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VIENNA, Austria: It is a matter of urgency that dental practices resume providing the full spectrum of oral care, according to the president of the European Society of Cosmetic Dentistry (ESCD), Dr Florin Lazarescu. The organisation has been documenting the impact that the SARS-CoV-2 pandemic has had on dentistry, and Lazarescu says that dentists have an ethical obligation to resume treating their patients, as well as a personal obligation to keep their dental practices afloat.
A week is a long time in politics, but two months can be an eternity in oral health. Strict public health measures enacted at various stages in March forced dental practices from Russia to Romania to close their doors, except for the provision of emergency care. Now that SARS-CoV-2 infection rates have begun to stabilise in many countries, Lazarescu told Dental Tribune International that the ESCD now considers the reopening of dental clinics urgent.
“Ethically, we are healthcare providers, and our priority is to our patients and their needs,” he explained. “Not only emergency treatment but also interrupted workflow may lead to higher complications and failures. More than this, a healthy oral cavity is the best immune shield and will definitely reduce the risk of transporting pathogenic organisms to the body. Then there is the financial side: we are responsible for sustaining our dental businesses, caring for our teams, saving jobs and—last but not least—supporting our dental technicians and suppliers.”
Would dental clinics be in a position to reopen tomorrow, if permitted?
It is not that simple, according to Dr Violeta Claus, the ESCD’s country chairperson for Luxembourg. “Some of our colleagues—in France, for example—are not able to restart owing to a lack of personal protective equipment (PPE). At the time of our survey, most of our colleagues had not received any PPE from their governments, dental associations or health departments.”
Claus explained that dentists in only five of the 37 surveyed countries had equipment provided to them in the first phase of their respective lockdowns. More materials are now available, but training staff on the implementation of safety protocols, administrative changes and new workflows has to be taken into consideration. “This would need additional preparation time, which will depend on the team size and on the safety protocols that have already been implemented,” she said.
Furthermore, human resources are an essential prerequisite to reopening clinics. Claus commented that “a healthy, motivated and committed team is a crucial aspect for the return to the dental clinic. Routines will now be different, the risk of infection and cross-contamination higher, and with this, there will clearly be a bigger responsibility for the whole team”.
Overcoming the obstacles to restart elective dental treatment
The ESCD has also compiled data on the availability of financial support. According to Lazarescu, even practices located in countries where dental clinics were not forced to close (such as Austria, Belgium, Germany and Serbia) have seen a significant reduction in both patient numbers and revenue. These practices too are facing earnest challenges, including a significant back-log of appointments and elective care.
“ESCD members are now waiting for patients with emergencies and interrupted treatment,” commented Lazarescu, “particularly in endodontics, temporary prostheses, periodontal maintenance, follow-up appointments and the continuation of orthodontic treatment. It will be a challenge to organise the daily schedule with respect to the prioritising of treatment and safety rules,” he said.
Clinics will need to develop a long-term
schedule and plan for seeing patients and providing treatment in the event of a second wave of the virus
According to Claus, further obstacles that clinics will need to overcome are insecurities about the future of dental care for practice owners, associates and staff, and regaining the trust of patients in dental settings. But the financial aspects are looming large. “Many dental practices will also have to overcome a lack of financial resources and difficulties with financial planning and cash flow.” Motivation will be a major part of the battle, Claus continued, and clinics will need to develop a long-term schedule and plan for seeing patients and providing treatment in the event of a second wave of the virus and the associated closures and public health measures that would come with it.
“It will be essential for dental teams to understand the new way of operating a clinic that takes into account all the aspects concerning the different stages of the SARS-CoV-2 pandemic until mass immunisation and/or a vaccination becomes available,” she asserted.
Dental clinics should be involved in testing patients for the virus, Lazarescu said. When asked what advice he would offer to dentists who are currently considering reopening their clinics, he simply said, “In our opinion, they should.”