A new paper published in the British Dental Journal in May 2020 reports on the new ways of partnership between the dental industry and dental professionals, in view of the extremely high risk of aerosol production during dental procedures, to reduce the risk of passing on COVID-19 infection.
The post-COVID-19 situation has led to the almost complete shutdown of all routine dental work, other than emergency care in the UK, as per the government’s advice. Urgent care is being offered at dedicated centers that fall under the NHS England and other centers to which it has delegated such facilities.
In common with other industries, the dental industry has also come to a grinding halt, with no sales of dental materials, equipment of consumables.
The government has taken different measures to help this industry, as with others. Some dental companies have sent many of their workers on furlough, some have put almost all their workers on work-from-home measures, and delayed VAT payments will help weather the recession in the short term. Customers are also finding themselves unable to pay or are offering delayed payments. Others are looking at government-assisted loans to tide over the present crisis.
With no way to predict when normalcy will be restored, many businesses are likely to close down permanently in the dental sector, as elsewhere. However, drastic changes are bound to occur once patient treatment recommences.
The main topics covered in the new paper include:
- Aerosol generating procedures (AGPs)
- The timeline of return to normalcy
- New methods of safe dental treatment
- New business methods
Aerosol generating procedures (AGPs)
The government has advised that the highest risk of viral spread is during any procedure in which upper respiratory aerosols are generated. In such a setting, it is mandatory that all workers involved in such procedures are adequately protected with personal protective equipment (PPE).
Further recommendations have been made on urgent dental care by the Chief Dental Officer. Dental practice includes many high-risk AGP procedures with the small size of the virus particles, at an average of 0.125 microns. This is the primary obstacle to the resumption of routine dental practice.
Some steps that will be inevitable before this happens include widespread testing of dentists, clinical staff, and patients, unless an effective mass vaccine is available before that time, or unless effective ways to suppress or shield workers from aerosols are found.
The Timeline of Lockdown Exit Strategies
Lockdowns can be executed rapidly, but take considerable time and ingenuity to lift without hazarding all the gains won so painfully. The authors predict that routine dental practice will probably not return to ‘normal,’ in terms of the pre-COVID-19 levels, at least until 2020 has passed.
The reason is the probable second peak of infection following a relaxation of the lockdown, which will inevitably follow the fall in infections due to such suppression strategies. The second wave is expected in October 2020, quite possibly, which could lead to a second lockdown or similar measures. This pattern may be repeated, with smaller peaks each time, until a vaccine is available and testing regimens have been honed to offer the best level of protection by carrier identification. This may well persist until the second half of next year, say the authors.
New Safe Methods of Dental Practice
Mitigation will play a key role in enabling recovery of the dental sector. The physical risk due to AGPs can be reduced by using PPE, sophisticated air filtration and decontamination systems, high-speed air evacuation systems, and disinfection/antimicrobial procedures for workers, equipment, and patients.
Not only are these steps costly and complex, making their implementation much more limited in scale and therefore reducing the number of compliant dental practices, but they increase the timeframe of treatment, and reduce the number of procedures that can be carried out every day.
This will have a heavy impact on current dentistry models. However, industrial partnership will become essential to help the profession and industry recover at least in part over the next year. Not only will there be a need to invest in new air-cleaning and product disinfection technologies, but new ways to avoid invasive treatments may be the focus of attention. The greatest challenge will be with respect to orthodontic and endodontic treatments and the provision of dental implants.
New Business Models
The lockdown has given many business owners to step back and review their business structure and methods and provided an opportunity to change as required. Fundamental alterations are bound to occur, including a more cost-effective use of staff, cutting down on office space, and improving work-from-home facilities.
Business travel will also likely see a steep fall as global meetings go out of favor. The same applies to physical interactions since virtual meeting apps are proving their worth in the lockdown situation. The power of modern communications technology is nowhere more obvious than in the way millions of workers can spend their working hours in a reasonably productive manner from home.
Customer-sales staff interactions will also change as new growth strategies and structures emerge, from providing safe access to dental facilities and comparing the worth added by face-to-face rather than virtual meetings.
Meetings and exhibitions are also likely to be significantly reduced to ensure safe conditions for both staff and customers. In fact, many large halls currently used for this purpose have been taken over by Nightingale emergency COVID-19 wards, which means they will require significant time and effort to revert to their old status.
Different trading practices and credit practices may also well evolve as some businesses shut down, and others adapt to lockdown.
International trade practices could also show massive changes as governments look into protecting their economies against future shocks, taking advantage of current shortages to sell strategic goods, and promoting domestic manufacture, service provision, and trade to boost their financial wellbeing.
Looking Ahead
The authors underline the fact that things are unlikely to get back to the ‘old’ normal soon, if ever. Instead, changes will occur in all these areas, driven by the need to avoid the spread of infection. This may lead to the resumption of dental practices at the ‘new’ normal level, accompanied by changes in products, delivery systems, technologies, and treatments, as well as healthcare systems themselves.
