Two Weeks after Dentists Re-Open, What’s the Reality for Patients?

After a long period of closure, dental practices in England were given the green light to resume operations on 8th June. Scotland and Wales followed suit on 22nd June, while dentists in Northern Ireland are allowed to re-open from 29th June.

But don't expect to be able to stroll into the waiting room, flick through some old magazines and then receive whatever treatment you need. Dentists are open, but with a number of restrictions in place to protect staff and patients as the COVID-19 pandemic continues.

If you have an upcoming appointment, or you're wondering whether to bother making one, here's a look at what to expect when you visit the dentist post-lockdown.

Are dentists open now?

The short answer is that yes, dentists are open now. But certain constraints mean they won't be able to treat as many patients as usual, or in the same way. There's more below on what exactly to expect if you need to visit the dentist while these measures are in place.

Why can't dentists re-open as normal?

In the initial months of lockdown in the UK, most dental practices were forced to close completely. Patients needing urgent dental care were instead directed to an Urgent Dental Care (UDC) centre. There was criticism of the time taken to establish this system, leaving many people unable to access the care they needed, but there are now around 550 of these hubs in operation.

Urgent care centres will continue to treat patients who cannot be seen in a regular clinic setting. The reason why dentists can't resume normal operations is that they are at significant risk of contracting COVID-19 if they treat a patient who is carrying the virus. Dentists must take special precautions with certain procedures, and not every dental practice is equipped to do this.

What are AGPs?

At the heart of many of the restrictions on dental treatment are Aerosol Generating Procedures (AGPs). An aerosol is a fine mist of liquid particles which, when generated during a dental procedure, can contain saliva. Any viruses, bacteria or fungi present in your saliva can easily be transmitted to nearby surfaces or inhaled by other people, and this clearly presents a big risk for dentists while COVID-19 is still present in the UK.

Aerosol generating procedures in dentistry include:

• High-speed and slow-speed drilling
• Air and water sprays
• Ultrasonic cleaning
• Air abrasion and sandblasting

One or more of these are used in the majority of routine and urgent dental procedures, making it difficult for dentists to carry out their jobs safely. They are required to wear special PPE (personal protective equipment) which is proving very expensive. This has sparked some discussion on whether dentists should start applying a ‘COVID PPE levy' to help cover their costs.

Many dentists have been simply unable to get hold of the PPE needed to perform AGPs. This dentist's diary of the first week after re-opening gives an honest account of the struggles practices all over the country are now facing. They managed to treat only 26 patients, compared to 600 in a typical pre-lockdown week. Worryingly, the limitations on the treatments they can perform in the clinic have meant the dentist had to resort to extracting some teeth which, under normal circumstances, could have been saved with a filling or endodontic treatment.

Extra precautions

It's not only in the treatment room that there are drastic changes. A steady flow of patients in and out of the clinic presents numerous opportunities for the virus to spread, so practices will be limiting the number of patients they see and implementing safe distancing measures, as well as ensuring that surfaces are regularly sanitized.

All of this means it takes longer to see each patient and appointments must be more thinly spread. This may make it harder for you to secure an appointment, especially if there is a rush of demand as clinics re-open.

When are dentists open in the UK?

By 29th June, dentists across all four nations of the UK will be open again to some extent. Here's what to expect where you live:

England

Dentists in England were allowed to open from 8th June, although a survey by the BDA found that around two thirds didn't feel ready to open on this date. Around 60% said they would be operating by the end of June, but only 15% were properly equipped to provide a full range of treatment.

Since practices can only see a limited number of patients each day, they will prioritise them according to their dental needs. Only around 8% of practices believe it will be financially viable to operate on this basis without government assistance.

Scotland

Dentists are allowed to open for urgent care not involving AGPs from 22nd June. A statement from the BDA warned of “financial oblivion” for dentists in Scotland due to the combination of higher operating costs and reduced patient numbers.

Authorities have distributed over 3 million items of PPE to dentists around the country, but this will only allow practices to treat around 10 patients per day.

