dentistry

NHS England updates Urgent Dental Care Guidance and Standard Operating Procedure

NHS England and NHS Improvement have issued updates to the Urgent dental care guidance and standard operating procedure and Dental standard operating procedure: Transition to recovery documents, along with a letter from Chief Dental Officer Sara Hurley.

“It is 12 weeks since dental practices in England were able to resume face to face dental care,” Sara Hurley begins in her latest communication. “Thank you for all your efforts in broadening access to dental care and supporting the collective NHS focus on a return to full operating capability across the whole of healthcare.”

To support practices as they continue to expand the range of treatments offered, the latest Covid-19 dental guidance update incorporates validated evidence and expert consensus. These publications serve as a framework for identifying and mitigating the risks to dental staff and patients.

“Updates include: Covid-19 screening questions to be asked in line with the case definition for possible Covid-19 and isolation requirements including quarantine advice for those entering or returning to the UK,” says Hurley.

To read Sara Hurley’s letter in full, click here.

The Urgent dental care guidance and standard operating procedure can be accessed here.

The Dental standard operating procedure: Transition to recovery document can be found here.

A-Levels chaos could cause dentistry students to be deferred

Several universities have demanded urgent clarity from the government following the back-and-forth controversy that has plagued this year’s A-Level exam results. Following the public outcry and anger generated by the algorithms initially employed to determine the A-Level results of pupils across England, Wales and Northern Ireland it has now been announced that students will instead be able to receive grades scored by their teachers.

Now, leading universities have stated that students receiving higher grades following the government’s U-turn could be asked to defer their place if there is no space left on their preferred course. In some courses, including dentistry, institutions may not be able to admit students this year.

“We are therefore seeking clarity from the Government and relevant agencies about ensuring as many students as possible can be accepted to their first-choice university,” said vice-chancellor Professor Chris Day and deputy vice-chancellor Professor Julie Sanders from Newcastle University. “We recognise, however, that some programmes have an externally-determined cap where numbers are tightly restricted because of space or specialist facilities. This is particularly the case for clinical subjects such as medicine and dentistry. We are therefore seeking clarity from the Government and relevant agencies about ensuring as many students as possible can be accepted to their first-choice university. Where this is not possible, we will guarantee a deferred place for next year.”

Queen’s University Belfast, meanwhile, is seeking clarity as to whether the quotas for medicine and dentistry courses could be adjusted. A spokeswoman said: “Any applicants to quota-controlled courses who meet the conditions of their offer but cannot be allocated a place for the forthcoming academic year will be provided an unconditional offer for the 2021-22 academic year.”

WHO calls for routine dental checkups to be delayed until Covid-19 risk is known

As dental professionals return to work following lockdown, the World Health Organisation (WHO) has called for a delay in routine dental checkups until the full risk of the spread of Covid-19 is known.

WHO states that there is currently no data on the spread of coronavirus from the dentist’s chair, while adding that more research is needed into common procedures that produce tiny floating particles that may cause infection if inhaled. These include three-way air/water spray, ultrasonic cleaning equipment that removes deposits from the tooth surface, and polishing. Dental facilities must have adequate ventilation to reduce the risk of the virus spreading in closed settings, WHO added.

“WHO guidance recommends in case of community transmission to give priority to urgent or emergency oral cases, to avoid or minimise procedures that may generate aerosol, prioritise a set of clinical interventions that are performed using an instrument and of course to delay routine non-essential oral health care,” said Benoit Varenne, a WHO dental officer. “The likelihood of Covid-19 being transmitted through aerosol, micro-particles or airborne particles … today I think is unknown, it’s open to question at least. This means that more research is needed.”

Last month, WHO released general guidelines on the transmission of the coronavirus, which acknowledged some reports of airborne transmission, but stopped short of confirming whether the virus spreads through the air.

“We think that the most pressing issue is related to the availability of essential personal protective equipment, PPE, for all health care personnel undertaking or assisting in the clinical procedures,” Varenne concluded.

Expansion of services in NHS dental practices in Scotland

NHS dental practices are to re-introduce a range of procedures, such as the use of drills, on a limited basis in Scotland. Practices have been able to see NHS patients for certain types of non-aerosol routine care as part of Phase 3.

Now dental practices, if they are ready, will be able to provide aerosol generating procedures (AGP) on patients with urgent dental problems from 17 August. This move will be supported by the provision of enhanced Personal Protective Equipment (PPE) to dental practices which will require to be individually fitted to dental team members to ensure they work effectively.

