Dr David Johnson reflects on the progress made on Urgent Dental Centres and the response of dentistry in Wales to COVID-19.
During this hazardous and difficult time, I’m proud to see dentistry in Wales pulling together with the Health Boards to ensure that patients with urgent dental needs are able to receive the treatment they need.
Guidance from the Welsh Government has been prompt and helpful. Clinics were identified quickly. Where works were needed, to ensure these clinics were able to treat patients safely, renovations were quickly carried out.
Wales moved fast to protect patients
Urgent Dental Centres (UDCs) have now opened in each of the Health Boards in Wales, and are seeing patients with swelling, trauma and bleeding.
A map of the Urgent Dental Centres in Wales
E-referrals and thorough planningIn Wales COVID-19 E-Referrals are being used. It is key to the success of this system that general practices remain accessible to their patients to give appropriate advice and triage for dental emergencies. Patients without COVID-19 symptoms may still access their general practice for non-aerosol generating procedures, such as a simple dressing or extraction, should the three A's not provide sufficient relief.
Once the triaging of calls has taken place, a patient is offered an appointment at the UDC if they meet the referral criteria. Following this, the dental team discuss the case and the likely treatment procedure, so that we can plan what surgical equipment and materials will be required. This is similar to how we conduct a briefing in theatre prior to each list and something we adopted in my Special Care Clinic many years go; it helps the day run smoother with minimal unplanned events.
During the conversation over the phone with the patient, we discuss the provisional diagnosis and treatment plan. This helps to limit the amount of chair side time and thus viral exposure time for the dental staff. You should do as much in advance as possible, to make the most efficient use of your clinical time in full PPE. We are currently estimating 90 minutes per patient, including time for any aerosols created to settle prior to decontamination of the surgery.
New habits and ways of working
PPE is key to infection control, and the PPE you wear is determined by each UDC protocol, however, you'll need to know how to put it on. I recommend this handy video guide to donning PPE. Follow local guidance for decontamination of the clinical environment depending on whether or not aerosols were used. After the clinical encounter, you'll need to remove your PPE safely. Again, here's a video guide to doffing PPE.
But there's a lot more to working in a UDC than simply learning how to wear the gear. You need to prepare properly for your shift and be ready for a new post-shift sanitisation regime. Read these tips on how to work in an Urgent dental Centre for an explanation of why you need to bring clean pillowcases (no, really!), why you may not need your loupes and why hydration and footwear are so important.
Reflecting on progress to date
I'm proud of the work my colleagues have done and are now doing every day in these Urgent Dental Centres. The CDS in particular have really stepped up in what are very difficult circumstances. As Manolis Roditakis, COVID-19 lead for Hywel Dda Health Board and a dentist working in a UDC, says "in the past 2 weeks, we have been able to provide a safe and efficient urgent dental service, both for the patients and the dental team." This is excellent progress. Like me, Manolis is grateful "for the hard, ethical and professional work everyone in the CDS is putting on during this pandemic." The service may not be perfect, but we are in the midst of a national crisis and I think it's important to recognise the progress we've made on putting patients, their health and their safety, first.
I know many dentists in England are particularly concerned about the delay in setting up UDCs. Half of the planned UDCs in England have so far been opened. I empathise with dentists in England who are frustrated that their patients are not able to get the urgent care they need. As dentists, all we want to do is what is best for our patients.
Dr David Johnson
Chair of Welsh Committee for Community Dentistry