Dentistry and Coronavirus - what on earth is going on?

GustyGardenGalaxy

A rapidly increasing number of people are suffering from dental problems now that dentists can't even carry out fillings (except at the urgent dental care centres which have huge backlogs of patients and seemingly a lack of the required PPE).

I know the reasons behind the lack of fillings and other treatments and that's the spray caused when water is applied during drilling and so on, this fine spray of droplets can contain the virus (and other viruses and bacteria of course, so potentially passing on COVID-19 to the dentist or nurse). I am though incredibly surprised that the dental profession hasn't come up with a viable workaround for this issue, is it really that difficult to solve the spray problem? Surely somebody could come up with a workable solution?

I'd also like to know what the guidelines are on treatments that dentists CAN safely perform - those not involving any spray would be replacing fillings that have just fallen out, replacing crowns which have become detached, examining gum-related problems and so on and so forth. So why aren't these procedures aren't at least being carried out?

Does it all come down to a lack of PPE for dentists and nurses?

It's completely ridiculous that people are increasingly suffering from dental issues due to COVID-19, why hasn't the dental profession found safe workarounds? Why the lack of PPE? I know, I know, it's understandably being prioritised for hospital staff, but the fact remains that there's another crisis in the making due to this and that's a lot of dental issues.

Also don't forget the frustration of dentists who just want to treat patients and the fact that they and the nurses are also suffering financially.

Owain_Moneysaver

Even non-drilling procedures often need a blast of compressed air to clean out the cavity - and that creates a risk.
PPE is in very short supply. Powered air purifying respirators are in incredibly short supply and they have the problem they can restrict vision and dexterity. 
Also while the PPE protects the dentist and the surgery assistant, it is also a contamination risk to the next patient. The whole surgery would have to be cleaned down between patients. Coronavirus is airborne and the aspirator (sucky thing) that takes away a lot of the spray and mess is also going to suck ambient air into the patient's mouth, where it can be inhaled. 
I don't know if you can add a poll - would people rather have coronavirus or toothache?

Undervalued

Owain_Moneysaver said:

Even non-drilling procedures often need a blast of compressed air to clean out the cavity - and that creates a risk.
PPE is in very short supply. Powered air purifying respirators are in incredibly short supply and they have the problem they can restrict vision and dexterity. 
Also while the PPE protects the dentist and the surgery assistant, it is also a contamination risk to the next patient. The whole surgery would have to be cleaned down between patients. Coronavirus is airborne and the aspirator (sucky thing) that takes away a lot of the spray and mess is also going to suck ambient air into the patient's mouth, where it can be inhaled. 
I don't know if you can add a poll - would people rather have coronavirus or toothache?

Quite.

Even without all the spray issues would you want to spend seven hours a day with your face a foot away from 20 or more stranger's mouths at the moment? Everybody else is being told to keep two metres away!

GustyGardenGalaxy

"I don't know if you can add a poll - would people rather have coronavirus or toothache? "

Speaking solely as somebody who currently doesn't have either but having had incredibly painful and even infected teeth before now , I'd take a chance on COVID-19 thanks.

Fire_Fox

Have you seen on the TV news reports on how incredibly uncomfortable full PPE can be? If there was a a PPE 'workaround', it would already be needed for/ supplied to medical or care professionals on the 'frontline'.

Spray is not the only risk with Coronavirus: sneezing, coughing, runny nose, dribbling, breathing, blood, touching or contacting surfaces in any room .... Both the dental team and subsequent patients could be at risk if everything was not cleaned sufficiently thoroughly between patients. Stopping the spread in a healthcare context with (allied) healthcare professionals not "completely ridiculous" at all.

I have had the long-awaited next appointment with the NHS Salaried Dental Service to address an impacted wisdom tooth and badly damaged molar cancelled, as well as a long-awaited ENT hospital out-patient appointment for (likely linked) issues with my hearing and (possibly) a chronic ear infection on the same side cancelled. It is very worrying, but understandable. At least I will not unwittingly infect NHS staff. I have mild cough-variant asthma which, rather unhelpfully, played up during my last dental treatment much earlier in the year.

brook2jack2

Dentistry is the most high risk procedure there is . It is not just how close you are but also the high viral load means that you are much more likely to get a really nasty bout of covid 19. 

That risk not only applies to the patient and dental staff but also to all the other patients that are seen that day , all of their contacts, family etc. 

The spray generated by dental treatment will travel up to 9 or 10 feet away from the patient and the virus will take 3 hours or more to deactivate. You need at least an hour after each patient to decontaminate. 

Dentists are not provided with PPE , we have to buy our own and you cannot source much of it, particularly respirators for love or money. 

In our area we can only provide very limited treatment , basically taking teeth out or possibly temporary fillings, and the urgent treatment centres can only do very limited drilling treatment ie taking nerves out of front teeth. Because of the time to decontaminate everything the centres can only see four people a day. 

When a patient rings a dentist up, the very real decision has to be made that is the situation serious enough to risk our lives, their lives and all of the patients in on that day and their contacts. 

This is going to remain a big problem as even with respirators the decontamination between each patient is going to make it unlikely that a dentist will be able to see more than a few people a day. 

Added to that many of us have been redeployed to other tasks on the front line against covid. 

Many of us are not being paid at the moment and many practices face bankruptcy in the very near future. There is very little likelihood because of the immense risks we run that routine dental treatment as we know it will be available soon .

Hermann

And don't forget the patients all get removed form the surgeries list if they don't visit for a checkup every six months!

Could be no patients left on the list anyway when they are allowed to open.

Maybe that rule has been relaxed, or perhaps was never really as strict as was being used!

brook2jack2

The more regular your check ups , the less problems you are likely to have. 

My suspicion is there will be such a backlog of treatment, so many practices gone bankrupt , and so many changes to cross infection procedures adding a lot of extra expense and extra time that an already overburdened NHS dental service will be on its knees and private practices will struggle to pass on the much higher extra costs . 

GHolmesAdmin

This is more serious than a lot of people might imagine, throughout history blood poisoning from rotten teeth has been a major killer.