This limited introduction, with care prioritised for patients in need of urgent care, replicates the arrangements in place in urgent dental care centres.

Chief Dental Officer Tom Ferris said: “NHS patients have been able to receive care and treatment including aerosol generating procedures through one of the 71 urgent dental care centres in Scotland. Now a limited range of AGP procedures will be available at NHS practices – this decision has been taken after carefully and thoroughly considering the balance between the overall risk of infection with the needs of patients to be seen by dentists.

“I am pleased that patients seeking such urgent procedures can now been seen at their NHS practice, and in turn, that practices can expand their services to patients.”

Background

AGPs are defined as any patient care procedure that results in the production of airborne particles, known as aerosols.

These are relevant to the spread of COVID-19 since transmission may occur through both direct air-borne infection and through contact with contaminated surfaces.

In urgent dental care centres dentists and the dental team are provided with enhanced PPE, including face-fitted masks.

Dental practices that wish to provide AGP care to NHS patients will be provided with a similar level of PPE.

The Chief Dental Officer and his team are in regular contact with NHS Boards to ensure dental practices have clear guidance on appropriate procedures for seeing patients. The Scottish Government have also been working closely with BDA (Scotland) in making the necessary preparations.

Towergate Health & Protection predicts a significant rise in businesses offering dentistry benefits

With dentists across the UK beginning to open their doors to patients, a significant backlog of people needing dental treatment as a result of the pandemic, and costs of treatment likely to increase – offering access to dental care is set to become one of the most popular health and wellbeing benefits, predicts Towergate Health & Protection.

Brett Hill, Distribution Director at Towergate Health & Protection, said: “With most dentists forced to shut due to Covid-19, only treating or referring urgent cases, businesses and employees alike will want to get back on track with dental care now that surgeries are gradually reopening. With access to NHS dentistry about to become more difficult than ever, and costs for private dentistry expected to rise, we are likely to see an increase in businesses investigating options available to support staff with their dental health, such as providing greater financial support for check-ups and treatment.”

Supporting increased cost

Dentists may well look to pass increased cost – due to additional spend required for Covid-19 infection control – on to patients. As a result, businesses will be looking at ways to help employees manage the additional financial burden by providing benefits that can support this outlay. Dentist surgeries are having to invest in PPE, to meet Public Health England requirements for operating safely, and won’t be able to see as many patients as before – to adhere to social distancing and cleaning regulations. Some associated costs will need to be transferred to the patient, and dental benefits – such as cash plans or those included within private medical insurance – can help employees with covering the expenditure.

Minimising related absence

Employers will also be keen for those staff suffering with non-urgent requirements to be treated as soon as possible, for their personal wellbeing, and to return to work more quickly and comfortably. As dentists work through the lockdown-induced backlog, demand for services may outstrip supply – so delays are to be expected. Waiting for slots to become available, the increased time required to physically attend appointments, and inability to work because of dental health issues can increase dentistry-related absence; but benefits can help with affordability if treatment is required – potentially preventing further delays from returning to work.

Hill added: “Employers will be very aware of the health concerns their staff may have faced during lockdown and will be eager to support them as restrictions are being lifted. With dental surgeries beginning to reopen across the UK, a key way for businesses to support staff will be by helping them to afford treatment and check-ups. By providing benefits, such as dental insurance or health care cash plans, businesses can support employees with getting their health back on track – in turn, potentially improving wellbeing and absence.”

BDA: additional financial support and clear communication needed for phased reopening of Scottish dental practices

The British Dental Association has said the Scottish Government now has a responsibility to manage patient expectations, following confirmation from the First Minister that dental practices were able to offer routine care using non-aerosol generating procedures (AGPs) from 13 July. 

Practices are still only provide a limited range of treatments and will not be carrying out routine examinations. The BDA has stressed the need for clear and consistent communication from the Scottish Government and NHS Boards.

Dentists’ costs have increased as practices began reopening last month. The Scottish Government has announced additional funding for the latest phase of reopening – a 30% increase in General Dental Practice Allowance. While this funding is welcome, it is insufficient to restore practice income to pre-Covid levels and could see some practices struggle to remain viable. The BDA has stressed the need for additional funding, given the financial pressures facing mixed NHS-private practices with a high percentage of private income.

The Scottish Government has also issued a revised Statement of Dental Remuneration (SDR) for the next phase of reopening. The BDA welcomed the inclusion of triage activity in the SDR but has concerns about other aspects, such as the lack of funding for lab bills and the reduced level of care that GDPs are able to provide when routine examinations restart in phase 3. 

