelid, neck or affecting swallowing or breathing
- Post-extraction bleeding that the patient is not able to control with local measures (NB in Northern Ireland, this is classified as an urgent rather than emergency need unless the patient has coagulopathy or is on anticoagulant medication)
- Dental conditions that have resulted in acute systemic illness or raised temperature as a result of dental infection
- Severe trismus
- Oro-dental conditions that are likely to exacerbate systemic medical conditions (NB in Northern Ireland, this is classified as an urgent rather than emergency need)
The SDCEP guidance suggests that approximately 1% of ‘emergency’ phone calls are likely to fall into the ‘emergency care’ category.
Aerosol Generating Procedures
Public Health England’s COVID-19 guidance for infection prevention and control in healthcare settings states that ‘human coronaviruses can survive on inanimate objects and can remain viable for up to 5 days at temperatures of 22-25°C and relative humidity of 40-50% (which is typical of air-conditioned indoor environments)’, and highlights the risk of ‘extensive environmental contamination’ from the use of ‘potentially infectious Aerosol Generating Procedures’ including ‘some dental procedures’.
The CDOs continue to advise against all aerosol generating procedures (AGPs) except where strictly necessary according to the relevant national protocol, and only for urgent or emergency care. The following lists of AGPs and non-AGPs have been synthesised from official advice in England, Scotland, Wales and Northern Ireland:
Aerosol Generating Procedures (AGPs):
- Use of high speed (turbine) drills/handpieces
- Use of ultrasonic / mechanised scalers
- Use of air-driven surgical handpieces
- Air abrasion
- Air polishing
- Slow speed polishing
- Use of high pressure 3:1 air syringe (“NB Risk of aerosols could be reduced when using a 3:1 if only the irrigation function is used, followed by low pressure air flow from the 3:1 and all performed with directed high volume suction. Dry guards, cotton wool or gauze can also help with drying and moisture control”)
- Opening teeth for drainage
If an aerosol generating procedure is necessary, the use of high power suction and rubber dam is recommended where possible.
- Examination and assessment
- Taking intra-oral radiographs
- Hand scaling with suction
- Simple / non-surgical extractions (“NB If this became a surgical extraction, a slow speed reducing handpiece could be used for bone removal, with cooling provided using saline dispensed via a syringe along with high speed suction. If this is not a suitable option, temporisation or referral would need to be considered”)
- Removable denture stages
- Removal of caries using hand excavation or slow speed handpiece
- Adminstration of local anaesthesia
- Placement of temporary fillings
- Soft tissue surgery (e.g. biopsy)
- Incision and drainage [we assume of a soft tissue]
As some non-aerosol generating procedures may increase the risk of aerosol through stimulating gag reflexes, saliva, sneezing or coughing, these should be either undertaken with additional care or alternative procedures considered e.g. using extraoral instead of intraoral radiographs.
Dental professionals providing face-to-face urgent care may also wish to be aware that guidance from the British Association of Oral Surgeons and British Association of Oral and Maxillofacial Surgeons advises that all urgent dental procedures, including oral examination, are treated as aerosol-generating.
Personal Protective Equipment
The Office for National Statistics (ONS) has estimated that dental professionals have among the highest potential occupational exposure to coronavirus, and the public health agencies of the four UK nations have a shared policy on the use of personal protective equipment.
This allows for disposable respirators, facemasks and eye protection to be used throughout a clinical session if not otherwise compromised (though aprons and gloves should continue to be changed on a single-use basis). Patients with possible or confirmed COVID-19 should now wear a surgical face mask in clinical areas, communal waiting areas and during transportation, except where this could compromise their clinical care.
The core government policy on equipment to be worn remains:
PPE for healthcare workers delivering or assisting with an aerosol generating procedure:
• FFP3 (filtering face protector, class 3) respirator
• long sleeved disposable gown
• eye protection (disposable goggles or full-face visor)
PPE for all other procedures - even for patients with possible or confirmed COVID-19:
• fluid repellent facemask
• eye protection if there is a risk of splashing or exposure to respiratory droplets
The Standard Operating Procedure in England states that the‘splatter’ created by dental procedures is not aerosol contamination, but rather droplets which universal precautions will guard against.
