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Not so long ago (although it feels like a lifetime ago and in a different universe) a visit to the dentist seemed like a walk in the park – except perhaps for those who suffer from dental anxiety.
You would casually stroll in, check-in at reception, sit down in the crowded waiting room and then eventually be called in for your dental appointment.
As we all know the end of last year a new strain of coronavirus 2 was identified in China, which was named COVID-19 (SARS-CoV-2).
It has spread very quickly between countries and had (and still has) a devastating effect on people and economies.
On the 12th of March 2020, the World Health Organization declared it a global pandemic. (1)
Due to the lockdown, dental surgeries in England closed their doors to the public at the end of March and were only allowed to reopen from the 8th of June.
All around us we are now coming to terms with the new measures put in place to try to reduce the spread of the virus. Naturally, this includes dentistry.
This article aims to give you an insight into how the patient journey has changed due to the pandemic and how dental practices have adapted to the new norm.
This virus spreads mainly via aerosols, droplets in the saliva, and coughs and sneezes of an infected person. (1)
In dentistry the following main risks have been identified:
The general definition is: activities carried out inpatient or medical care, which result in the release of aerosols (airborne particles). (3)
In dentistry this means any treatment carried out with using the high-speed handpiece (drilling of the teeth), an ultrasonic scaler (used for cleaning the teeth), drying and washing the teeth etc.
Some procedures categorised as high risk even where the water or ‘drill’ isn’t used, e.g. taking impressions, which could trigger gagging or coughing.
Generally speaking, dental surgeries are already known for their stringent infection control and cleaning procedures.
The guidelines related to these are strictly followed by all members of staff at all times.
Unfortunately, dentistry is one of the professions with the highest risk of the transmission of COVID-19. In light of this, the dental surgeries have updated their Standard
Operating Procedures (SOPs) to comply with the NHS’s guidance for dentistry overseen by the Chief Dental Officer (CDO) of England.
SOPs are the protocols we follow when we carry out any procedures related to patient care.
All the additional new rules are created to serve one purpose: to minimise the risk of transmission of COVID-19. This is achieved by reducing the person to person contact as far as reasonably achievable and by lowering the risk of transmission via aerosol and droplet.
If you have an appointment booked you are most likely will be contacted previously via phone reminding you of your appointment and explaining what to expect. You will be also required to answer COVID-19 related questions (in some cases you will be sent forms to fill out electronically, e.g. medical history, NHS form).
You are advised not to arrive too early for your appointment as many dental surgeries are asking their patients to wait outside to avoid people sitting in the waiting area.
Upon arrival to the surgery, you will have to notify the reception (either by calling the practice on your mobile or in some cases there is an intercom system you can use) and they will inform the dental professionals.
A new role has been created in dental surgeries: the runner dental nurse. They have a very important part to play.
When the dental team is ready in the surgery, the runner nurse will greet the patient at the door, let them in, give the patient a mask to wear, ask them to disinfect their hands with hand gel provided and take the patient’s temperature.
In some cases, they will ask COVID-19 related questions (if those haven’t been asked previously).
They will escort the patient straight to the surgery to avoid the patient having to wait around in the waiting room.
If they have any belongings (coat, handbag, anything they don’t want to have with them on the chair) it will be placed in a plastic box or a secure storage container to minimise surface contamination.
The container is disinfected after every appointment.
Once in the chair, you most likely will be asked to remove the mask and to rinse before your treatment/examination starts.
Ideally, a peroxide-based mouthwash is used for this purpose, which is proven to reduce the viral load in the mouth and throat.
It goes without saying, that social distancing cannot be observed when it comes to patient care.
After your appointment has finished, you are asked to put your mask back on and the runner nurse will take you to the reception (giving you some more of the hand gel) where you can settle your bill and/or book another appointment.
There is a changed look at the reception areas with plastic screens fitted and floor markings for social distancing present.
The runner nurse will then escort you out of the building.
PPE has immense importance in protecting the patients and staff from any risk of cross-infection.
The new SOP guidance requires dental professionals to wear the following PPE:
The guidance is changing and evolving constantly with new evidence surfacing; however, it will be a while before we can go back to the ways we have practised before. Some of the new protocols will likely stay in place for a long time to come.
The dental teams are working very hard to make sure all the patients receive the care they need as soon as possible.
However, all the dental practices have long waiting lists of people because of the lockdown phase.
Rest assured behind all that PPE there are the same compassionate, committed and caring dental team members, who are passionate for patient care.
Even if you can’t see it, we are smiling at you and we are working hard to make your visit as safe and as pleasant as it can be!
By Hajnalka Takacs (qualified dental nurse and oral health educator).
N.B.1: The information in this article is based on the measures put in place in dental surgeries in England (which can vary slightly from practice to practice). Dental practices in other countries may have adopted different safety protocols to minimise the risk.
N.B.2: The author confirms that the content of this article is created solely for educational purposes. The content is for non-commercial use only, and in no ways the author has gained any financial benefit from the platform it has been uploaded to or from any of the companies mentioned in the text of the article.