Coronavirus (Covid -19)  Policy

 

Given the unprecedented situation in the UK regarding the COVID-19 virus we feel it is important to reassure you that we are continuing to keep our practice safe for both you and our team. As a dental practice we work in an environment where the prevention of the spread of a whole range of infections is woven into everything that we do. In addition, we want to assure all our patients that we are paying particular attention to the latest government guidance and have implemented strict control measures by closely monitoring and following guidance from NHS, CQC, WHO and Public Health England. As a team, we are doing everything we possibly can to remain fit, well and able to work so that we can continue to provide our usual high standard of dental care for you.

On the Current guidance we are continuning with our services and prioritising treament which are considered necessary and cannot wait. All other treatments such as routine check-ups, hygiene visits and treatment procedures which generate aerosol will be postponed in an attempt to reduce transmission of the virus. This policy is under review as the current situation regarding Covid-19 evolves.

Summary of advice for England – from Office of CDO, DoH, England

  • Continue to check through the hyperlink the online live standard operating procedures which update automatically as guidance from  Chief Medical Officer (CMO) and Public Health England (PHE) is published.

In particular to note the requirements:

  • To clearly display the communication posters on COVID-19.
  • Practices should set up mechanisms to establish whether any potential patient or anyone in their household has symptoms, prior to any visit, by phone or text.
  • Dental care services should not be delivered to those with potential COVID-19 symptoms or those in their households.
  • Use robust infection control procedures, wiping down surfaces between patients with extra vigilance to include door handles etc. and use standard PPE.

In addition, CDO England will now be asking dental practices to:

  • 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.

CDO England acknowledges the profession’s clinical judgement in applying this guidance, to best serve and protect their patients and their staff.

Our interpretation and Eastcote Lane Dental Practice’s position on the above guidance  the following policy applies with IMMEDIATE EFFECT

  •  As stated yesterday, we continue to challenge, communicate and stay abreast of guidance.
  •  Your safety and our patients’ safety comes first.
  • We do also recognise, however, that patients with swellings, abscesses, cellulitis, trauma and true emergency may not have access to the same A&E services that they would in normal operating conditions. It is our continued responsibility to support, treat and care for emergency patients to minimise the escalation and burden on an already stretched secondary care.
  • Our original policy statement with hand-washing, wiping of surfaces and “often-touched” surfaces will continue.
  • Our Practice Infection Control Policy has been reviewed in line with the current guidelines from  Covid -19 Infection Control   to support additional measures that need to be taken.
  • Self isolation guidance for 14 days will still continue, we will continue to keep a register of symptoms and Vidhi and I will support those who are in a position to potentially end their isolation.
  • We will be avoiding all aerosol generating procedures and these will ONLY be reserved for the patients that fall into the Emergency Category, defined below. These include:-
  •  All treatments involving the use of a fast-handpiece (air-rotor) will be stopped unless in case of emergency.
  • All treatment involving the use of an ultrasonic handpiece will be stopped
  • Use of 3-in-1 air/water spray to be stopped, unless in case of emergency.
  • We will continue to see emergency patients.

Our definition of Routine Dental Care and Emergency Dental Care has been adopted from the Faculty of General Dental Practice (UK) 

Routine care includes treatment for:

  • Mild or moderate pain: that is, pain not associated with an urgent care condition and that responds to pain-relief measures
  • Minor dental trauma
  • Post-extraction bleeding that the patient is able to control using self-help measures
  • Loose or displaced crowns, bridges or veneers
  • Fractured or loose-fitting dentures and other appliances
  • Fractured posts
  • Fractured, loose or displaced fillings
  • Treatments normally associated with routine dental care
  • Bleeding gums

Dental emergencies includes treatment for:

  • Dental and soft-tissue infections without a systemic effect
  • Severe dental and facial pain: that is, pain that cannot be controlled by the patient following self-help advice
  • Fractured teeth or tooth with pulpal exposure
  • Trauma including facial/oral laceration and/or dentoalveolar injuries, for example avulsion of a permanent tooth
  • Oro-facial swelling that is significant and worsening
  • Post-extraction bleeding that the patient is not able to control with local measures
  • Dental conditions that have resulted in acute systemic illness or raised temperature as a result of dental infection
  • Severe trismus
  • Oro-dental conditions that are likely to exacerbate systemic medical conditions such as diabetes (that is lead to acute decompensation of medical conditions such as diabetes)

ALL NON-EMERGENCY APPOINTMENTS ALREADY BOOKED FOR PATIENTS OVER THE AGE OF 70 YEARS OLD WILL BE CANCELLED – THIS IS EFFECTIVE IMMEDIATELY.

ANY PATIENTS OVER THE AGE OF 70 WHO ATTEND THE PRACTICE FOR NON-EMERGENCY REASONS MUST BE ADVISED TO RETURN HOME IMMEDIATELY.

THIS APPLIES TO ANY VULNERABLE/AT-RISK PATIENT UNDER THE AGE OF 70 YEARS OLD TOO.

  •  No new restorative work to be commenced, including removal of caries or periodontal therapy which can wait.
  • All new elective/cosmetic dentistry consultations to be stopped
  • Crowns that have not yet been fitted, to be consolidated in diary and completed
  • Dentures required to be completed to allow a patient to meet their nutritional needs to be completed
  • Broken dentures (not lost teeth) to be continued to be repaired
  • No implant surgery to be carried out, existing appointments cancelled
  • Implant restorative work to be postponed , existing appointments cancelled
  • All routine examinations/checkups to be postponed where
  • Hygienist appointments to be postponed  where possible
  • Hand scalers to be used in place of ultrasonic handpieces
  • the below groups will be cancelled:-
  • aged 70 or older (regardless of medical conditions)
  • under 70 with an underlying health condition listed below (i.e.anyone instructed to get a flu jab as an adult each year on medical grounds):
  • chronic(long-term)respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
  • chronic heart disease, such as heart failure
  • chronic kidney disease
  • chronic liver disease,such as hepatitis
  • chronic neurological conditions,such as Parkinson’s disease,motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
  • diabetes
  • problems with your spleen–for example, sickle cell disease or if you have had your spleen removed
  • a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
  • being overweight(a body mass index (BMI) of 30 or above
  • those who are pregnant

Note: there are some clinical conditions which put people at even higher risk of severe illness from COVID-19. If you are in this category, next week the NHS in England will directly contact you with advice the more stringent measures you should take in order to keep yourself and others safe. For now, you should rigorously follow the social distancing advice in full, outlined below.

People falling into this group are those who may be at particular risk due to complex health problems such as:

  •  people who have received an organ transplant and remain on ongoing immunosuppression medication
  • people with cancer who are undergoing active chemotherapy or radiotherapy
  • people with cancers of the blood or bone marrow such as leukaemia who are at any stage of treatment
  • people with severe chest conditions such as cystic fibrosis or severe asthma (requiring hospital admissions or courses of steroid tablets)
  • people with severe diseases of body systems, such as severe kidney disease (dialysis)