David McColl, Chair of the Scottish Dental Practice Committee, said: “The Scottish Government has a responsibility to manage patient expectations. Yes, we are moving to the next phase of reopening, but very little will change in terms of the treatments we can offer to our patients. Routine dentistry has not returned, and this fact needs to be clearly communicated. Dentists now face a vast backlog of dental treatment, and it will be some time before we return to anything resembling ‘business as usual’.

“Ministers now need to provide appropriate financial support to ensure the sustainability of NHS dentistry. We need the Government to engage more regularly and effectively with the profession and the public as we continue to navigate our way through these difficult times.”

Video consultation services in Wales extended to dentistry

The Minister for Health and Social Services in Wales, Vaughan Gething, last week announced that video consultation services in the country were to be extended to dental practices, as well as opticians and community pharmacies. This follows on from the successful rollout of such services in primary, secondary, and community care during the Covid-19 pandemic.

Video consultation has rapidly expanded across Wales during the last few months, ensuring that the public retains access healthcare services during the Covid-19 response. More than 6,400 GP video consultations have been undertaken so far, along with 8,800 video consultations to support community and secondary care. The Welsh government states that 92% of patients have rated the service as excellent, really good or good.

Not only has video consultation allowed essential services to continue, but it also helped to protect patients and NHS employees from an increased risk of infection. The service has reportedly saved 36,000 miles of travel and 1,200 hours of travel time. It has also reduced Co2 emissions by an estimated nine tons.

A pilot will now take place during July to extend the services to dentistry, optometry and community pharmacies, all of which have experienced an increased demand for additional services. As social distancing has restricted some services, video consultation will help support the reintroduction of some.

In dentistry, video consultations will support pre-visit consultations to provide an understanding of the patient’s medical history and to facilitate a clinical assessment.

“Delivering care closer to home through the use of technology has always been a key part of ‘A Healthier Wales’, to deliver healthcare away from hospitals to communities, and where possible in people’s homes,” said Gething. “The coronavirus pandemic has meant that we have had to rapidly expand and adapt services. Video consultation has allowed us to overcome the challenges that social distancing brings. The delivery of video consultation has been fast tracked and is testament to the work of NHS Wales in delivering this service ahead of time  to support patients. Thousands of people have already received care via video consultation. I’m pleased to be able to extend this service to dentistry, optometry and community pharmacies which will see even more people benefit.”

Man who hadn’t visited the dentist in 27 years has jaw removed due to ameloblastoma

Several tabloid media outlets have this week reported on the case of Darren Wilkinson, a 51-year-old man from Sheffield who has had 90% of his jaw removed after an ameloblastoma tumour was discovered. Wilkinson reportedly hadn’t visited the dentist in 27 years, finally going after his wife registered him and booked an appointment. The tumour was described as being ‘the size of a fist’.

Wilkinson’s wife, Mel, explained that “he would wake up in the morning with blood on his pillow and have a really bad breath from time to time”. However, she simply “thought he wasn’t brushing his teeth properly”.

Wilkinson’s case was later referred as non-urgent to the Charles Clifford Dental Hospital in Sheffield. It was there that two biopsies confirmed that the large shadow seen in the dentist’s x-ray was in fact an ameloblastoma that needed to be removed as soon as possible.

The operation to remove 90% of his lower jaw and to insert titanium plates was scheduled for the March, but postponed due to Covid-19, instead taking took place in April. A week later, it is reported that Wilkinson developed sepsis and needed to undergo emergency surgery. In total, Wilkinson underwent six emergency surgeries due to complications and infections.

While Wilkinson is currently unable to eat, drink, or speak, the plan is for him to receive a transplant from his lower leg bones in an attempt to rebuild his jaw. In the meantime, he has established online support groups for those with similar diagnoses and is working to raise awareness of rare tumours, such as ameloblastoma, while raising funds to support the Bone Cancer Research Trust.

NHS England releases GP Patient Survey Dental Statistics – January to March 2020

Between January and March 2020, 2.3 million adults were asked for their views on NHS dentistry as part of the GP Patient Survey. Participants were asked if they had tried to obtain an appointment with an NHS dentist and, if so, whether it was with a practice they had been to before and if they had been successful. They were also asked what their overall experience was of NHS dentistry.  Patients who hadn’t tried to obtain an NHS dentist in the previous two years were asked to select the main reason for not trying.

The GP Patient Survey (GPPS) was significantly re-developed in 2018 in order to keep pace with changes in frontline general practice. This included updating the terminology on some of the existing questions, including additional questions and removing questions deemed to be of limited use. The format and layout of the questionnaire was also re-designed in places and, for the first time, 16- and 17-year olds have been included in the survey. There have not been changes for 2020 meaning comparisons can be made between the most recent three publications, but not completely with years prior to this.

