Most dentists are open again now but services are still limited due to COVID-19 restrictions.
NHS dentistry will likely operate as an emergency and urgency only service for the foreseeable future.
Closure of dentistry
In light of the pending pandemic, the Chief Dental Officer of England initially suggested dentists should see fewer patients. She eventually managed the risk of transmission of COVID-19 in dental practices by instructing them to close. So on 25h March 2020, dentists ceased all face-to-face appointments and switched to operating a telephone triage service.
Over the following weeks and months, a new Urgent Dental Care hub system was set up in each region of the country. Appropriate protective equipment (PPE) was delivered to a small number of practice to enable provision of emergency and urgent dental care on a referral only basis.
Reopening of dental practices in England
On the 28th May 2020, the government suddenly and clumsily permitted dental practices in England to reopen from June 8th 2020. The Chief Dental Officer of England quickly acknowledged the need for adequate PPE and updated infection control procedures.
Poor planning and management by the government and NHS England, combined with the very short notice given for dental practices to reopen lead to difficulties in the supply of PPE. New NHS guidance on infection control procedures was released only a few days before dentists were expected to reopen causing further delays in preparation.
Despite the poor management of the situation by the government and NHS England, most dental practices have managed to quickly reopen on an emergency and urgency only basis.
The risk with COVID-19 and dentistry
Unlike most other infectious diseases, it is feared that COVID-19 may spread between people in tiny particles of water called aerosols. Aerosols may be generated by common dental procedures such as drilling, scaling/cleaning, blowing cold air and water, and even by coughs and sneezes.
Larger splashes and droplets of water tend to fall to the floor and can be easily cleaned away between patients. The much smaller and lighter aerosols can stay in the surgery’s air for around an hour – until the air in the room is changed.
All dental practices carefully screen all patients to help avoid patients with COVID-19 symptoms from attending the surgery. It is known however, that some patients who are infected with COVID-19 do not display any symptoms. It is thought that these asymptomatic but infected patients may still have the virus in their saliva. Dental treatment on these patients could generate aerosols containing the virus and potentially infect the following patients and staff.
COVID-19 Risk management in dentistry
While it is not possible to eliminate the risk associated with coronavirus in dentistry, this risk is currently being managed by:
- operating a telephone triage service and booking face-to-face appointments only when necessary
- vastly reducing the number of face-to-face appointments each day, and asking patients to attend alone to help social distancing
- use of appropriate PPE
- avoiding aerosol generating dental treatment where possible
- leaving a ‘fallow time’ of 1 hour after any aerosol generating procedure to allow the air to change
Affect on capacity
The 60 minute fallow time is having a devastating affect on the capacity of all dental practices to provide dental treatment. It means most practices will have a waiting list to provide aerosol generating treatments.
Most surgeries will only be able to see 2-5 patients for aerosol generating treatment per day. This is compared with a normal pre-coronavirus day of 20-40 patients.
How and when to see your dentist
Most NHS dental practices will be prioritising dental emergencies and urgencies. You may have to wait for routine treatment, but emergency and urgent appointments and advice should be readily available.
If you are already registered with a dentist then the best way to find out how and when you can and should see your dentist is to check your dentist’s website for more information.
If your dentist does not have a website then you should call them and ask instead.
Do not attend your dental practice without first having booked an appointment. All dentists are still operating a telephone triage service to book appointments. You will not be permitted to walk-in or sit-and-wait.
Emergency and urgent dental treatment
Routine dental treatment
If you are not registered with a dentist already then you should search for a local NHS dentist. Be prepared that you may have to travel further than you would like due to. The restrictions in place to help manage the risk of COVID-19 have reduced the capacity of dental practices so that most do not have the spare capacity to accept any new patients.
Dental practices are not restricted by catchment areas so you can register with any NHS dentist accepting new patients. You can also register at more than one practice. So should a more conveniently located practice start to accept new patients in the future, it’s fairly easy to register again.
Registering with a new NHS dentist takes time and so is usually only suitable when you need routine treatment. If you require emergency treatment you should read our guide on how to access a NHS emergency dentist near you.