By Dr George Druttman

Dental practices were fully shut down at the end of March until further notice during the COVID-19 crisis. Why? For the obvious reason that there is no greater high-risk close contact environment than that during a dental examination, magnified even more so during a dental procedure.

Current challenges for patients and dentists

For dental patients the present problems are huge both in terms of availability of emergency and urgent dental treatment, not to mention less urgent or routine care treatments. For dentists there is concern for the viability of many dental practices surviving as businesses when, for an extended period of time, there is no income at all coming in, and no government help with huge ongoing fixed overheads.

How the dental care landscape may change post COVID-19 pandemic?

The prime concern will be to protect clinical staff and patients from possible infection.

• Hygiene and infection control standards: already very high, in dental settings, will need to be elevated even more, with the clinical team wearing PPE (Personal Protective Equipment) such as long-sleeved gowns (to be changed for each patient), more sophisticated respirator masks and full-face visors.
• Rigid patient vetting: potential testing of all patients for viral antigen and antibody status (if that is available) may be required prior to each appointment at the practice. Viral antigen status shows if the infection exists. Viral antibody test will show if the patient had the infection and has developed some immunity.
• Testing of all practice staff: will need to be checked regularly to show patients that they are disease-free. Only when both the staff and the patient are shown uninfected would the appointment proceed.
• Additional infection control measures: wiping down all equipment and surfaces, although done regularly anyway between patients, will need to be more extensive and thorough. This could apply to reception and waiting room areas in addition to social distancing procedures in the waiting areas.

This protocol would likely remain in force until a vaccine is available for everyone and the public as a whole is protected. This may not happen until mid-2021, at which time there would be some relaxation for the need of this level of pep and the routine testing of individuals will no longer be necessary.

Significant burden for dental practices

So, for most of this year after dental practices re-open there will be a significant additional burden on dental practices, all of which, of course, impact the patients.

• Busyness of the practice: for a while practices will be inundated with work as they try to clear an accumulated backlog from the period of total shut down.
• Longer appointments: procedure times are likely to be twice as long, so fewer patients will be seen per day. This may become a huge problem for NHS practices that often see 35-40 patients a day.
• Business costs: unless the personal protective equipment and the tests themselves are provided to the practices free, these will add a very significant overhead for the practice. Even if the government do so for NHS practices, would they also support private practices? The government is not unexpectedly notorious for its lack of concern over the private sector. Will fees to patients, both private and even NHS have to be increased to enable practices to remain financially viable?
• NHS Practice availability: will the government continue to provide NHS dental services, when it is realised that a lot more money needs to be invested in other areas of the NHS? This may put in question the longer-term viability of NHS dental practices and the public’s possible increased need and dependency on private practices.

One thing is for sure: when this crisis is over it may well be a very different social, medical, economic landscape both in this country and around the world.  From now on, the provision of dental care is a field very exposed to radical change.