There have also been changes with regards to geographies. A number of CCGs were merged, and boundaries were changed so that the number of CCGs was reduced from 195 in previous years to 135 this year.

The results from the survey responses are presented here at national (England), regional and Clinical Commissioning Group (CCG) level.

Main results

  • 3 million GP Patients age 16 and over were contacted, 740,000 replies were received, with a response rate of 32%.
  • Of all respondents asked, just under three fifths (57.9%) tried to get an NHS dental appointment in the last two years.
  • Of the group of respondents who had tried to get an appointment in the last two years;
  • 84.3% rated their NHS dental experience as positive (50.8% very good and 33.4% fairly good);
  • 91.6% were successful in getting an appointment, a success rate of 93.8% when excluding the ‘can’t remember’ category.
  • Respondents who had not been to the practice before were less successful in getting an NHS dental appointment. Younger adults and ethnic minorities also reported a lower success rate. A lower proportion of younger adults and respondents from ethnic minorities had been to the practice before, compared to other respondents.
  • The remaining two fifths (42.1%) did not try to get an appointment with an NHS dentist in the last two years, 26.0% had never tried to get an NHS appointment and 16.1% had tried but over two years ago.
  • Of those who had not tried to get an appointment:
  • 37.4% mentioned private dentistry as the reason for not trying to get an NHS appointment; 25.9% prefer private dentistry and 11.5% stayed when their dentist moved from NHS to private.
  • A fifth (20.5%) of those patients who did not try stated they had “not needed to visit the dentist” as the reason for not attending.
  • 13.4% of the respondents who didn’t try to get an NHS dental appointment gave their reason as “I didn’t think I could get an NHS dental appointment”.

The full summary of the Dental Results from the GP Patient Survey can be found here.

Growing inequality between private practice and NHS dentists in Scotland?

NHS dentists in Scotland have expressed concerns over a growing inequality between patients able to afford treatment from private practices and those who rely upon NHS services in the country. NHS practices are not currently able to provide the full range of treatments, with the widespread belief being that this is because of the cost of PPE.

Now, according to The Scotsman, NHS dentists in Scotland have written to the government, asking why they are unable to provide the full service that their private practice counterparts, which have been able to afford fully fitted face masks, are. The Scottish government’s Chief Dental Officer, Tom Ferris, has told NHS dentists, however, that they will only be given standard PPE, ruling out dental treatments that involve drilling or use compressed air.

“There is a difference between dental provision in different places but the CDO has a very clear route map back to full dental care,” commented Scotland’s National Clinical Director, Professor Jason Leitch. “Emergency dental care and drilling has been available on the NHS in 70 or so Urgent Care Centres throughout the country. Tom, the CDO, is working quickly to move to the next step of the route map which would allow aerosol generating procedures to be done in the thousands of practices. I wrote with Tom to the private dental practices and asked them very clearly to follow the same route map as the NHS dentists. We have slightly less control over what they do because of the nature of contracts, but it was clear advice to follow the same as the NHS. Care has been available and it’s coming back to full dental care.”

Members of the public are still apprehensive about returning to the dentist following the Coronavirus outbreak. One Scottish dentist has said that they have only been visited by a few patients each day, and that even then, it is only when the patient is “in complete agony, which is leading to extractions rather than just fillings”.

“Dentistry isn’t putting anyone at risk, they’re well trained at infection prevention and control and I know they’ll all have adequate PPE so I don’t think patients are at risk,” asserted Leitch. “Tom is very keen to get NHS practices back as soon as we can with the full gamut of care. We’re making choices for a broad range of dentists across the nation.”

Yet, Dr Mohammed Samad, Chair of the Scottish Dental Practice Owners Group, claims that Scottish dentists are receiving conflicting advice from the government and individual health boards. “Why can NHS hubs be provided with adequate PPE to do AGPs but AGPs cannot be completed in general practice under the NHS? Is there a belief that dentists in practice are not as skilled or trained as those in hubs or is it the PPE supply?” he asked.

The Scottish government, meanwhile, has said: “There is no two-tiered system of dental health care in Scotland. NHS patients are able to receive care and treatment including aerosol-generating procedures through one of the 71 urgent dental care centres in Scotland. As part of phase three the Chief Dental Officer has commissioned an expert review of aerosol-generating procedures and will be writing to the profession shortly on how they might be introduced safely.”