Alyn Morgan BChD MSc MFDTEd, a GDC Registered Specialist in Endodontics, Director of U Dentistry Ltd in Ilkley, a Senior Clinical Teaching Fellow in Restorative Dentistry, and Honorary Secretary of the British Endodontic Society, explains the thinking behind the new BES Covid-19 research grant and calls for research to address the impact of Aerosol Generating Procedures in dentistry with respect to Covid-19.
To say that UK dentistry has undergone a monumental upheaval in recent months is a considerable understatement. New words and phrases have entered the dental lexicon which now form part of our lingua franca – it is almost impossible to look at dental social media sites, watch webinars or even have simple conversations with colleagues without “donning”, “doffing”, “FFP3”, “AGP” and “fallow time” being omnipresent.
Whilst the way we do dentistry has changed since our welcome return to clinical practice on June 8th some of the changes are relatively minor and in line with broader societal measures, such as no shaking hands with patients and maintaining a 2-metre distance from colleagues where possible being the most obvious. Other changes have made a huge difference and are affecting the financial viability of dental practices.
The increased concern over AGPs (aerosol generating procedures) and the requirement to leave surgeries fallow for a period after such a procedure is carried out is without question a threat to the ongoing survival of independent primary dental practices and indeed to many of our secondary care and teaching environments. The requirement to leave a surgery empty, not generating income for up to an hour following even the simplest of restorative procedures, presents an impossible barrier to the delivery of efficient and cost-effective dental care. Adding the requirements of enhanced PPE and the need for longer decontamination times the problem is compounded to the extent that it is impossible to consider that, at the time of writing, just a week into reopening, that any UK dental practices are operating other than at a considerable loss.
What makes this situation all the more unpalatable is that the evidence that these business defining guidelines are based on is weak or in many cases non-existent. Early on in the process it was apparent that many of the
decisions taken by Public Health England and NHS England were based on the medical experience where AGPs are different – even the use of the word aspiration, which in the dental context is a very strong mitigator for AGPs, was conflated leading to the suggestion that aspiration was something to be avoided.
Given the need to act and provide guidance in the presence of a weak evidence base, it was inevitable that the recommendations from those who regulate dentistry would be highly conservative, correctly placing a premium on patient safety. However, if dental practices are unable to operate viably then the nation’s dental health will suffer and patients will not be able to access the care they need. It is clear that we need to operate both safely and effectively; to do so we need access to good evidence that backs up our practice.
It was against this backdrop that the British Endodontic Society recently took the decision to issue a research call to consider the science behind AGPs in dental practice and what steps can be taken to identify and then mitigate the risk in the current COVID19 pandemic to allow both practitioners, regulators and, most of all, patients to take comfort that we are working in the most appropriate way possible.
The BES has made up to £40,000 available for this research call and looks forward to working with academic institutions to undertake a truly translational approach to this problem. We also welcome the opportunity to collaborate with any others in the dental community (for example, other professional societies and bodies or businesses in the dental equipment or supply trades) to ensure we can work together and provide, very quickly, much needed answers to the problems we currently face on this issue.