Dental professionals may also wish to consider the updated joint guidance on PPE from the British Association of Oral & Maxillofacial Surgeons and British Association of Oral Surgeons. Their original advice recommended that:
- all urgent dental procedures, including oral examination, are treated as aerosol-generating in terms of PPE
- an FFP3 mask is covered by either a surgical mask or visor
- an FFP3 mask can be worn for an entire day or session
The updated advice states:
- Policy should not be compromised because of capacity. Public Health England guidance represents a useful minimum, not a mandated maximum level of PPE, and clinical judgement is always needed.
- Re-using FFP3 masks, in line with Public Health England guidance, creates additional risks which may in some cases be greater than using a surgical mask
- If your patient pathway does not support using a single FFP3 mask beneath a full face visor for a whole session that is likely to include an Aerosol Generating Procedure, consider using a waterproof surgical mask under the visor for short examinations or treatments with low Aerosol Generating Exposure potential.
The British Orthodontic Society has published guides to PPE and decontamination for orthodontic procedures.
Cochrane Oral Health has published a commentary for the dental and oral health care team on PPE. Dentists may also be interested to read the commentary from the COVID-19 PPE rapid review team at the Oxford Centre for Evidence-Based Medicine.
A number of practitioners have asked about the efficacy of patients using mouthwash prior to examination or treatment as a means of reducing transmission risk. We understand that NERVTAG (the New and Emerging Respiratory Virus Threats Advisory Group), which is advising the government on the threat posed by Covid-19, has considered this for NHS England and found no evidence to support it. However it is up to individual practitioners to consider whether to adopt this measure, in addition to other precautions, if there is no risk to the patient from doing so.
The Chief Dental Officers' advice that no routine orthodontic care take place remains in place throughout the UK.
The British Orthodontic Society has issued an Orthodontic Services Initial Recovery Protocol , a table of AGPs and non-AGPs in orthodontics and AGPs in orthodontics discussion document, and guides to PPE and decontamination for AGPs and non-AGPs.
It has also published a series of documents in preparation for the immediate post-lockdown phase, encompassing:
- cross-infection control
- IT and remote working
- patient communication and template 'welcome back' letter
- pre-attendance screening questionnaire
- workforce management
- 'Your next orthodontic appointment' video and posters for patients
It has also published a Covid-19 guide to the management of orthondontic emergencies and advice for patients undergoing orthodontic treatment during the COVID-19 pandemic, and providers may also wish to consult its guidance on virtual consultations for emergency triage and advice and guide to orthodontic emergency centres.
The British Endodontic Society has published guidance for primary dental care on the triage and management of dental pain likely to be of endodontic origin and on the diagnosis and management of endodontic emergencies during COVID-19.
NHS dental practices are advised to maintain good audit trails tracking the effect of the pandemic on their service delivery.
Though there is no framework to claim for activity or apply patient charges for a service delivered by phone, NHS England has advised providers to keep a manual record of patient contact/triage with a view to informing contract management arrangements for 2020/21. NHS Greater Manchester advice includes:
- Maintaining records of staff and dentist absence and the reason for the absence
- Recording days when the practice is unable to open
- Maintaining records of other work carried out within the practice as a result of patients not being seen (updating policies and undertaking audits, for example) to demonstrate that time spent not seeing patients was used constructively and contributed to the improvement of patient services
- Maintaining records of any other work undertaken at the request of the NHS
The DDU recommends that:
- practitioners keep a log of when they checked the COVID-19 advice so they can demonstrate what they have done to stay up to date
- each practice or department appoints a lead person with responsibility for checking the relevant advice regularly and disseminating it
- practitioners make sure to view documents from a website rather than relying on a saved copy, to make sure you are working from the most up-to-date guidance.
The BDA has published advice on record keeping during the COVID-19 pandemic, though this is only available to its members.
To ensure the continued viability of practices, the NHS has continued remunerating them during the coronavirus pandemic, and practices may be able to access wider government support for small businesses. Practices in England continue to receive monthly NHS income, less a deduction for variable costs. However practices receiving continued NHS income must continue to pay 100% of the salaries of staff and associates, and are not eligible to apply for wider coronavirus-related assistance for the NHS proportion of their revenue. Practices in Scotland are receiving 80% of their usual NHS Item of Service and patient contribution income. Practices in Wales also continue to receive monthly NHS income, and must continue to submit FP17Ws for any patients with urgent care needs that they see. NHS practices in Northern Ireland are receiving 80% of their expected NHS income, though this may be recovered in future years.
