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Dentists call for roadmap to ease COVID restrictions

One year on from the resumption of face to face care in England, the British Dental Association has called on the four Chief Dental Officers to collectively commission the respected Scottish Dental Clinical Effectiveness Programme (SDCEP) to develop a roadmap for safe relaxation of current restrictions currently limiting access to dentistry across the UK.

Practices across the country are continuing to operate at a fraction of their pre-pandemic capacity to meet infection prevention and control (IPC) guidance, with an estimated 30 million appointments now lost since March 2020 in England alone.

In a message to the CDOs of England, Wales, Scotland and Northern Ireland, the BDA has stressed that SDCEP is now best placed to review any new scientific literature and also assess the wider prevailing conditions, and produce recommendations for IPC de-escalation that are founded on the best available evidence but also take into account expert views of a safe yet pragmatic way forward for dentistry.

The BDA has said this review should include but not be limited to:

Community infection, transmission and vaccination rates, as well as the threat posed by emerging variants of SARS-CoV-2.
The relevance of AGPs to COVID-19 transmission. Evidence is accumulating that infective aerosols arise principally from coughing by COVID-positive patients, with medical interventions posing a relatively very low risk. This suggests that high-level PPE might not be necessary in dentistry except for the treatment of patients known or considered likely to be infected with SARS-CoV-2.
The range and impact of international dental Standard Operating Procedures (SOPs). A comparison of dental guidance from around the world was compiled by Cochrane in May 2020, but the pandemic has progressed since this publication and IPC practices will have evolved. More information should now be available on any transmission of COVID linked to dental settings.
The impact on poor oral health and inequalities. We will see the impact of limited access to care, the suspension of dental public health programmes, poor lockdown diets and altered oral hygiene habits. The demand for dental services and the number of high-needs patients are therefore likely to be greater than before March 2020.
Missed or delayed diagnosis of oral cancers across all UK nations as a result of reduced access to dental services.
Dental antibiotic prescribing remains elevated relative to 2019 levels. Timely access to urgent dental care, which is currently impeded by IPC requirements, is essential for dentistry to play its part in averting a further global health disaster due to antimicrobial resistance.
The impact of the current IPC requirements on the dental workforce. 47% of dentists in England are likely to leave the profession in the next year if existing SOPs remain in place, with a similar proportion intending to reduce their NHS commitment. Such an exodus would have a devastating and long-lasting impact on already inadequate levels of access.
Patient triaging and waiting arrangements. These key factors impact on patient flow and therefore on capacity.
The BDA has underlined the need for clear and consistent guidelines and public communications alongside practical support to underpin a safe de-escalation of IPC requirements across dentistry.

BDA Chair Eddie Crouch said:

“It’s a year since face to face care resumed in England, but the restrictions we work to remain largely unchanged.

“So today we have asked all four UK Chief Dental Officers to begin work on a roadmap to ease restrictions.

“The risk we face today from the virus needs to be balanced against the millions unable to access care, and threats to the very sustainability of this service.

“It is time to let the experts weigh up the risk of COVID transmission with the dangers of prolonging the status quo. We know this issue is already high on the official agenda but patients and the profession deserve clarity on the way ahead.”