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BELFAST, UK: The SARS-CoV-2 virus has not only brought with it the fear of infection, but has also caused great pain to dental patients who have had limited access to dental care during the lockdown. In addition, it has brought distress to dentists who have been concerned about the sustainability of their dental practices and have sympathised with those patients who have been left in agony. Fortunately, as the number of infections is slowly decreasing, dental professionals are resuming their practices in order to address the oral health needs of patients; however, many remain fearful of the business challenges that lie ahead of them.
Owing to the pandemic and the subsequent closure of dental practices worldwide, patients have had to delay their dental appointments, and some have even resorted to do-it-yourself dentistry. To avoid patients taking matters into their own hands, dental practices in the UK and Northern Ireland have recently introduced a gradual remobilisation programme. The phasing in initially began with dental practices offering face-to-face consultations to patients in need of urgent oral healthcare that did not require aerosol-generating procedures (AGPs), but will soon include the provision of dental examinations and non-urgent treatments that do not involve using AGPs.
“Dentists need time to prepare, but PPE remains the elephant in the room”
- Dr Richard Graham, BDA Northern Ireland
Situation in Northern Ireland
On 29 June, dental practices in Northern Ireland will enter Phase 2 of the general dental services re-establishment plan, which will include the provision of non-urgent dental care. Starting from 20 July, dentists in Northern Ireland will also be allowed to carry out AGPs, which constitute the vast majority of dental treatments. Dentists who perform AGPs will be expected to use full personal protective equipment (PPE), which might lead to financial difficulties. According to the British Dental Association (BDA) Northern Ireland, the price of PPE has increased by up to 6,000%, having an estimated cost of £20–£30 per kit. Additionally, the ongoing PPE shortages could interfere with the progress of returning to normal practice.
“We finally have a timetable. Dentists need time to prepare, but PPE remains the elephant in the room,” said Dr Richard Graham, chair of the BDA’s Northern Ireland Dental Practice Committee, in a press release. He added that practices face not only PPE shortages but also major increases in costs for protective kits. He commented: “We can put out the welcome mat, but without access to government supply chains, we will be in no position to treat patients.”
The association is hoping that the government will provide the much-needed long-term financial support required in order to enable dentists to survive the “new normal”, which will manifest itself in reduced hours, fewer patients, social distancing protocols and strict infection control guidelines.
According to BDA Northern Ireland, over 90% of English practices reported that they were struggling to maintain their financial sustainability owing to the SARS-CoV-2 lockdown. To address the issue, the BDA recently launched a petition in which it urged the government to extend the COVID-19 business rates relief to healthcare providers in England.
Gradual reopening of dental practices in Scotland
Dental practices in Scotland are scheduled to reopen this week, from 22 June. Dentists received the news on 18 June, just a couple of days before the scheduled start, and had to immediately make the necessary preparations, such as implementing the Practice Recovery Toolkit and ensuring that practices have sufficient PPE stocks as well as the necessary surgery preparation.
Although dentists in Scotland have welcomed the news, they fear that resuming normal service will bring with it certain business difficulties, namely the financial distress caused by lower patient numbers and increased practice costs. For the time being, practices are only allowed to provide non-AGPs, and the date for routine dental care has not yet been fixed. Despite the government’s recent distribution of more than three million PPE units to dental practices in Scotland, the current PPE supply only allows practices to admit around ten patients daily.
“Practices should never have been left in limbo, but now face even greater challenges as they reopen their doors”
- Dr David McColl, Scottish Dental Practice Committee
The BDA believes that, in order to overcome the present challenges and keep the dental service in Scotland viable, practices will need long-term support from the government. “Practices should never have been left in limbo, but now face even greater challenges as they reopen their doors,” said Dr David McColl, chair of the Scottish Dental Practice Committee, in a statement. “Dentists have been looking forward to welcoming our patients back into our practices, but already we are hearing from colleagues who simply can’t afford to reopen, given the limits of the current government support package,” he continued.
“Without meaningful help, increased costs and lower patient numbers could prove fatal for practices across Scotland,” McColl warned.
For the time being, patients who require dental treatment that involves AGPs should be referred to a local urgent dental care centre.