The BDA has published a briefing on the financial support available for dentists and practices in Scotland. Details of the support available to dental practices more widely are available on the BDA’s coronavirus financial impact page.
Accountancy firm UNW has published advice on the financial impact of COVID-19 for dentists and dental practices, as well as Viability Planning Forecast templates for dental practices and a 12-week cashflow forecast template.
The National Association of Specialist Dental Accountants and Lawyers (NASDAL) has issued a ‘guide to the current financial state of play’ for dentists and dental practices.
The British Orthodontic Society (BOS) published financial guidance for primary care orthodontics during the recovery phase. The BOS also released legal guidance for practice owners, which may be of interest to the wider profession.
The Medical and Dental Defence Union of Scotland has published Covid-related employment law advice.
Members of the Medical and Dental Defence Union of Scotland have had their subscriptions markedly reduced since April - by around 75% for full time dentists.
The Dental Defence Union is offering its members 'reduced subscriptions and prompt refunds tailored to individual circumstances' on application, and has made its online learning resources available to non-members free of charge during the pandemic.
BDA Indemnity has reduced subscriptions by around 70-80% for Associate Dentists and 65-70% for practice owners.
Dentists Provident is offering its members the opportunity to suspend their cover during the pandemic.
Practice Plan and DPAS gave client practices half of their monthly admin fee back in April and May.
Practitioners are reminded that the BDA Benevolent Fund supports dental students, dentists and their families in financial need, irrespective of whether they are or were members of the BDA. Available 9.30am - 5.30pm Monday to Friday, call 020 7486 4994 or email firstname.lastname@example.org.
All healthcare staff, including NHS dentists and dental care professionals, are classified as key workers for the purposes of the pandemic. This means that otherwise-closed schools and nurseries should continue to provide education and childcare to their children so they can continue working.
NHS Education for Scotland has issued checklists of actions for dental practices at and during closure.
Wesleyan has published a business continuity infographic.
The Care Quality Commission said that dental providers do not need to inform it if they are closing temporarily, or only managing emergency cases, as a result of COVID-19. The CQC also said that providers can apply for a fast, free DBS check for staff or volunteers they need to start work urgently as a result of the pandemic.
The GDC said that it will be sympathetic to those registrants who are unable to maintain their CPD responsibilities in present circumstances. However it has also confirmed that it will not be reducing its Annual Retention Fee during the pandemic.
Emotional and health support
**The dental faculties of the Royal Colleges of UK and Ireland are co-hosting a Health & Wellbeing webinar at 6pm on Tuesday 2 June. Register here.**
Members of the Faculty of General Dental Practice (UK) or the Faculty of Dental Surgery of the Royal College of Surgeons of England who are based in the UK or Ireland can access mental health and wellbeing support from a trained counsellor. Call 020 7869 6221, 24 hours a day, and state your organisation as the Royal College of Surgeons of England.
Confidental is a helpline offering emotional support and signposting for dentists from a team of trained volunteer dentists. Freephone 0333 987 5158, 24 hours a day.
The NHS Looking After You Too service is offering primary dental care professionals either employed by, or contracted to work on behalf of, the NHS, free one-to-one support from trained, experienced coaches via phone or video link. Sessions are available between 07:15 and 22:00 and the first session will last up to 45 minutes. Register here.
Denplan is offering its dentists and their employees free access to a virtual GP service, and a 24/7 helpline offering advice on a range of health, lifestyle, legal and wellbeing issues, until 31 July. To access the service, email DenplanGP@simplyhealth.co.uk.
The NHS Practitioner Health Programme offers specialist therapeutic support to dentists in England experiencing mental ill health or addiction problems can (whether or not they practice under an NHS contract). Normally the service is available 8am – 8pm Monday to Friday and 7.30am to 2.30pm on Saturdays, freephone 0300 030 3300. However the service has been expanded during the pandemic, with 24/7 support available by texting NHSPH to 85258or calling 0300 131 7000. A wide range of resources are also available here.
Members of the British Association of Dental Nurses can access a health e-hub and confidential helpline.
Urgent care recommendations for dental specialities are available on the website of the Faculty of Dental Surgery (RCS England).
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