Wales

A statement released by the Welsh Government on 19th June announced that dental practices could re-open from 22nd June, earlier than the previously scheduled date of 1st July. This coincides with the Red alert in dentistry being de-escalated to Amber.

Dentists will be free to provide a wider range of treatments to patients if they are equipped to do so safely. However, they will prioritise those needing urgent care.

Northern Ireland

Dentists in Northern Ireland are re-opening in a phased approach which allows them to provide non-urgent care without AGPs from 29th June. AGPs will follow later from 20th July, although practices who are equipped to safely provide AGPs before then may be fast-tracked from 1st July.

As with the other nations, the expense and lack of PPE is expected to be a barrier to treating patients effectively.

What to expect if you visit a dentist

Here's a summary of the BDA's current guidance for patients visiting a dentist. Since the situation is developing all the time, you can check for updates here.

• When you call to book an appointment, you'll be asked some screening questions, and these will be repeated when you arrive at the clinic.
• Don't turn up without an appointment, even if you need urgent care.
• If you develop any coronavirus symptoms before your appointment you should call the clinic to inform them.
• You may be asked to wash your hands or use hand sanitizer before entering, and you should wear a mask – or at least be prepared to wear one if asked.
• You should arrive on time for your appointment. If you are early, you may be asked to wait outside to limit the number of people waiting.
• You should keep at least two metres away from any other patients who are present. Some clinics may be operating a strict ‘one patient at a time' policy and others may just have measures in place to keep everyone a safe distance apart.
• If possible, come alone for your appointment, unless you are accompanying a child or a person in need.
• There won't be any magazines or children's toys in the waiting area.
• The dental staff might be wearing more protective equipment than you're used to, and they won't shake your hand when they greet you.
• Your dentist may ask you to use a mouth rinse before beginning your examination.

Keep in mind that not all clinics are able to perform all procedures. After assessing your case, your dentist may need to refer you to an urgent care centre for further treatment. Please be understanding of this and follow their directions, even if it's frustrating that you have to wait longer for your treatment. Your dentist will be able to prescribe pain medication and antibiotics to help in the meantime.

Can I book a routine checkup?

We always stress the importance of regular dental checkups, even if you don't have any concerns about your teeth. Routine checkups and cleanings have been off the table since at least 23rd March when the government enforced strict lockdown measures.

A simple checkup doesn't necessarily involve any AGPs so most dentists should, in theory, be able to perform them. However, they are likely to prioritise patients who are in pain and need urgent care. Treatment slots are extremely limited so in reality, it might be a while before you can visit for a checkup. Also note that you won't be able to get a scale and polish unless your dentist has the correct PPE – and even then, they may want to keep it for higher-priority patients.

Can I get my braces adjusted or taken off?

Current advice from the British Orthodontic Society (BOS) is that orthodontists should perform treatments as allowed by their respective governments. Until now they have only been able to see patients in emergency situations, but now they may be able to start more routine orthodontic procedures like adjusting and repairing braces.

If you're due to get your braces off, the orthodontist may not be able to use a high-speed drill to remove all the bits of adhesive from your teeth. They will do what they can with the tools they have, and the rest should eventually come off as you brush your teeth.

In summary

Allowing dentists to re-open is a step in the right direction, but there's a long way to go before dentistry in the UK gets back to anything like ‘normal'.

If you need to see a dentist, contact your usual practice or some others in your area to see if they can fit you in. If you don't have an urgent treatment need, expect a long wait. Many people have been unable to visit a dentist over the past few months, and are now trying to get an appointment. You can also call NHS 111 if you are having trouble contacting a dentist locally and you need urgent care.

When you do get to the dentist, follow any instructions they give you and be understanding of the fact that they are doing their best to operate in difficult circumstances. These measures are in place to protect you as well as the dental team and other patients. If your dentist can't perform the procedure you need, prepare to be referred to an urgent care centre instead.

For an update on the situation, view this post from November 2020.