Natalie Bradley is a dentist who has spoken about her work in a designated urgent dental care facility in a community clinic in London.
This Easter weekend, I spent the majority of my time in one of the designated ‘cold’ urgent dental care hubs in London.
Patients access the hub via NHS 111, and as the weekend went on, the number of patients with urgent problems escalated. Together with two other dentists and two dental nurses, we did telephone assessments for all those booked in via 111, used the 3As to give advice, analgesia and antimicrobials as appropriate, and booked some patients in for treatment.
Many of the patients I spoke to did not have their own regular dentist, had tried to call a dentist but had been directed to 111 because they were not that practice’s patient. I’m appealing to any dentist who is taking urgent calls right now to please consider helping those who are not your patients. This will reduce the load of the already overstretched 111 call centres.
While our staff have been fit tested for the appropriate PPE to perform Aerosol Generating Procedures (AGPs) if they are absolutely necessary, unfortunately we have yet to receive stock of the masks. This has proved a challenge and some out-of-the-box thinking when seeing some patients who have needed to come into the clinic. For example, a patient with irreversible pulpitis, who luckily, had an open cavity so I was able to do rudimentary extirpation using hand excavators; or a trauma case where in order to place the splint, I resorted to using L-pop acid-etch instead of my usual, etch and separate bond.
The elephant in the room for these patients is where do they go for follow-up and how long will the treatment or advice I give them manage their problem? Usually, I would advise follow-up with their dentist as soon as possible when opening a tooth, or following trauma. But right now that simply isn’t possible and we don’t know when it will be.
Will this end up with more restorable teeth being extracted, or ultimately more true dental emergencies requiring hospital admissions? There has already been a reported case of a hospital admission due a dental issue in a time where we need to minimise people being admitted to hospitals.
It is absolutely crucial that services like ours, who need this PPE are prioritised. It’s not only patient safety at risk, but the safety of our NHS staff and their families.
Until then, many clinicians’ hands are tied with what help they can offer to patients.
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