Extraordinary Times

By Dr Andy Healy, Pall Mall Dental

Many of you reading this may have had your dental appointment cancelled or postponed recently because of the current Covid-19 pandemic.

I thought I would take this opportunity to explain the reasons why dental clinics across the UK have had to make this tough decision.

Last week many of us in the dental profession instigated additional procedures in order to reduce the risk of Covid-19 being transmitted to our staff or patients.

Initially these were intended to postpone non-essential appointments such as check-ups, as well as any patients deemed at high risk or serious complications if they caught Covid-19. By reducing the number of appointments, we hoped to reduce footfall through the clinic whilst allowing the clinical staff more time to ensure greater disinfection of each surgery between patients.

We already have some of the most rigorous cross infection controls in healthcare given every patient could be an unknown carrier of an infectious disease.  By adding further disinfection of both clinical and public areas within the clinic several times per hour, and combining pre-appointment screening of patients for symptoms, we hoped this would allow us to continue providing care to our patients, albeit with a reduced appointment schedule.

On Friday 20th March the Department of Health updated their Standard Operating Procedures for Primary Dental Care which recommended dentists reduce the amount of Aerosol Generating Procedures (AGP) to as low as possible. This was followed by the Chief Dental Officer also recommending that only severe dental emergencies be treated, and not on anyone exhibiting Covid-19 symptoms (fever above 37.8°c and new dry, cough).

But why are AGPs such an issue?

The high-speed dental drill we use is powered by compressed air and cooled by water that are both ejected at high velocity out of the drill and onto the tooth as it is operated on. This high velocity spray combines with the patient’s saliva to create an aerosol that is liberated up into the surgery atmosphere. Over the next few hours this aerosol lingers in the air and eventually lands on every surface. 

This consequence of our drilling procedures has always been known and our cross infection controls include wiping down every surface with potent disinfectants in between patients.

However, in the last week or so there has been new evidence about the Covid-19 virus that ultimately changed our profession’s view on the risk posed by these AGPs.

Some of you may have read about the Italian Authorities attempt to control the virus spread in a town called Vo by mass testing, contact tracing and isolation. 

The significant piece of new evidence that came from this endeavour was that after testing 3,300 people, 6 tested positive but had no symptoms and would be able to spread the infection.

With an aerosol containing virus particles lingering around in the air of the surgery for several hours this worrying evidence that people with no symptoms could be spreading the virus led to a swift decision to abandon all operative procedures.

To every dental practice this is a crushing blow to our businesses’ ability to thrive and move forward but had to be done for the protection of our staff and our patients.

In our clinic we have postponed everything for 4 weeks, reviewing the situation almost daily in response to the developing situation.

So if your dental appointment has been cancelled this week there are very good reasons why your dental practice has taken these extraordinary measures.

For we live in extraordinary times.

Finally I wish everyone a swift and healthy end to this unprecedented time and remember please, Stay in, Protect the NHS, Save lives.