I would like to thank you, the patients, for your patience and forbearance over the last 9 months and for your understanding and cooperation during what has been a very challenging year for all of us.
I re-opened the Practice following the first lockdown on the 8th of June. Since then we have been offering as complete a service as possible working to the guidance documents issued by: the Faculty of General Dental Practice, Denplan, the British Dental Association, Public Health England and the Chief Dental Officer and the Scottish Dental Clinical Effectiveness Program.
This latest lockdown recognises that dental practices must stay open and has not materially altered the restrictions under which we are operating.
This policy outlines the modifications to our usual procedures that I intend to employ once the practice reopens. It is not known at this time whether the procedures I am putting in place below are temporary or whether they will become a permanent feature of the way dental practices must be run to ensure patient and staff safety in the future. This is likely to be a â€˜livingâ€™ document and to change in line with new scientific evidence over time.
The dental profession has always achieved a high standard of infection control having had to adapt to the challenges of other infectious diseases and the fear surrounding them in the past. There are always adaptations that have to be made and conforming with them gives safety and confidence.
In the Practice our normal cross-infection control protocols against infectious pathogens are already woven into all clinical activity carried out on the premises. A dental practice is already a very clean environment compared to public areas and there is no evidence of COVID-19 transmission occurring in the dental profession throughout the world. Researchers have collectively evaluated all of the updated guidance and observed what measures have been put in place in other countries and we feel that the measures which are outlined in this policy vastly reduce the risk of transmission. Please be assured that all of our staff both clinical and non-clinical will be complying with our updated procedures to reduce the risk of cross infection in both directions.
What this means in practice
Reducing the risk of transmission of Covid-19 in a workplace and clinical environment means effective social distancing or appropriate protection to allow the closer contact necessary for dental care, risk assessments of the health of all those on the premises and of the procedure to be carried out and hand and respiratory hygiene. I understand that patients and staff will have questions about the safety of the practice and so below I have set out the measures we are using to reduce or mitigate the risk of infection transmission.
Due to the coronavirus epidemic different dental procedures currently now require different levels of PPE. The requirement is to use enhanced PPE for certain procedures that generate aerosols like filling and scaling teeth. So for routine appointments that do not generate aerosols we wear facemasks, visors, gloves and aprons. For the procedures that generate aerosols through the use of certain drills and scalers we wear hairnets, full gowns, high filtration facemasks, gloves, and visors. As always the PPE (except visors) is single use and disposed of after every patient.
We may look very different; whilst our masks may make us appear impersonal and distant, please be assured we are still the same friendly team underneath it all! We apologise in advance for the necessary reduction in social interaction that this may necessitate.
The coronavirus is spread in droplets, splatter and aerosols produced by an infected person coughing or sneezing and also by contact with surfaces contaminated with aerosol or contact from hands that have been coughed into. Following a procedure that potentially can create an aerosol the surgery used has to be left â€˜fallowâ€™ and not disturbed while the aerosol settles. There is much discussion about how long an aerosol takes to settle out of the air and the current guidelines give various time spans depending on factors used to reduce the spread of an aerosol and more quickly remove it from a room.
It is difficult for us to carry out some dental procedures without generating aerosols which could be a theoretical source of infection and we obviously wish to keep this to a minimum. Currently the dental literature suggests:
- Our use of our normal high-volume suction reduces aerosol production by over 90%.
- The use of dental rubber dam where possible reduces bio aerosols by a further 30 to 90%.
- Our regular surgical facemasks filter approximately 60% of remaining airborne particles.
- FFP2 and FFP3 masks filter 94% and 99% respectively of airborne particles in both directions (patient to clinician and clinician to patient).
- The use of ventilation and air filtration in the surgeries to change and clean the air more quickly
The fallow time affects appointment booking as a surgery cannot be used while it is â€˜fallowâ€™. This coupled with the extra cleaning that needs to be carried out after this period has by necessity drastically reduced the number of appointments we can offer.
- In order to maintain social distancing as far as we can only one patient is allowed in the reception at any time unless a parent or carer is accompanying a patient. All other family members are asked to stay in their cars or at home. This is strictly enforced.
