The Probe - Proudly serving the dental profession for over 60 years

Smile July/August 2020 – Oral health during and after serious illness and disability GDC Development Outcome: C

Course Dates: 25th August 2020 - 25th August 2022
Enrollment Dates: Enroll Anytime
Who can Enroll: Anyone
Course Language: English
Price: FREE

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{my}dentist begins rollout of air filtration units across network

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{my}dentist, the UK’s largest dental chain, is to invest in more than 2,500 air filtration units to reduce fallow time between dental appointments across its network.

The new units, which represent an investment of more than £1.25 million, will ensure that surgeries have at least 10 air changes per hour and the fallow time after aerosol generating procedures (AGPs) to be reduced to just 20 minutes.

This will mark a huge step in the restart of routine dentistry at {my}dentist, significantly increasing available surgery hours and meaning much greater access for patients and improved productivity for clinicians.

The rollout of the air filtration units across the network will be complete by mid-October.

In addition, there are a small number of practices in Wales and Scotland where {my}dentist is installing fixed ventilation to ensure that it meets the required government standard.

Nyree Whitely, Clinical Director for {my}dentist, said: “There is one overriding obstacle that is preventing more patients getting access to the care they need and our clinicians being able to return to their normal levels of productivity: that is the 60-minute fallow period that is currently required between aerosol-generating procedures.

“None of us know how much longer the pandemic will last, but it is clear that patients need our services now more than ever. The installation of these units will help us take a step closer to being able to support more patients and ensure our practices are among the safest in the country.”

Further investments {my}dentist has made in protective measures during the pandemic have included a nationwide review of suction in all of its surgeries, improving efficiency where necessary to ensure that all units achieve a minimum of 300 litres per minute as well moving to an increased level of wide bore aspiration of the aspirator tips. This is in addition to strict social distancing and hygiene measures to reduce the risk of transmission.

ADG: Children face ‘triple whammy’ of coronavirus dental dangers

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Thousands of children could soon require hospital operations to remove unsavable teeth due to a ‘triple whammy’ of dental dangers, states the Association of Dental Groups (ADG).

Hospitals in England carried out an average 177 operations a day on children and teenagers last year to remove teeth, costing the NHS more than £40m.

Now the Association of Dental Groups is warning that lockdown will make the problem significantly worse as:

  1. Many children have stopped going to the dentist or been unable to get appointments
  2. Children are more likely to snack on more sugary foods and drinks while stuck at home
  3. Community oral health programmes for children have been interrupted

Neil Carmichael, Chair of the ADG, said: “Before lockdown, there were multiple operations being conducted every day to remove children’s teeth across the UK. Since then children have faced a triple whammy of dental dangers so it’s inevitable that things will get worse. When routine appointments restart, dentists could have their work cut out dealing tooth decay among children. In hospitals all the signs are that we’re looking at more operations than ever to remove children’s teeth.”

There is mounting evidence than millions of people have been staying away from dental surgeries or being unable to get appointments during lockdown. A major new poll by the ADG suggests that children in 50% of households across the UK have missed or decided against a visit to the dentist since lockdown began.

The UK already the lowest number of dentists per capita of any G7 country, leading to growing concerns that a backlog of care may well occur after the pandemic unless measures are taken to aid recruitment into the profession.

Dentists have also expressed concern over ‘lockdown diets’ including more sugary treats and fizzy drinks having an adverse effect on children’s oral health. One survey for a member of ADG found that 77% of dentists expect the ‘lockdown diet’ to have an adverse impact on the nation’s oral health. Other anecdotal evidence suggests an increase in sugary baking particularly at the beginning of lockdown and an increase in sugary snacking. 

Finally, dental professionals have expressed concern over community dental services which normally deliver child oral health improvement programmes through Local Authorities, which have now been disrupted. These are early intervention, preventative programmes in areas of likely poor child oral health.

