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Published: Sunday, 22 March 2020 13:01

Written by News Editor

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The BDA has responded to the new guidelines which probably spell the end of most routine care in England, lamenting the absence of any current safety net to support services through this crisis. The FGDP(UK) has published a consolidation of the advice given out by the four UK Chief Dental Officers.

British Dental Association

The news that dentists in Northern Ireland will get financial support[i] as patient numbers fall off due to the current pandemic leaves NHS England very much the odd one out when it comes to offering such help. In an email to all GDPs in Northern Ireland, the Health and Social Care Board’s head of dental Michael Donaldson said the support will be made available through the Department of Health (DoH), saying: "I would like to reassure you that financial support is at an advanced stage of development in the DoH with the aim of bridging the short term cash flow issues faced by dental practices.”

The British Dental Association (BDA)[ii] has responded to the new guidelines which probably spell the end of most routine care in England, lamenting the absence of any current safety net to support services through this crisis. In a press release the Association said: “While emergency care will continue, new NHS England guidance effectively means most routine treatment which involves ‘aerosol’ generating procedures will end. While not ruling them out the NHS England now advises avoiding all aerosol generating procedures wherever possible.”

Singling out England as an outlier, the BDA says it is the last UK nation to provide up to date clinical guidance following the declaration of the pandemic, and the ramping up of the official response. “Many practices across England have already suspended non-urgent care unilaterally in the face of equipment shortages and concerns around safety of both staff and patients”, they add.

The BDA warns: “With patient numbers already in freefall, guidance has been published without clarity on the shape of any rescue package to maintain the financial viability of practices in England through this crisis. Other UK nations have begun setting out financial mitigation plans, and have stated aspirations to preserve the same levels of patient access when the pandemic ends.”

Talks are continuing with NHS England to identify what help might be provided for dentists and their teams. BDA chair Mick Armstrong said: “We are likely to see the end of routine dentistry as we know it. The question of whether or not normal service ever resumes rests entirely with Government.”

Faculty issues guidance

The Faculty of General Dental Practice (FGDP(UK)) issued a consolidation[iii] of the guidance issued by the Chief Dental Officers of the four UK governments. They say: “After a week in which most general dental practices have been left in the dark, the Chief Dental Officers (CDOs) have now issued updated advice for the ’delay’ phase of the coronavirus pandemic, which will bring a halt to much routine dentistry throughout the UK.”

The key new points, effective immediately, are:

• Cease all care of anyone who should be self-isolating (whether or not they are symptomatic)
• Cease non-urgent care for patients who are 70 or older, pregnant or have a serious underlying health condition
• Cease all aerosol generating procedures for all patients receiving non-urgent care
• Where aerosol generating procedures are necessary, the dental team should all wear a full-face shield or goggles/visor in addition to a surgical face mask

Practices are also advised:

• To establish which patients are or should be self-isolating prior to appointments (travel history is now irrelevant; anyone who has a new and continuous cough, or a temperature of at least 37.8 degrees, should stay at home for 7 days; and anyone sharing a household with someone with one of those symptoms should stay at home for 14 days, and if they become symptomatic themselves, 7 days from that point in time)
• To postpone routine care for patients who are or should be self-isolating
• Not to provide urgent or emergency care for patients who are or should be self-isolating; they should be seen in dedicated centres which are being established, not in general practice
• To identify patients in high risk groups (‘social distancers’) and postpone their routine appointments
• To offer cancellation to anyone who wishes to avoid travel
• To review all open courses of treatment for all patients, and identify those requiring care that cannot be postponed
• To ask patients to travel unaccompanied where appropriate
• To wipe down door handles and other surfaces between patients with extra vigilance
• To remove all unnecessary items from waiting rooms and work surfaces
• To provide handwashing facilities for patients and carers
• To cancel domiciliary visits for routine care
• To establish business continuity plans
• To ensure practices are registered to receive email updates from the NHS

Practices in Scotland have also been advised that the requirement for a patient or guardian to sign a GP17PR or GP17(O)PR has been suspended to avoid multiple patients using the same pen or tablet within the practice.

Definitions of routine, urgent and emergency care are provided in the NHS England commissioning standard for urgent dental care.

Routine care includes treatment for:

• 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

Urgent care includes treatment for:

• 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
• Fractured teeth or tooth with pulpal exposure

Dental emergencies 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
• Post-extraction bleeding that the patient is not able to control with local measures
• 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 such as diabetes (that is lead to acute decompensation of medical conditions such as diabetes) 

[i] https://www.belfasttelegraph.co.uk/news/northern-ireland/dentists-will-get-financial-support-over-patients-drop-39056703.html

[ii] https://bda.org/advice/Coronavirus/Pages/latest-updates.aspx

[iii] https://www.fgdp.org.uk/news/covid-19-new-guidance-and-support-%E2%80%98delay%E2%80%99-phase

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