frequently asked questions answered – Dentistry Online

With lots of speculation floating around dentistry about COVID-19, Priya Sharma answers some frequently asked questions.

It has been an unprecedented and surreal year as the world faces the powerful COVID-19 pandemic. The impact in the field of dentistry has been profound.

COVID-19 has become part of our new normal. As such we must adapt our professional lives accordingly. We have been overwhelmed with an abundance of guidance and regulations that have often been vague, in turn creating an infinite amount of questions. In this brief article, we outline practical answers to the questions you have been asking.

How many COVID-19 cases have been reported in the United Kingdom?

The total number of lab-confirmed cases of COVID-19 was 301,555 at the end of July. Sadly 45,961 have died as a result of coronavirus. The highest amount of deaths is in England at 41,360. Clearly this paints a bleak picture. For current statistics you can log onto the following website coronavirus.data.gov.uk.

What are the symptoms of coronavirus?

The symptoms of coronavirus are:

• A high temperature
• A new, continuous cough
• A loss or change to one’s sense of smell or taste (anosmia).

Do I screen members of the dental practice for the above symptoms?

Yes, it is a good idea to screen the dental team upon arrival to the practice. If they have any one of the above symptoms, then they should use a face mask and leave the practice immediately. They should then seek testing.

You can book tests via nhs.uk/coronavirus. They should self-isolate for 10 days if their test is positive or they are experiencing symptoms.

What if a member of the practice is living with someone or been in touch with someone with COVID-19 symptoms?

In this case the member of the practice must self-isolate for 14 days from the day of onset of symptoms in their household member.

How does NHS Test and Trace work?

NHS Test and Trace service will alert you if you have been in close contact with someone who has tested positive. They will then advise what to do.

Often they will tell you to isolate for 14 days from your last contact with the COVID-19 positive patient. If you develop symptoms then you should seek testing.

Should dental practices screen patients before attending the appointment?

Yes, absolutely. It is best to screen patients for coronavirus symptoms if they have been in touch with a suspected COVID-19 person or someone in their home is isolating.

You should do this prior to arriving at the practice and then double check when they arrive at the practice.

Can patients receive routine dental care?

We can offer all dental care, including routine care, to patients. However, you must ensure you have the correct PPE and infection control procedures in place.

Can we carry out aerosol generating procedures (AGPs)?

Dentists can carry out AGPs if they appropriately risk assess beforehand. Also, ensure you have appropriate PPE and infection control procedures in place.

Can we carry out AGPs in a windowless surgery?

Avoid procedures that generate aerosols in windowless surgeries and those with windows that you cannot open. If there is additional mechanical extraction ventilation, then you can generally carry out AGPs in that surgery.

For confirmation you may want to contact a heating ventilation and air conditioning (HVAC) engineer.

Are there any concerns with using the air conditioning?

Air conditioning in dentistry is receiving a lot of attention. However, the bottom line according to the Health and Safety Executive (HSE) is this:

‘You can continue using most types of air conditioning systems as normal. But, if you use a centralised ventilation system that removes and circulates air to different rooms, it is recommended that you turn off recirculation and use a fresh air supply.

‘You do not need to adjust air conditioning systems that mix some of the extracted air with fresh air and return it to the room. This increases the fresh air ventilation rate. Also, you do not need to adjust systems in individual rooms or portable units. These operate on 100% recirculation…’

What are the current fallow times?

Dentistry requires no fallow for non-AGPs. Currently a 60-minute fallow is required post-AGPs. Be mindful that the fallow commences the moment the dentist stops the AGP. Not when the patient leaves the surgery.

There is anticipation in the coming weeks of further fallow guidance. It is the hope that there may be a reduction in the fallow period and also clear guidance on mitigation.

How can we reduce the fallow time?

There has been a huge influx of machinery inundating the dental market proposing to reduce the fallow time. This includes air purifiers, air cleaners, HEPA filters, ultraviolet irradiation, fogging machines, etc.

Most of the studies have been carried out by the companies themselves. There are no large rigorous studies. At this time there are no accepted quantification of how much machinery or high-volume suction or rubber dam reduces the fallow time.

If a dentist decides to reduce their fallow time they should properly risk assess. Demonstrate how they arrived at the new fallow period and retain any supportive documentation.

Where should I don and doff my PPE?

Ideally practices should use separate rooms/surgeries to don and doff PPE.

The dental team are able to don in a clean surgery before the patient arrives. They can doff PPE after the procedure in the surgery, except the face mask and eye protection. Teams can consequently remove these outside of surgery and dispose of them appropriately.

How long will all of this go on for?

Oh the power of a crystal ball…unfortunately it is challenging to predict.

The first confirmed UK case was on the 31 of January. Today the presence of COVID-19 is still very much present and continues to pose a very real threat.

Research is ongoing for the search of a vaccine but this is still yet to come. In the interim, we should take a holistic approach implementing all guidance in the practice for the safety of yourself and your patients.