4. How can I prepare for reopening?
Practices in England were allowed to reopen from 8 June and so, dentists all over the country have been working hard to prepare their practices to open as soon as physically possible since that date. The Office of the Chief Dental Officer England has published
Standard Operating Procedures to cover a phased transition for dental practices towards the resumption of a full range of dental provision.
guidance from NHS England states that from Monday June 15, dental practices are required to ensure that staff wear a surgical mask when not in PPE to reduce transmission risks.
It also states that if a staff member has been in contact with someone confirmed as a COVID-19 case, whether a co-worker or a patient, and contact with this person occurred while not wearing PPE, they should self-isolate for 14 days following
Test and Trace requirements. Practices are also advised to make business continuity arrangements for staff absence due to self-isolation.
Members can also download our
toolkit for returning to face-to-face care. This toolkit aims to help teams implement the changes needed to gear up to providing appropriate treatments at appropriate times. It provides practical advice on every step of the process, including advice on:
- Infection control, cleaning and PPE
- How best to communicate the changes to patients
- Employee management and training
- NHS contractual arrangements.
Our aim is to support you in the practical application of widely agreed measures, so you can return to face-to-face care with confidence. This toolkit primarily applies to dentists in England, but may also be useful to dentists elsewhere. We also contributed to the FGDP (UK)’s work, so you will see similarities and alignment between the two pieces. We will update this toolkit as more information becomes available.
5. What about practices in Wales, Scotland and Northern Ireland?
Scotland, Northern Ireland and Wales have all confirmed dates on which high street can dentistry can officially resume.
Since 1 July dentists have been allowed to offer more treatments in practice and the criteria for urgent care have been relaxed. Practices can now be at heightened amber status and only offering non-AGPs, or in low amber status and offering AGPs as well, as long as they are set up and signed off by the relevant authority.
To support you in this, we have adapted our
toolkit for members in Wales. It is to be used alongside the Welsh Government’s guidance to help dental teams complete
Assessment of Clinical Oral Risks and Needs (ACORN) forms for patients, both routine and urgent.
Previously issued documents include:
For more information on changes to NHS dentistry in Wales please see
The Department of Health has confirmed the new timetable for dental recovery in Northern Ireland. Phase two, the provision of non-urgent care, will resume on 29 June. Meanwhile, phase three, which includes aerosol-generating procedures, will commence on 20 July.
However, there is a fast track option available. If your practice can demonstrate that key conditions around infection and prevention control are met, you will be able to move to phase three on 1 July.
Dentists in Scotland were allowed to return to routine non-aerosol generating procedures from 22 June. In light of this news, we published our new
Toolkit for Scotland to help high street practices prepare for reopening.
Previously, the National Clinical Director and CDO issued a
joint letter to private practices and Healthcare Improvement Scotland (which is responsible for inspecting private practices) has issued
guidance on reopening. The guidance stresses the importance of patient and staff safety, and of not contributing to an increase in the R number.
The Scottish Dental Clinical Effectiveness Programme (SDCEP) has published a
practice recovery toolkit which all practices in Scotland should use as the basis for re-opening during phase two of remobilisation.
6. What PPE is essential for re-opening?
Dental practices must have the correct PPE available to provide face-to-face care while community transmission of COVID-19 continues. This includes: masks, fluid repellent gowns, show covers, eye protection and gloves.
Facemasks make up one component of PPE. They are used most effectively in conjunction with eyewear, gloves, face shield and protective outerwear. For non-aerosol generating procedures (non-AGPs) fluid-resistant surgical masks (FRSM) Type II are advised and used with the wider PPE measures detailed below.
For AGPs the FFP2 respirator’s greater comfort makes it the mask of choice while providing sufficient protection for aerosols created in the dental environment. FFP3 (filtering face piece level 3) masks meanwhile provide greater filtration and potentially provide some marginal protection compared to an FFP2 mask.
Where, for cultural, religious or health reasons facial hair is present which will affect the seal of FFP2/3 masks, practices should consider as an alternative, the use of an FFP2 mask with a Type II fluid resistant surgical mask over the borders, in conjunction with a face shield/visor. A through risk assessment needs to be implemented at a local level if this suggestion is adopted. Another alternative is the use of a powered air purifying respirator (PAPR) hood. This does not require any fit-testing but wearers may have difficulty using loupes and other aids.
However, there’s more to PPE than masks. For more information on PPE and returning to face-to-face practice
see our toolkit.
7. How can I obtain PPE and book fit-testing?
Some dentists are having difficulty securing a reliable and affordable supply of PPE. We’re also concerned by reports that dentists are having difficulties securing an appointment for fit-testing.
The Office of the Chief Dental Officer England has said that PPE for dentists is available from dental wholesalers for practices to purchase. This should include equipment necessary for aerosol generating procedures (AGPs) including gowns or coveralls, and FFP2 respirator masks.
The HSE website has advice and
training materials on fit-testing respirator masks.
Fit-testing is required for FFP2/3 masks to determine if a particular size or model provides an acceptable fit for each team member who will be wearing them. It needs to be conducted by a trained fit tester to verify that the respirator device performs as intended.
nationwide directory of fit-testers and
list of approved training providers .
8. What if my staff do not want to return to work?
We recommend that you communicate with staff in an open and cooperative manner at this difficult time.
Health and Safety at Work legislation says to take reasonably practicable measures to ensure staff safety. To that end, we recommend you have clear rules on how dental practices should operate in place. Members can download our
toolkit on returning to face-to-face care for support and advice.
If you have taken these steps and clearly communicated them to your staff, but they refuse to return to work, then you may be able to consider disciplinary action. We advise members to take advice before taking any disciplinary action as employees may have legal protection.
If employed NHS staff do not wish to return to work, see
question 21 below for more information.
9. Should I screen staff for COVID-19?
We recommend you consider implementing a daily health screening check point and log for all employees entering the workplace. Our
daily screening log can be used to document this. Dental staff should pay special attention to their own symptoms and stay home or be sent home immediately with symptoms of COVID-19 (fever, cough, sore throat, headache and muscle soreness, which may be accompanied by nasal symptoms).
This is one of the many steps we recommend practices take to ensure they are operating as safety as possible for staff and patients. Members should see our toolkit on returning to face-to-face care for a comprehensive overview of the practical steps we recommend.