It has been a year since face-to-face dental care has resumed in England, prompting the British Dental Association (BDA) to ask the four chief dental officers (CDOs) to commission the Scottish Dental Clinical Effectiveness Programme (SDCEP) to develop a roadmap for the safe relaxation of current restrictions currently limiting access to dentistry across the United Kingdom.
UK practices are continuing to operate at a fraction of their pre-pandemic capacity to meet infection prevention and control (IPC) guidance, with an estimated 30 million appointments lost since March 2020 in England alone, the BDA said.
In a message to the CDOs of England, Wales, Scotland, and Northern Ireland, the BDA said that SDCEP is now best placed to review any new scientific literature, assess the wider prevailing conditions, and produce recommendations for IPC de-escalation founded on the best available evidence while accounting for expert views of a safe yet pragmatic way to move forward.
The BDA said this review should include but not be limited to community infection, transmission, and vaccination rates, as well as the threat posed by emerging variants of SARS-CoV-2.
Also, this review should include the relevance of aerosol-generating procedures to COVID-19 transmission. Evidence is accumulating that infective aerosols arise principally from coughing by COVID-19 patients, the BDA said, with medical interventions posting a relatively low risk. This suggests that high-level personal protective equipment might not be necessary in dentistry except for the treatment of patients known or considered likely to be infected with SARS-CoV-2.
The review additionally should consider the range and impact of international dental standard operating procedures (SOPs), the BDA said. Cochrane compared dental guidance from around the world in May 202, but the pandemic has progressed since this publication, and IPC practices will have evolved. More information should now be available on any transmission of COVID-19 linked to dental settings, the BDA said.
The impact on poor oral health and inequalities should be reviewed as well, the BDA said, including the impact of limited access to care, the suspension of dental public health programs, poor lockdown diets, and altered oral hygiene habits. The BDA expects the demand for dental services and the number of high-needs patients to be greater than before March 2020.
Further, the BDA said the review should note missed or delayed diagnoses of oral cancers across all of the nations in the United Kingdom as a result of reduced access to dental services.
Dental antibiotic prescribing also remains elevated relative to 2019 levels, the BDA said. Timely access to urgent dental care, which currently is impeded by IPC requirements, is essential for dentistry to play its part in averting a further global health disaster due to antimicrobial resistance, the BDA said.
Noting the impact of the current IPC requirements on the dental workforce, the BDA noted that 47% of dentists in England are likely to leave the profession in the next year if existing SOPs remain in place, with a similar proportion intending to reduce their National Health Service commitment. Such an exodus would have a devastating and long-lasting impact on already inadequate levels of access, the BDA said.
Finally, the BDA said, the review should consider patient triaging and waiting arrangements, which affect patient flow and capacity.
The BDA said it has underlined the need for clear and consistent guidelines and public communications alongside practical support to underpin a safe de-escalation of IPC requirements across dentistry.
“It’s a year since face-to-face care resumed in England, but the restrictions we work to remain largely unchanged. So today we have asked all four UK chief dental officers to begin work on a roadmap to ease restrictions,” said BDA chair Eddie Crouch.
“The risk we face today from the virus needs to be balanced against the millions unable to access care, and threats to the very sustainability of this service,” said Crouch. “It is time to let the experts weigh up the risk of COVID transmission with the dangers of prolonging the status quo. We know this issue is already high on the official agenda, but patients and the profession deserve clarity on the way ahead.”
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