COVID-19 Chief Dental Officer Summary of Guidance

All four Chief Dental Officers (England, Wales, Scotland & Northern Ireland) have released their summary of guidance for each of their home countries, relating COVID-19 outbreak and these fast-changing times.

England

• The Chief Dental Officer for England has now issued updated advice, in a letter to the British Dental Association, confirming that practices should:
  • reduce the number of routine check-ups by cancelling patients from vulnerable groups (and offering cancellation to anyone else who wishes to do so) to reduce the need to travel.
  • consider the potential risk of asymptomatic cases attending in this delay phase and reduce exposure of staff and patients to infection by avoiding all aerosol generating procedures wherever possible.
  • agree local arrangements to consolidate, where necessary, the provision of any essential, routine NHS work that cannot be delayed and urgent dental problems.
• Dental care services should not be delivered to those with potential COVID-19 symptoms or those in their households.

Wales

• The amber alert issued by the Welsh Chief Dental Officer recommends reducing exposure of staff, clinicians and patients to infection by avoiding all aerosol-generating procedures wherever possible.
• The CDO is clear that these decisions are for individual clinicians to make using their clinical judgement. However, they have recommended that planned restorations should be deferred, and where unavoidable, the use of rubber dam is mandatory to reduce aerosols. The tooth planned for preparation can also be wiped with a cotton wool roll dampened with a hypochlorite solution such as Parcan to reduce viral particles. A mask, visor and apron should be used.
• The CDO is also advising that vulnerable patients, including older people, pregnant women, and those with underlying health conditions, should have their treatments postponed where possible. This will reduce the need for those individuals to travel and conserve supplies of personal protective equipment.

Scotland

• The Scottish Chief Dental Officer recommends reducing exposure of staff, clinicians and patients to infection by avoiding all aerosol-generating procedures wherever possible.
• The CDO is also advising that vulnerable patients, including older people, pregnant women, and those with underlying health conditions, should have their treatments postponed where possible. This will reduce the need for those individuals to travel and conserve supplies of personal protective equipment.
• The advice also states that:
  • For patients with symptoms of COVID-19, urgent care should only be delivered at designated urgent dental care treatment centres, with calls being handled by NHS24 and appointments arranged by local NHS Board.
  • For patients without symptoms of COVID-19, urgent care should be delivered as normal. In exceptional cases, when a short aerosol-generating procedure is unavoidable, for example to “open to drain”, use a full-face visor and fluid-resistant facemask and effective high-volume suction. Routine dental care to these patients should continue as usual wherever possible, without undertaking aerosol-generating procedures.
  • The number of routine check-ups should be reduced by postponing appointments with patients from vulnerable groups.
  • All unnecessary items should be removed from waiting rooms and work surfaces and they should be cleaned regularly.
• Further guidance on the use of aerosol-generating procedures can be found here.

Northern Ireland

• General dental practitioners are not expected to examine or provide routine treatment to vulnerable people (those aged 70 or over, anyone with an underlying health conditions, and pregnant women).
• All non-urgent domiciliary visits should be cancelled.
• Request, wherever possible that patients attend practice unaccompanied.
• Restrict aerosol generating procedures to urgent and emergency care.
• Provide routine care to patients with no symptoms wherever possible but do not undertake aerosol generating procedures.