By Dr George Druttman

It is no secret that the UK’s response regarding the provision of dental care during the Covid-19 lockdown has been woefully inadequate. To date, a lack of clarity and direction from the dental governing body has resulted in serious confusion for both practitioners and the general public.

So, how does the UK’s response compare to other countries. Below is a brief summary.

UK

All dental practices (both NHS and Private ) were told to close fully as of Monday, 23^rd March until further notice. ‘Urgent Dental Care Centres’ (UDCC) were meant to provide emergency treatment as they allegedly were supposed to be equipped with appropriate personal protection equipment (PPE) to protect staff and patients.

Practices and UDCCs were supposed to carry out e-consultations prior to referring or accepting patients for treatment. It seems that clinical treatment is limited to non-aerosol generating procedures and so for dental pain (when antibiotics are not sufficient) the only treatment is tooth extraction (as opposed to tooth ‘saving’).

Meanwhile, six weeks into the lockdown, it is almost impossible for dental practitioners, let alone members of the public to find the location of such centres online. Here in central London, I know of two London Hospitals that are supposed to provide urgent dental care. How did I find them? I looked on the internet!

Stories float around in the press of a woeful lack of these facilities,  lack of PPE and funding as well as the inevitable report of patients in pain having to do their own emergency dentistry (shades of the Dark Ages!) Some practices do provide online consultations, and some don’t. There is a very limited amount of help one can give a patient in dental pain over the phone. The government guidance for both patients and practitioners is confusing and ineffective.

Australia 

Australia has had a very measured, well thought out and executed response. From the outset there has been an abundance of clear protocols available electronically, offering support and guidance to practitioners. This has been led by the Australian Dental Association closely advising the Government. From the start there has been sufficient PPE for dental practices which were allowed to see patients on an emergency basis, even allowing for more complex procedures (such as root treatment and repairing fractured teeth).

Germany

The response was managed at regional, rather than Central Government level, without an overriding order to close dental practices. Very clear practical clinical recommendations were provided to dental practitioners early on by the German Dental Chamber of Commerce.

The early mass testing of the population has facilitated identification of Covid-19 individuals and so any of those requiring emergency treatment were able to be treated appropriately.

Dental care is an essential service and as such, needs to be taken seriously during such a crisis.”

France

Dental practices in France were shut down a week earlier than in the UK. These are set to re-open on May 11^th . Specific guidelines and protocols for treatment and case selection have been  provided to dentists . Dentists will be able to provide treatment to all patients , although different protocols will apply to those with symptoms or those who have had close contact with Covid +ve individuals

Italy 

Dental practices were advised to cease all routine dental care but to remain open to provide emergency services only. General protocol and specific guidelines have been provided to practices by the Italian Dental Council for an expected increased dental practice easing of lockdown expected from May 2^nd. Testing on any suspected Covid-19 cases should be done and any patients that show symptoms or have been in close contact with someone who does, would not be treated in general practice and, if possible, have treatment delayed.

Denmark

Dental practices were ordered to cease providing routine care in mid-March and instructed to provide emergency treatment only. On the 22^nd April these restrictions were lifted although additional ‘protective’ measures have been recommended. In-surgery testing has been introduced to identify patients not at risk (Covid-19) for such normal treatment.

China 

China very quickly introduced the setting up of local clinics and departments within hospitals and dental schools, with no apparent shortage of PPE. These emergency treatment centres provided tele-dentistry (online/telephone consultations) and continued to provide a fairly comprehensive range of dental services, including root canal treatment.

In conclusion:

• Most countries have had much earlier and clearer advice from and co-operation between the professional dental body and Government than the UK.
• The majority of countries have allowed dental practices to provide emergency only treatments to the general public during lockdown, albeit with enhanced additional PPE.
• Several countries have identified and advocated the use of testing of individuals before being seen in the general dental practice setting.

What is blatantly obvious that, in contrast to the UK almost all countries have taken the stance that dental care is an essential service and as such, needs to be taken seriously during such a crisis. To compound this attitude, information, protocols and guidelines to both patients and the profession in the UK is extraordinarily inadequate compared to other countries, resulting in much confusion and inadequate provision of dental care, even at the ‘emergency’ level.