COVID-19: 23rd March Update I, BDA issues urgent advice to dentists

COVID-19: 23rd March Update I, BDA issues urgent advice to dentists

The BDA has issued urgent advice to dentists, sent by email to members on March 22. They say there should be a reduction in the amount of routine dental activity, particularly in respect of vulnerable groups and that staff and patient exposure to potential infection should be reduced by avoiding all aerosol generating procedures wherever possible. The BDA will continue to make the case forcefully that support should be offered to protect dentists’ NHS income and that this protection extends to associates.

BDA issues urgent advice to dentists[i]
In all four nations of the UK, governments and officials have issued recent advice in relation to the provision of primary care dentistry. This clinical advice has reflected the UK Government’s developing position in relation to increasing social isolation, reduction in use of public transport and use of health services, and also growing unease, as infection levels grow, about the potential for spread of COVID-19 from asymptomatic patients.

Official advice across the UK is not exactly the same, but there is a consistency in guidance that there should be a reduction in the amount of routine dental activity, particularly in respect of vulnerable groups and importantly that staff and patient exposure to potential infection should be reduced by avoiding all aerosol generating procedures wherever possible. 

Appropriately, all dentists should exercise their own clinical judgement, taking into account their own practising circumstances. However, given the high proportion of patient interaction in dentistry that has the potential to involve aerosol generation, the BDA believes that for most practices it is likely that compliance with the guidance of the various UK administrations will mean a significant reduction in routine clinical activity. Indeed, for many practices, the practical consequences of the guidance will mean ceasing routine care entirely, given the difficulties of identifying in advance patients who will not need aerosol generating procedures. The BDA supports dentists and practices choosing to stop regular patient treatment. 

We believe that current guidance should be more explicit given the continuing spread of the virus and uncertainty around asymptomatic transmission and the associated risks. Given this uncertainty, the BDA recommends that no aerosol generating procedures are undertaken on any patient without appropriately fitting FFP3 masks, other required protection equipment and protocols.  

Further, given the uncertainty and reflecting the practical consequences of the current official advice, we recommend that practices cease routine dentistry and operate an advice and emergency service only. Consistent with Government advice to limit social contact, face to face contact should be kept to a minimum but telephone advice should remain available during normal hours. This service will be important for patients, particularly until fully fledged emergency provision is in place. Each practice should make its own risk assessment of what is safe and what can be delivered by way of an ongoing emergency only service. 

The situation is changing rapidly and it may well be that as the pandemic evolves emergency only treatment and patient contact will only be deemed appropriate in particular setting and temporary practice closure may become mandatory. 

As things stand, the chance of advanced PPE equipment, protocols and training being widely available to avoid this seems unlikely, with resources appropriately being directed to intensive care. In any case, the development of Government advice around social isolation has the potential to further limit the availability of routine care.  

The purpose of this advice is to give maximum protection to dentists and staff but it remains an individual practice decision as to what level of service continues to be provided on the basis of rigorous risk assessment. 

Again, there will be variation across and within UK countries, but local discussion should be taking place around the provision of NHS urgent dental care, particularly as the amount of routine care decreases. Arrangements for the provision of emergency care will become increasingly important if and when the country moves towards further social isolation and further lockdown of normal activities. Dentists involved in urgent care in specialist centres will require full personal protective equipment including FFP3 face masks. 

Clearly, a reduction in clinical activity will have financial consequences for practices and for associates. The BDA is acutely aware of this and we continue to make the case forcefully to all administrations that support is offered to protect dentists’ NHS income and that this protection extends to associates. We are also conscious of the impact on private dentistry and are arguing to government that private practices should have appropriate access to the range of wider financial support being made available to business across other sectors.

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

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