SDPO raises concerns over out-of-date PPE in Scotland

The Scottish Dental Practice Owners Group (SDPO) has raised serious concerns that NHS dental teams in Scotland have been issued face coverings that may not be “fit for use”. The organisation reported that when practices received their PPE to begin aerosol generating procedures from Monday 17th August, some discovered that the FFP3 masks they received were “significantly beyond their expiry dates, in some cases by almost a decade”.

The SDPO even claimed that, in some cases, the original expiry dates had been covered with a new date of expiry label. To top it off, those dates had also passed, with the most recent being in 2019.

The SPDO said: “Preliminary inquiries to the mask manufacturer 3M suggest that they do not consider masks beyond their expiry date to be fit for use. Practitioners have serious concerns about the safety of masks of this age. How can masks this old be passed as safe when the manufacturer suggests otherwise? SDPO members are practice owners and must consider patient and staff safety. We lack confidence that the masks issued to dental practice staff are fit for use, and we are very concerned that NHS dental teams across Scotland have been issued with masks that may compromise patient and staff safety.”

However, a spokesperson for the Scottish Government stated: “Revalidating stock and extending the shelf-life of masks is standard practice to maintain pandemic stock levels and this was used in relation to FFP3 respirator stocks as announced in March. Any PPE which has been issued to NHS boards for onward distribution to dental practices and may have passed its original expiry date has been re-tested to ensure it remains safe to use. Such testing has been approved and reviewed by the Health and Safety Executive and to standards relevant to the PPE being tested. Critically, this PPE – supplied free of charge by our NHS – enables dentists to carry out urgent and emergency care while ensuring the safety of patients, dentists and all dental staff. Each board has a proactive programme of fit-testing for FFP3 masks under way with each practice requiring a fit test for a dentist and dental nurse; this is a rolling programme of work, there are around 1000 dental practices in Scotland.”

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.

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.”