Sue Jordan, Assistant Director, Oral Health Improvement for CDS-CIC, which deliver community dental services and oral health improvement across much of east and central England said: Over lockdown 90% of our outreach to the most vulnerable communities in our regions has been shut down. In normal times we support more than 2000 young children to do supervised teeth cleaning and today not one child will be receiving that help. We have helped children as old as three who didn’t know which way to hold a toothbrush. They won’t be receiving that help any more or the structure that they need to prevent dental problems. They won’t be able to get that help until post-covid routines can be normalised either.

“All the evidence we have suggests that early preventative care for dentistry has a huge return on investment. We know that our work can save up to nearly £7 for every pound spent. After Covid, that bill will eventually come due with massively negative consequences for the children and the NHS. Dentistry really is a critical preventative service, the problems that get worse for these children suffer during lockdown can only get exponentially worse over time. we are going to have a real uphill struggle getting back on track when this is all over.”

The CDS-CIC work with Local Authorities, the NHS and other Community organisations to identify the most at risk children for dental problems. Their work helps identify and educate younger people in particular to improve their oral hygiene.  https://communitydentalservices.co.uk/

Data around number of dentists taken from https://www.nao.org.uk/report/dentistry-in-england/

FGDP(UK) & CGDent to update Covid-19 guidance following SDCEP AGP review

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The Faculty of General Dental Practice UK and College of General Dentistry have welcomed the Scottish Dental Clinical Effectiveness Programme’s review of the mitigation of aerosol-generating procedures, and will be issuing updated COVID-19 guidance shortly in view of its recommendations.

The SDCEP document, published today, represents the agreed positions of a working group comprising dental professionals from across primary care, secondary care, academia and public health, in addition to expert opinion from subject specialists in particle physics, aerobiology and clinical virology. The consensus report was compiled following a review of the currently-available evidence on the generation and mitigation of aerosols in dental practice, and the associated risk of coronavirus transmission.

Among the key positions, and in contrast to those adopted to date in official protocols, the report divides dental procedures into three categories of aerosol generation potential according to the instruments used, with fallow periods recommended only for the highest risk procedures, and suggests the determination of fallow time using a multifactorial approach with a ‘benchmark’ of 15-30 minutes.

The FGDP-CGDent guidance, published in June, also set out a more nuanced approach to considering the generation of aerosols in dental practice, and while allowing for potential adjustment of fallow time, accepted a 60 minute period following procedures carrying a higher risk of exposure to potentially-infective aerosols.

Ian Mills, Dean of FGDP(UK), Trustee of CGDent and a member of the SDCEP’s review group, said: “SDCEP’s review of dental AGPs has been extremely thorough, and followed a rigorous and methodical approach. Its publication is potentially a very significant moment in the recovery of dental practices in the midst of the coronavirus pandemic and I commend the SDCEP Team for the hard work and dedication they have shown in producing this report.

“We welcome in particular the more refined stratification of the transmission risk inherent in types of dental procedure; the allowance for fallow time to be calculated from the cessation of the procedure; and the sophisticated approach to calculating fallow time, which considers both procedural and environmental mitigation factors such as high-volume suction, the use of rubber dam and provision of adequate air ventilation.

“These approaches align exceptionally well with our own guidance and we feel it is important that current standard operating procedures are reviewed in light of SDCEP’s recommendations. Adoption of these measures will enable the increased delivery of patient care to tackle the backlog of unmet need, and avoid further deterioration in dental access and oral health inequality. A reduction in fallow time will also support the viability of practices, while the maintenance of universal precautions will continue to keep both patients and members of the dental team safe.

“We aim to update our guidance as soon as possible, and are currently working with partners to develop an online Fallow Time Calculation Tool to support its implementation.”

SDCEP’s Mitigation of Aerosol Generating Procedures in Dentistry – A Rapid Review is available at https://www.sdcep.org.uk/published-guidance/covid-19-practice-recovery/rapid-review-of-agps.

The current FGDP-CGDent guidance, Implications of COVID-19 for the safe management of general dental practice – a practical guide, is available at https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide and https://cgdent.uk/standards-guidance.