FGDP(UK) & CGDent to update COVID-19 guidance following SDCEP AGP review

The Faculty of General Dental Practice UK and College of General Dentistry have welcomed the Scottish Dental Clinical Effectiveness Programme’s review of the mitigation of aerosol-generating procedures, and will be issuing updated COVID-19 guidance shortly in view of its recommendations.

The SDCEP document, published today, represents the agreed positions of a working group comprising dental professionals from across primary care, secondary care, academia and public health, in addition to expert opinion from subject specialists in particle physics, aerobiology and clinical virology. The consensus report was compiled following a review of the currently-available evidence on the generation and mitigation of aerosols in dental practice, and the associated risk of coronavirus transmission.

Among the key positions, and in contrast to those adopted to date in official protocols, the report divides dental procedures into three categories of aerosol generation potential according to the instruments used, with fallow periods recommended only for the highest risk procedures, and suggests the determination of fallow time using a multifactorial approach with a ‘benchmark’ of 15-30 minutes.

The FGDP-CGDent guidance, published in June, also set out a more nuanced approach to considering the generation of aerosols in dental practice, and while allowing for potential adjustment of fallow time, accepted a 60 minute period following procedures carrying a higher risk of exposure to potentially-infective aerosols.

Ian Mills, Dean of FGDP(UK), Trustee of CGDent and a member of the SDCEP’s review group, said:

SDCEP’s review of dental AGPs has been extremely thorough, and followed a rigorous and methodical approach. Its publication is potentially a very significant moment in the recovery of dental practices in the midst of the coronavirus pandemic and I commend the SDCEP Team for the hard work and dedication they have shown in producing this report.

We welcome in particular the more refined stratification of the transmission risk inherent in types of dental procedure; the allowance for fallow time to be calculated from the cessation of the procedure; and the sophisticated approach to calculating fallow time, which considers both procedural and environmental mitigation factors such as high-volume suction, the use of rubber dam and provision of adequate air ventilation.

These approaches align exceptionally well with our own guidance and we feel it is important that current standard operating procedures are reviewed in light of SDCEP’s recommendations. Adoption of these measures will enable the increased delivery of patient care to tackle the backlog of unmet need, and avoid further deterioration in dental access and oral health inequality. A reduction in fallow time will also support the viability of practices, while the maintenance of universal precautions will continue to keep both patients and members of the dental team safe.

We aim to update our guidance as soon as possible, and are currently working with partners to develop an online Fallow Time Calculation Tool to support its implementation.

SDCEP’s Mitigation of Aerosol Generating Procedures in Dentistry - A Rapid Review is available at https://www.sdcep.org.uk/published-guidance/covid-19-practice-recovery/rapid-review-of-agps.

The current FGDP-CGDent guidance, Implications of COVID-19 for the safe management of general dental practice - a practical guide, is available at https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide and https://cgdent.uk/standards-guidance.

Sara Hurley, Chief Dental Officer England has also made an announcement on the SDCEP review. She said:

I welcome the publication of the Scottish Dental Clinical Effectiveness Programme (SDCEP) Review of Mitigation of Aerosol Generating Procedures in Dentistry. The rapid review of the evidence related to the generation and mitigation of aerosols in dental practice adds to our understanding and risk management of transmission of COVID-19 in dental settings. As the authors state in the review’s introduction, it is important to stress that the SDCEP consensus recommendations do not have the status of guidance. However, we can confirm that this review is informing Public Health England’s development of government Infection Prevention and Control guidance necessary for the continuing restoration of dental care services whilst the COVID-19 pandemic continues.

In the event of Public Health England and the government updating the IPC advice, we will update our SOPs for dental practices in England to reflect changes. In the interim the current IPC guidance for dental practices in England still applies, as detailed in Appendix 1 to our current Standard Operating Procedure (SOP) for Primary Care Dentistry – Transition to Recovery SOP (28 Aug 2020).

Thank you for your continuing commitment to the provision of high quality safe dental care in these exceptional times.