The war between Dentistry and COVD-19

Learn how the pandemic has caused an impact within dental clinical care.

Note: words formatted in bold can be found in the glossary.

The Covid-19 pandemic has had widespread implications. The healthcare profession was poised at the forefront, dealing with the ever-evolving nature of the virus and the pressures it placed on its staff and services, whilst endeavouring to provide all patients with the best standard of care at all times. This period of time left the dental profession almost forgotten in spite of constant communication between health professionals on how best to continue practising dentistry whilst the pandemic continued to evolve. This placed stress and demand on dentists and governing bodies, as well as the confusion regarding how to treat patients in a COVID safe manner. This was partly due to the delayed guidance and advice given to the dental profession due to the excessive pressure that was already placed on the NHS. The Impact of COVID-19 on Dentistry The pandemic has impacted dentistry in many different ways.  

Methods of transmission in a clinical setting.

This means dental professionals are a very high risk group in terms of exposure to and transmission of the virus. For instance, dental instruments such as the dental drill, use high speed gas to rotate with running water. This generates aerosol mixed with patient saliva and blood. As coronavirus is an airborne virus, it can be transmitted from the patient to the dentist through the aerosol generated.

Additionally, once a dentist has performed an AGP (aerosol generating procedure), they need to leave the room for “fallow time” , which allows the air to settle so that the room can be cleaned for the next patient. This significantly reduces the number of patients that can be seen and creates more stress for the dentist because they have to ensure the thorough cleaning of the dental office.

Proper PPE (personal protective equipment) also needs to be worn for AGPs to be performed to keep both the dentist and patient safe. This has resulted in increased operating costs for practice owners due to equipment and PPE to manage the aerosol in the room. It is also difficult to acquire the PPE, such as the FFP3 mask due to the cost.

FFP3 Mask

 With patients also wearing masks for their appointments and only removing for the check up/ procedure, communication and building rapport has become harder. It has also been difficult for dentistry to provide follow up care and emergency dental care. The pandemic has inevitably impacted dental patients. Patients were unable to see their dentist for routine check-ups since dental practices closed in March. As a result, they may have more severe pain or treatment needs – this increases short term stress and anxiety for patients coping with these issues at home.

“Several dentists offered me the treatment as a private patient stating that they would need either a deposit or payment upfront, but no one would help my husband as an NHS patient.

-Samantha

Dental practices were forced to close for extended periods of time. Even with them open, having the appropriate shielding measures in place was crucial to practise dentistry. Many patients were also cancelling their appointments in fear of contracting the virus. Statistically, dental practices were running at 20% of their original capacity. This raised financial issues for practice owners, because of AGPs and PPE, and the potential worsening of undiagnosed problems. Upon dental practices reopening, patients have had to wait longer for appointments due to the backlog because emergency patients are prioritised. Urgent dental care hubs were set up in April 2020, which reflects the potential decline in dental health due to emergency treatment and pain relief requirements.

Rubber dam used to isolate single/ multiple teeth from the rest of the mouth to reduce aerosol generation

Telephone and video consultations were also introduced to pre-assess patients to determine whether a face to face consultation was needed. This helped to limit the amount of unnecessary contact between the dentist and patient. Here, an AAA triaging system was used- Advice, Analgesics, Antimicrobials. Although it was difficult to correctly assess a patient at times, the use of these systems has also had its advantages. It can, therefore, be argued that COVID has accelerated the use of technology within dentistry.

Finally, the impact on dental students can be easily overlooked, but is nevertheless important. Dental education has been affected with the suspension of face to face teaching and transition to online teaching, which may cause uncertainty and anxiety surrounding dental students gaining sufficient experience in dental procedures and meeting treatment requirements. Alterations were also made to the curriculum to accommodate the missed teaching. The multiple lockdowns resulted in clinical experience time reduced due to not being able to see a patient for months. Dental students have had to suffer a lack of socialising that accompanies university life – adapting to this new way of living has impacted mental health. With lectures moved online, there have been a lot of rules and guidelines to get used to.

Lots of people are aware of the impact that COVID-19 had and currently is having on Medicine and other sectors of the economy, but the detrimental impacts it has had on dentistry has not been talked about as much, in comparison.  The picture that is emerging is one where access to dental services has been severely limited and the time needed to recover them will be significant, where uncertainty continues about what services are available to the public and patients, and where some sections of the population are either unwilling or unable to access oral health care services.

Summary

Glossary

TermDefinition
AirborneTransported through air.
AGP AGPs are defined as any medical or patient care procedure that results in the production of airborne particles – known as aerosols. This procedure is commonly used in dentistry.
PPEPersonal Protective Equipment – worn by individuals to prevent the transmission of viruses (e.g. masks, disposable gloves)

All rights belong to their owners: initial content made using Adobe, before modification to publish on this webpage.

Pictures belong to Adobe.

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