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“I hate the gap,” says 49-year-old Angela Wood, who recently had a tooth extracted. “Luckily it’s at the side of my mouth and everyone says you can’t see it, but I can. I’m very self-conscious of it. Very.”
Wood is one of many people across England to have lost a tooth during the Covid-19 pandemic, because while dental practices were allowed to reopen on June 8, one month later, the treatments dentists can offer are still limited. Shockingly, it comes down to PPE shortages.
Aerosol generating procedures (AGPs) require a higher level of PPE than non-aerosol treatments, meaning in some cases, extractions are the only option.
“We have a shortage of PPE,” explains dentist Kate Davis, who treats both private and NHS patients in Somerset. “The PPE I need to perform advanced treatments such as fillings, root fillings, crowns and difficult extractions is the same PPE doctors need in hospitals for treating patents with Covid.
“So all I can do at this stage is simple temporary fillings, simple extractions, dentures and examinations.”
Wood developed tooth and jaw ache in the bottom-left side of her mouth at the start of lockdown – something relatively usual for her, as she grinds her teeth. But due to practice closures, she wasn’t able to see her dentist to adjust her mouth guard or check if there was another problem. The pain eventually grew unbearable.
After weeks of phone calls and a prescription of antibiotics that made no difference, Wood secured a face-to-face appointment. Here though, the dentist informed her she’d have to lose a tooth.
“I was told in ‘normal’ circumstances, I could have root canal treatment on this, but they were unable to say when this could take place now and it could be months,” she says. “I had been in pain for six weeks solid, day and night. The extraction itself was pretty horrendous and took over half an hour.”
Unfortunately, the extraction didn’t solve her pain. When Wood contacted the dentist again, she was told the only option available was a second extraction.
Not wanting to lose a second tooth, she sought the advice of a private jaw specialist, who diagnosed her with severe Temporomandibular disorder (TMJ), which causes pain of the jaw. The consultant, she says, believes the first extraction was not necessary.
“After the extraction I was waking with nightmares about the whole experience regularly,” says Wood. “So far I’ve spent £315 on private dental care, with no end in sight as to when I can get my entitlement to NHS care.”
The British Dental Association (BDA) confirmed to HuffPost UK that patients are being submitted to tooth extractions that may have been avoidable. “Many practices have been left with no option but to offer extractions on teeth that could have been saved,” said BDA chair, Mick Armstrong.
“As long as official guidance and PPE shortages set limits on what dentists can do, we will keep seeing Victorian dentistry delivered in 21st century Britain.
“Higher costs and a collapse in patient numbers mean thousands of practices face a deeply uncertain future. The government needs to step up to ensure a service millions depend on can survive the new normal.”
Roxanne Kavanagh, a 50-year-old based in Yate near Bristol, has also recently had a tooth extracted. She began experiencing pain in the bottom right side of her mouth in April, but says all she heard when she called her NHS dentist and the local emergency dental hub was “extractions, extractions, extractions”.
“I don’t have many teeth left, through no fault of my own, so I didn’t want this extracted unless I absolutely had to,” she says.
She spent months in pain, but managed to find a private dentist in Somerset with enough PPE to perform an aerosol treatment.
The private dentist performed a treatment called a non-vital pulpotomy on Kavanagh’s tooth for £400, but warned her that it might not work. Kavanagh had to borrow the money from her mother – she claims benefits, so would usually be entitled to free NHS dental treatment.
Unfortunately, the treatment failed. Kavanagh couldn’t afford to pay for a second treatment offered to try and save the tooth, so ended up having it extracted anyway. “If NHS dentists are still not doing AGPs, what’s the use of restaurants opening and McDonalds opening if nobody has any teeth to eat with?” she says. “It’s like it’s gone back to the 1900s.”
Kavanagh has been left with dry socket – a painful side effect that sometimes occurs following an extraction – and says the whole experience has left her feeling “abandoned”. She’s also concerned about the accessibility of dentistry for people on a budget.
“Before Covid, I didn’t really have a fear of dentists or my teeth,” she says. “Now I wake up every morning and think: ‘how’s my teeth, how’s my teeth, how’s my teeth?’ I’m scared what will happen if I get another toothache. Am I going to go in and all they’re going to say is, ‘sorry, all we can do is pull your teeth out’? It’s made me very paranoid over my mouth.”
Dentist Kate Davis says she’s “confident lots of people will suffer loss of teeth that will have been, in part, contributed to by delayed treatment” in this pandemic. Teeth that could’ve been saved with a simple filling are being left untreated in some cases, she says, meaning decay spreads and can infect the nerve in the middle of the tooth.
“In order to save this tooth, you would then need either a root filling (which, unless you are a NHS patient, costs considerably more than a simple filling) or an extraction,” she explains. “For some patients the cost of the root filling will lead them to choose the more drastic extraction.”
Another financial barrier is the cost of PPE. Some private practices, including the one Davis works for, “have been forced to add a PPE surcharge to patients”. Her practice charges £7 per appointment for the PPE required for basic treatment (check ups, extractions and dentures) or £40 for the total PPE required for more advanced treatments (fillings, crowns and root fillings).
“These costs are sadly a necessary evil, the cost to my company alone for PPE has increased 100-fold since coronavirus,” she says. “All of these things will make seeing a dentist harder and more expensive. Prevention of dental disease has never been more crucial.”
Commenting on the issues, a Department of Health and Social Care spokesperson told HuffPost UK: “We are working around the clock to make sure all frontline healthcare staff, including dentists, have the PPE they need as routine services begin to resume.
“Our priority is to ensure public and patient safety and the NHS has made it clear that this is a gradual restart, with the pace set by individual clinicians. The 600 NHS urgent dental care centres will also continue to treat patients in need until dental practices can safely offer a wider range of services.”
In the meantime, patients like Wood and Kavanagh will have to save for dental implants – the average cost is £2,415 per tooth in the UK – or live with tooth gaps forever.
“Dentistry is not open as we know it,” Kavanagh says. “I fear for the future of dentistry in this country now.”