OT: Dentistry

I received the following by email. It may be helpful for some.

The tldr version is to try to get antibiotics if you have a problem, and put up with it if possible, as the likely treatment at an urgent care centre is extraction. Essentially, dental care has gone backwards 500 years at the moment.

"I think that you will find that all dental practices are closed by order of Government. The reason is simply because Government has signally failed to provide proper PPE to practices, completely the opposite of what the Secretary of State for Health said about two weeks ago when he claimed that umpty gazillion pieces of PPE had been distributed to dental practices. On the basis of that claim I had two staff go to my practices to see if boxes had been left outside. It was a pointless gesture...

Care for patients in practice is current being offered by phone only on the basis of the three As; Assessment (by phone), Advice and Antibiotics (when appropriate). Practices are simply not seeing patients at all.

There have been Urgent Dental Care (UDC) centres set up at key places, mainly dental hospitals and clinics where full PPE is available. Patients who need treatment which cannot be done under the three As are referred by their practice to one of these centres where treatment is often extraction - no complex treatment, especially those which involve a water spray such as using the high speed drill, is done, with the staff dressed in full PPE.

As of the last couple of days, Government is currently giving out conflicting advice that dentists can open up using a lower level of protection PPE to do "simple" treatments, mainly smoothing broken edges and extractions and the like. Needless to say, the profession is not happy with this as it does leave them vulnerable to the lurgy to a degree and it remains to be seen if practices do open up. My practices will not be, I have a responsibility for nearly 20 personnel and I am not prepared to risk them given that some of them have small children. All the staff have been furloughed and only the dentists are on call to give advice by phone.

If you have a problem, you should, in the first instance, ring your regular dentist who will triage your problem. All dentists should have someone who can take calls during working hours who may refer you to a UDC for treatment should you need it, er, urgently. Outside of those hours, you should ring 111 who may also refer you to a UDC.

I'm sorry if this sounds a little bleak but it's a fact and that's the way it is. No-one is enjoying the current situation and we all hope and pray that this situation comes to an end sooner rather than later and dentists can return to looking after their patients properly."

Reply to
GB
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I have pulled out most my teeth myself, keep them in a sealed bag in the bathroom cabinet.

Reply to
John

(snip)

How many procedures are there in modern dentistry (other than extraction) which do not involve a high-speed drill? The problem is not just PPE for the dentist and assistant. High speed drills produce high levels of aerosol spray. Some of that would be airborne in the surgery for some time and be a risk to the next patient. It would also settle on just about every surface in the surgery and be a risk unless the surgery was disinfected scrupulously between patients.

Reply to
Jeff Layman

Orthodontics mostly involves UV cure cement and bits of bent metal.

Dentistry will be a nightmare for the foreseeable future. You have to cool the dentists drill or burr and the result is loads of aerosol.

They might be able to do pre-treatment testing for Covid-19 once the tests are available, fast and reliable enough to be trusted.

Almost all of those requirements are not met at present.

Reply to
Martin Brown

I'm sure that you're right, but COVID-19 is susceptible to UV-C radiation, and high power UV-C lights are available. Check out the Osram Puritec range, for example.

Reply to
GB

I've seen reports of UVC being used to sterilise PPE. But using it for a whole room seems to me to raise a lot of issues. Eg (a) logging exposure time if lamp position and/or lamp-surface distance vary, (b) airborne pathogens that reach the parts UV doesn't*, (c) PPE for operator, (d) effects of repeated UVC exposure on equipment: plastics eg aren't usually tested to survive it and (e) dentist's tender bits on the chopping block unless GDC approval given to the process.

*other than by reflection - and even polished stainless steel is not a great reflector of UV C
Reply to
Robin

Very good point, but perhaps you could use a suitably alcoholic coolant, or some other sterilising solution like hypochlorite?

(I quite fancy the idea of my (private) dentist offering the option of brandy, whisky, or gin flavoured drill coolant)

You mean antibody tests presumably. There's a pretty high incentive to develop these at the moment, and probably no reason why they should be particularly expensive. Presumably while virus tests rely on PCR they are going to be more expensive and not very fast (hours rather than seconds).

Indeed

Reply to
newshound

It's hardly the governments job to provide PPE to a private practice

the real reason is because no realistic amount of PPE can protect a dentist from such close contact with a patient for there not to be hugely increased risk

Reply to
tim...

the one time I've had unbearable pain, the tooth was too far gone to be save and had to be pulled anyway

I don't miss it

tim

Reply to
tim...

Curiously, my dentist has already had Corona. Back at the beginning of March.

Reply to
GB

Yes, but those are mainly for cosmetic reasons and represent a fraction of the usual dental practice visits.

I wonder if it might speed up or even force the use of lasers in dentistry to replace drills?

Reply to
Jeff Layman

I would have thought that, as for care homes, it would be up to the dental practice to provide its own PPE, given that most dentists are private enterprises.

Reply to
Tim Streater

I think there may be some mixed messaging. There *was* a fuss about PPE not reaching all [wholly/partly NHS?] practices in the early days when they were still seeing patients. But AIUI the /instruction/ to cease treatments was not made for that reason: it would after all have been rather illogical to tell those with suitable PPE to down tools.

I'd also like to quote a bit from a blog my dentist pointed me to at the end of March, from the the Dean of the FGDP:

"Two things have struck me during the many meetings and discussions over the last week. Firstly, it would seem to me that everyone is working tirelessly to try and minimise the impact of this pandemic: dentists, dental care professionals, professional representatives, regulators, commissioners, NHS managers and Chief Dental Officers. This may not always be apparent, but I can assure you that many of our colleagues are working night and day to try to improve the situation.

The second point which I feel needs to be highlighted, is the lack of tolerance and understanding which is being shown. The ?be more kind? movement appears to have lasted as long as a pack of toilet rolls on a supermarket shelf. We are quick to jump to conclusions, but slow to reflect and admit we were wrong. I fully appreciate how anxious and frightened many of us are, and how angry we are at the apparent lack of support, but the outpouring of vitriol on social media towards colleagues is completely unacceptable."

Nice to know sometimes that one is not the last sane person in the country :)

Reply to
Robin

Not going to help, is it. Lasers work by ablation. Have you ever watched something being laser-cut?

Reply to
newshound

On 17/04/20 17:18, newshound wrote: l.

But a spot at several thousand degrees will, shall we say, have a disrupting effect on a virus that a high-speed drill wouldn't. I doubt, that, in any case, the volume of ablated material is anywhere near that produced from aerosolised dental "swarf". It may be possible to put a suction/extraction device on the side of the laser to remove as much ablated material as possible, but as someone who thinks that hook they put in your mouth feels like 40mm waste pipe, I wouldn't be keen on anything more added during the procedure!

Reply to
Jeff Layman

Yes, once again we find that what ministers are told is happening is in fact not the case. I do hope somewhere in the long chain of command somebody will get a grip, as although you could say there are shortages, it should not have taken this long to sort it out if the left hand know what the right hand was doing. That tends to be a common failing in the NHS admin generally, as every trust is a closed Silo and so nobody is actually seeing the whole picture. Brian

Reply to
Brian Gaff (Sofa 2)

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