- The inner front door is kept locked and patients are asked to attend at their appointment time and not earlier.
- The waiting room remains closed for the time being.
- We are trying to eliminate waiting inside the practice and at reception so often we may ring you after your appointment to book further appointments or take a payment. Appointments are made with gaps between to reduce the number of people of people in the building and to allow time for the extra cleaning and paperwork currently required.
- Where you have been used to having double appointments with me and the hygienist on the same day this cannot currently be guaranteed.
- Please try to keep the personal belongings that you bring with you to only the most essential and minimum.
- There is now a screen at reception to protect and socially distance receptionists and patients.
- We are asking for payments by card only if possible; and we kindly request that you avoid cash payments at the reception desk.
- Risk assessment of Covid-19 status: you will be asked questions relating to whether you have tested positive for coronavirus or currently have the symptoms of Covid-19 when we confirm your appointment by phone and then again as you enter the building. Rather like the safety demonstration given to passengers before a plane takes off familiarity breeds contempt I realise this is repetitive if you have had a few appointments but due to the rapid onset of Covid symptoms and to respect the safety of all who use the building we have to keep asking these questions and I ask that you pay attention to the questions.
- The scheduling and confirmation of the appointment will be based on your â€˜riskâ€™ status and the nature of the treatment planned. If we feel there is a possibility of you having been infected, even if you are asymptomatic, we will respectfully request for you to delay booking any appointments with us for 2 weeks and to follow government guidelines regarding testing and self-isolating.
- Please be sensitive to the vulnerability of others to this disease. If you have symptoms do not attend.
- Currently I am recommending that patients in the high-risk groups for developing complications from coronavirus delay any non-essential dental treatment if possible until the trend of this surge becomes clear.
- If you are in a high-risk group and do want an appointment or require treatment we will schedule your appointment at the beginning of the day.
- In some cases I will contact a patient prior to their appointment to assess what procedure I am likely to need to carry out and therefore its risk level to allow us to plan appropriately.
- Currently there is little evidence that temperature testing is reliable in helping to determine the status of a person as someone can have Covid-19 and not have a temperature, so temperatures will not be taken as you arrive. Someone can have a temperature due to a dental abscess.
- The staff (and myself) complete a health risk assessment as they enter the building at the beginning of the day and will be sent home for testing if they display signs of the disease. I have a strict procedure in place to manage Covid-19 among the staff, a member of their family or for if a patient is taken ill on the premises.
Hand and respiratory hygiene
- On entering the building everyone is asked to use the alcohol hand rub in reception, there are other hand rub stations throughout the building and you will be asked to use these
- Facemasks are mandatory in the building, staff wear these continuously and patients remove these only once seated in the dental chair.
- Catch it, Bin it, Kill itÂ signage is posted to remind people of the need to avoid coughing and sneezing over other people, disposal of tissues and hand cleaning after
- For the time being the toilet is to be used as little as possible and I would ask people to 'go' before they leave home. If you do need to use it please inform a member of staff first so that it can be cleaned afterwards. Please do your best to ensure that you leave the facilities as you would expect to find them and wash your hands thoroughly afterwards.
- The hand drier in the toilet is turned off and paper towel is to be used instead.
Arriving at the practice
- You will be met at the door by either me or my nurse - we will be wearing masks, visors and aprons.
- You will be asked the Covid-19 risk assessment questions. If there is any suggestion that you are unwell you will be asked to leave immediately.
- If there are no concerns then you will be given a face mask to wear and then asked to clean your hands with hand rub.
- You will be accompanied directly to the surgery where you will be asked:
- To place your belongings in a plastic box;
- To remove the mask.
- At the end of the appointment you will be asked to replace the facemask, use the alcohol hand rub, collect your belongings and accompany Penny downstairs.
- You can then use the hand rub again if you wish.
This policy will be constantly reviewed and updated as necessitated by circumstances over time. If you have any questions regarding this guidance or about your dental care, please do not hesitate to contact us on: email@example.com or call us 01603 624012.
I thank you for all your patience and hope that this coming year brings calmer and safer times for us all.