Reassuring patients in the post-COVID 19 pandemic period
As dentists navigate the after-effects of the coronavirus pandemic with a partial lockdown lifted, there is a lot to draw focus to as financial, social, and professional responsibilities continue to linger. The government having softened the social distancing regulations, has also offered an opportunity for dental professionals to open up their practices with their own clinical judgments.
An article from Dentistry shows the concerns regarding COVID-19 in a survey where it is being reported that almost twice as many patients would delay their routine dental appointments than attending them. They also show that almost 80% of adults think dentists and hygienists will have to work extra hard to reassure patients that their practice is safe and hygienic. This brings up a very concerning time for dentists who wish to reopen but may face several challenges due to the current contemporaries.
How is The UK battling with COVID-19?
The current social climate in the UK suggests that a tremendous improvement has been observed in our battle against COVID-19 and we are successfully now “past the peak” with new cases and fatalities declining gradually every day. We are in the process of “flattening the curve” with the “R” number appearing to be below 1, yet the dental industry has shown a rather different story. In a study conducted in early 2020 by Guo et al on 2537 dental patients, it was observed that the proportion of dental and oral infections increased from 51.0% pre-COVID 19 outbreak to a whopping 71.9% during COVID-19. This gives us a clue that the post-COVID 19 era is to anticipate the drastic rise in the patient demands for dental services.
However, the British Dental Association (BDA) warns that there will be no return to “business as usual” for dentistry short term. A previous survey foretold that 1 in 3 UK adults was expected to visit their dentist less frequently after the ‘lockdown’. This seems to be true as dentists who have gone back to business after the lockdown are seemingly seeing far fewer patients than they had expected.
Reopening dental practices
On May 28, chief dental officer Sara Hurley released ‘return to work’ guidance for dentists in the UK. It incorporates details on preferred patient flow and practice layout that will obey the guidelines for social distancing, hand-hygiene signage, and stringent instructions on hand-sanitization stations to promote excellent hygiene and protection. As per the statement released by the CDO, all dental practices have been allowed to reopen beginning the 8th of June 2020. This, of course, is in consideration with necessary infection prevention and control (IPC) and personal protective equipment (PPE) requirements in place. The CDOs for Scotland and Wales have also unveiled ‘back to work’ guidance with the latter including ‘de-escalation SOPs’ in order to restart primary care services.
According to a survey conducted by the British Dental Association (BDA), just over a third of the practices (36%) successfully opened on 8 June, with only about 15% deeming fit and in a position to offer a full range of treatment. About 60% of practices estimated that in this precocious reopening ruckus, they will be able to treat less than a quarter of the patient numbers they saw pre-COVID-19. This is especially concerning given that “research earlier this year revealed that the NHS in England and Wales was already struggling with issues including lack of access, annual price hikes, and long waiting lists”, reports Which?
How can you as a dental professional reassure your patients?
As dental practices in England begin to reopen, the emphasis is to be put on personal protective equipment (PPE) and enhanced disinfection of rooms and equipment. According to Dentistry, the sequencing and scheduling of patients for treatment as services resume should be inclined with:
- The urgency of needs
- The particular unmet needs of vulnerable groups
- The available capacity to undertake the activity
Dental settings are also recommended to take steps to risk assess their workforce and deploy appropriate actions. Some of the intended protocols set into place that may realistically predict the upcoming nature of dental practices and help resuscitate dentistry in the UK are:
1. Wellness and relationship rebuilding
A lot of patients have been ‘out of the office’ for a long time ever since the lockdown took effect. It isn’t far-fetched to expect that many patients may have had dental complications during this dormant period and have been looking to get treatment for them. However, due to the corona-scare and the undetermined state of dental offices, they may not be aware of or maybe put off by the idea of dental practices reopening.
As a dental professional, it is your job to begin reestablishing your relationship with your patient and reassuring them that you and your dental team are taking proper measures in your office. Send re-opening announcements to your patients to let them know that you have decided to come back to business and that you are following proper protocol for the same.
2. Before the patient arrives
Practices should triage the patients over the phone by taking a complete medical assessment with necessary photographs and of any issue, the patient is currently pursuing treatment for. This virtual triage is an opportunity to update the patient’s medical history, carry out a COVID-19 risk assessment, and discuss potential treatment options. The FGDP guidance suggests sending patients a ‘digital pre-appointment pack’ that may include consent forms to be filled remotely. This allows for face-to-face contact during treatment to be kept as minimum as possible.
3. Patient flow and practice layout
The ‘new normal’ in this post-COVID-19 era demands changes in your dental setting. Stringent control over the patient flow and layout of your practice should be taken into account. Your practice should be arranged to comply with social distancing measures. Measures to separate and minimize patient numbers in practice at any one time should be put in place. This includes the use of Perspex screens on the reception desk to protect the patient and your staff. Also, establishing single entry and exit points for patients and creating select areas for donning and doffing of PPE may help exemplify the social distancing compliant regulations.
4. Communal area
Zonal communal areas with tape spaced in 2-meter intervals is a method adopted by many to promote social distancing. A dental practice with sufficient patient flow should consider fitting physical barriers such as perplex shields to ensure a minimum of 2-meter distancing. Contactless card payments should be set up wherever possible.
Any unnecessary items or accessories such as magazines, toys, or TV remotes should be removed from the waiting areas. Regular sanitization of public-use items like chairs, door handles, and lift buttons should be thoroughly done. A mobile system of hand sanitization for patients may also be implemented. Forms that cannot be signed by the patient remotely should be signed on their behalf.
5. Supplies and equipment
Check stock for necessary items such as PPE and consider the availability of PPE fit-testing. All equipment must be properly sanitized and maintained. Refer to the manufacturer’s guidance, HTMO1-05, and CQC guidance.
6. Staff screening and training
All staff returning to work must be screened. An efficient risk assessment for staff must be put into place to protect and identify potential cases of COVID-19. Additional staff training that includes rubber dam placement, four-handed technique, donning and doffing of PPE and decontamination must be considered.
7. Patient communication and selection
Inform all patients of standard healthcare guidelines that state that a potentially infected patient may not seek dental treatments in a non-emergency facility. A detailed report of patients may help identify and prioritise the patient to be treated. Urgent dental care may be provided to patients who do not show signs of or are not at increased risk of COVID-19.
8. Other considerations
Signage of the rooms within the patient helps the patients and staff know where they can and cannot go. Arrows are helpful to guide the patients into and out of the practice safely without accidentally breaking any social distancing rules. Posters that encourage and explain hand hygiene and social distancing should be put up to create awareness.
In addition to these guidelines, the dental organization Alpha Omega have published a set of evidence-based protocols for the phased ‘back to work’ dental practices titled ‘Returning to Dental Practice: Realistic considerations, practical solutions’, which have been sent to key government officials, England’s chief dental officer (CDO), and major figures in the dental industry. They state that proper downtime in between patients may be helpful in curbing the outrageous spread of COVID-19. Leaving a room to ‘air’ for 30 minutes before wiping down the surfaces is ideal.
Routine dental practices may not return to ‘normal’ until 2020 has passed. Many experts confirm that this state of organized dental office reopening and functioning may be the ‘new normal’ that is here to stay. While we are battling with the “bug”, dental practices are expected to take proper precautions when reopening. ‘A return of high street dentistry will be welcome news to millions of patients left with few options during the lockdown,’ says Mick Armstrong, chair of the British Dental Association. ‘Dentists will be keen to start providing care as soon as safely possible, but we will need everyone to be patient as practices get up and running.’