Supporting dental services during Covid-19
We supported practices to adapt to new ways of working
Like so many professions, dentistry was severely affected in 2020. The vast majority of dental healthcare is delivered in primary care. Very rapidly after the original lockdown in March, most direct patient care there stopped.
Practices had to shift to providing their patients with reassurance and advice by phone only, with particular attention on those who might require referral to a designated centre for care. With its strong reputation for providing dental guidance, our Scottish Dental Clinical Effectiveness Programme (SDCEP) team was keen to support dental practices as they rapidly adapted to these new ways of working.
The role of SDCEP
The initial focus for primary care was to manage patients with emergency or urgent dental needs with a Government directive to follow the three As – Advice, Analgesia and Antimicrobials. In less than a week, we adapted our existing Management of Acute Dental Problems guidance to suit the new circumstances imposed by the pandemic. The amended guidance, published online in late March, was accessed over 20,000 times within the first five days. We also reconfigured our guidance on recommending and prescribing analgesics for pain and, when necessary, antibiotics for infection to provide much needed additional detail.
By mid-May it seemed likely that primary care dental practices might soon begin to see patients in their premises again. We anticipated this, creating a guide to reopening and other tools to help practices to operate safely and with minimal risk of COVID-19 transmission. This ‘Practice Recovery Toolkit’ included a reopening checklist which was adopted by health boards as a means of quality-assuring practices before patients could attend.
Information gathered through surveys and focus groups of patients and dental professionals was invaluable throughout this period. This enabled the SDCEP team to understand what was needed to address the challenges being encountered when creating these resources. Favours from many colleagues were called in to provide input and review, always working within incredibly short timescales. Based on website traffic, the early SDCEP resources were clearly in demand with around 320,000 page views in the first three months after lockdown, over three times higher than the equivalent period in 2019.
Challenges and solutions
There has been huge concern and uncertainty about aerosols as a potential route for COVID-19 transmission. With much of dental care involving use of instruments such as drills and scalers that generate aerosols, this severely restricted the range of treatments that dental teams could provide.
To help address some of these uncertainties, in June we convened a large expert group to conduct a rapid evidence review on the generation and mitigation of dental aerosol generating procedures. The group included not only dental professionals from across the UK but also patient and subject specialists from virology, aerobiology and particle physics. Working remotely, this group considered the limited evidence available and other factors to reach agreed positions on several key issues for practices. We adapted our usual guidance development process to deliver the review in just a few weeks rather than many months.
SDCEP Director Prof. Jan Clarkson said
“The success of all of this work is not only due to the agility and dedication of the SDCEP team, but also the willingness of so many colleagues to collaborate in various ways, completing surveys, providing feedback and those who attended many online meetings. We are so grateful to them for their incredible commitment throughout a very intense period when there were so many competing demands on their time.
“Most recently, the rapid review has now informed important changes in UK guidance issued in October that aims to enable practices to carry out aerosol generating procedures again safely.”
Writing documents alone is unlikely to adequately change or improve clinical care. Colleagues within NES’s Dental Directorate have used our publications and other national sources to develop a series of webinars. These have helped thousands of dental professionals to understand and implement the new ways of working that are needed.
Controlling dental aerosols and understanding their potential as a route for COVID-19 transmission is still the subject of intense research. The aerosol generating procedures rapid review is a living document. Going forward, we will continue to monitor the available evidence and update the review for use in guidance in the UK and further afield.
With dental healthcare unlikely to return to the way it was before COVID-19, the SDCEP team also expects to continue to adapt to changing demands for support of the dental profession as it evolves in the months and years ahead.
About SDCEP and our COVID-19 resources https://www.sdcep.org.uk/
January, 01 0001