Every Monday we’ll answer your questions on Covid-19 and health in a feature published online. You can submit a question here.
This week, HuffPost UK reader Chris asked: “When do we expect dentists to resume routine procedures, such as fillings?”
Depending on where you live and the state of your finances, getting a dentist’s appointment during the pandemic has been either near-impossible or relatively fuss-free.
When lockdown was first announced, dental practices across the UK remained closed until June. Anyone needing emergency help was told to phone their dentist, with a view to being referred for urgent treatment in hospital. But capacity was limited and some ended up carrying out DIY dentistry at home.
Since June, dental practices have been steadily reopening across the UK, but most have been working on an emergency basis trying to deal with a backlog of patients needing urgent work – so routine appointments are getting pushed back. The main problem with delaying such appointments is that they act as a preventative measure, so people don’t experience hefty dental issues later down the line, which often require drastic (and expensive) procedures.
Routine appointments are also an opportunity for dentists to keep an eye out for other issues like gum disease and oral cancer – and the earlier patients are treated for an issue, the better the prognosis.
Eddie Crouch is chair of the British Dental Association and works at two practices in south Birmingham, offering both NHS and private appointments. He tells HuffPost UK he can’t provide a date for when routine NHS dental appointments will resume across the board. Reports suggest it might not be until 2021.
When will routine appointments resume?
The NHS England website states that because of coronavirus, changes have been made to routine dental treatment. In England, some routine dental treatments are available again. An NHS spokesperson said: “NHS dentists have been asked to resume full services, and in the meantime over 600 urgent dental care centres have opened since April 2020. At the height of the first covid wave, NHS dentists were also funded to be available to their patients for advice, guidance, issuing prescriptions and any onward referral.”
In Scotland, patients with urgent dental problems are being prioritised. A Scottish government spokesperson said: “We will continue to work to fully remobilise NHS dental services as soon and as safely as possible. At present NHS dentists can provide a range of non-urgent care including a full examination of soft tissues to check for mouth cancers, tooth extractions, dentures, orthodontic treatment and the re-fixing of bridges and temporary crowns.”
In Wales, dental practices are open “for urgent, non-aerosol care”. A Welsh government spokesperson said: “Routine dental examinations have not stopped but people are being seen according to need. Practices have been asked to treat people who have experienced problems during lockdown and consider prioritising those who had treatment delayed because of the pandemic.”
While in Northern Ireland, routine care and treatment can be provided, but practices are prioritising patients with the greatest need – so some routine or non-urgent treatments are postponed. Its Health and Social Care Board said in a statement that dental practices are “particularly impacted” by the pandemic.
“Most dental procedures are aerosol-generating ... This has therefore led to a significant reduction in the quantity of treatment that can be provided by dentists,” reads the statement.
So, why can’t routine appointments resume?
Paul Grygan, clinical lead for an Urgent Dental Care Clinic in Northern Ireland, says there are two main reasons why a normal service can’t resume right now. The first is because they need to make sure there’s enough PPE to go around, and the second is because of the risk from aerosol-generating procedures (so basically, most of the procedures dentists carry out).
The worry is that these aerosol-generating procedures – whether that’s drilling a tooth, removing one, or simply cleaning them – could spread Covid-19, as aerosols from a person’s mouth (who may or may not be infected) are being propelled into the air and onto nearby surfaces.
Another big challenge facing dentistry right now is the social distancing and standard operating procedures, which has meant the volume of patients they can see is “significantly reduced”, Crouch says. In some cases capacity to see patients has been reduced by a half – sometimes more.
A poll of 2,672 practices in England in July revealed while almost all practices reported they’d resumed face-to-face care, two thirds were operating at less than a quarter of their pre-Covid capacity and one quarter were seeing just a tenth of their former patient numbers.
Current restrictions also mean dentists have to leave an hour’s gap between patients after an aerosol-generating procedure and do a deep clean of the room. This means they’re seeing fewer patients and generating less income, while having to foot the bill for more PPE.
Why are some people being asked to pay privately for treatment?
Despite getting funding from the NHS, a lot of dentists work on a basis where they use income from private appointments to subsidise the other (NHS) side of their business. Some patients are finding when they call up for an appointment, they’re told they cannot be seen. Or that they can be seen, but only if they pay privately.
Independent watchdog Healthwatch England has been collating people’s experiences of NHS and social care services during the pandemic, including dentistry. A report involving responses from 19,700 people revealed many have had to go private if they wanted treatment for what their dentist considered to be a “non-emergency”.
The report also highlighted some dentists have applied additional charges to patients to cover the cost of PPE, making dental care even less accessible.
What needs to happen now?
At the moment, there isn’t enough financial support available for these practices. While many struggling businesses on the high street have qualified for measures such as business rates relief, dental surgeries do not get this support. “Many of the dentists are falling through the cracks,” says Crouch, and as a consequence of that, “many practices are [financially] vulnerable”.
With local lockdowns in force and Covid-19 cases rising again in the UK, it doesn’t bode well for the return of routine dental appointments anytime soon.
One silver lining is that Crouch doesn’t believe we’ll return to the situation we saw in March where dental practices were closed completely and only triaging patients over the phone.
However there are fears that the issues with accessing dentistry, which was a problem pre-Covid anyway, will simply widen the gap between those who can afford to go private and those who can’t in the coming months.