Dentist

brook2jack2

MoneySeeker1 said:

Out of interest - are dentists having the current viewpoint of "dire emergency only - if that" visits because of Government regulations telling them that is how they must deal with this - or was it their own choice?

The English, Welsh ,Scottish , Northern Irish chief dental officer, the general dental council, the department of health , CQC , HIW ,NQIA (Welsh Scots, Irish English health inspection bodies ), the government , the local clinical commissioning groups, the health boards Etc etc etc  have all imposed this restriction on dentists and are inspecting and monitoring to make sure that its adhered to. 

Virtually every country in the world imposed similar restrictions as the risks imposed by dental treatment is recognised as so high. Some countries ahead of us in infection are starting to open up again but in a severely restricted way due to the massive restrictions necessary to make treatment as safe as possible. http://fedcar.eu/en/news/2020/04/how-we-will-continue-to-regulate-our-dental-professions-when-facing-covid-19/

Even if dentists could easily access pp3 masks (they are not supplied by the NHS , dentists have to source and buy their own equipment) there would still be severe limits on what could be provided at acceptable risk to all. 

No PPE and decontamination is 100% effective , there is always a risk and the difficulty is balancing the risks of treatment vs antibiotics, painkillers and advice to the wise circle of people who could be potentially infected from each and every treatment. 

ripplyuk

Thankfully my dentist is seeing people, though you have to pay a £150 fee on top of any treatment costs. It’s interesting that up until this virus, the NHS and many dentists (including on here) were adamant that antibiotics do not help at all with a tooth abscess. So many people were left in pain waiting for their appointment. In my friends case, it was 3 weeks and he was in so much pain he could barely eat. Now, with the lockdown, antibiotics are being handed out straight away for a tooth abscess, which I’m glad to see. Of course, it needs to be the right antibiotic or it won’t work. In my own case, I was given amoxicillin which was useless but Clindamycin worked very well. 

nigelbb

brook2jack2 said:

MoneySeeker1 said:

Out of interest - are dentists having the current viewpoint of "dire emergency only - if that" visits because of Government regulations telling them that is how they must deal with this - or was it their own choice?

The English, Welsh ,Scottish , Northern Irish chief dental officer, the general dental council, the department of health , CQC , HIW ,NQIA (Welsh Scots, Irish English health inspection bodies ), the government , the local clinical commissioning groups, the health boards Etc etc etc  have all imposed this restriction on dentists and are inspecting and monitoring to make sure that its adhered to. 

Virtually every country in the world imposed similar restrictions as the risks imposed by dental treatment is recognised as so high. Some countries ahead of us in infection are starting to open up again but in a severely restricted way due to the massive restrictions necessary to make treatment as safe as possible. http://fedcar.eu/en/news/2020/04/how-we-will-continue-to-regulate-our-dental-professions-when-facing-covid-19/

Even if dentists could easily access pp3 masks (they are not supplied by the NHS , dentists have to source and buy their own equipment) there would still be severe limits on what could be provided at acceptable risk to all. 

No PPE and decontamination is 100% effective , there is always a risk and the difficulty is balancing the risks of treatment vs antibiotics, painkillers and advice to the wise circle of people who could be potentially infected from each and every treatment. 

The overwhelming majority of dentists are not salaried NHS employees but self-employed contractors providing a service to the NHS in return for payment plus seeing private patients so it’s entirely correct that they should purchase their own equipment & not expect it to be provided by the NHS. Likewise for the overwhelming majority of GPs.

brook2jack2

The overwhelming majority of dentists are not salaried NHS employees but self-employed contractors providing a service to the NHS in return for payment plus seeing private patients so it’s entirely correct that they should purchase their own equipment & not expect it to be provided by the NHS. Likewise for the overwhelming majority of GPs.

The difficulty is most of dentists usual suppliers are reserving PPE for NHS England , so dentists cannot buy PPE easily at all. On the open market there is precious little and what there is has gone up in price 10 to 20 fold. Even then it is virtually impossible to get hold of pp3 masks and filters which is what dentists need to carry out treatment involving an aerosol . This is the situation world wide , not just the UK.

in our local area dentists have been asked to take over the local NHS weekend emergency dental clinics etc as the health board doesn't have the manpower to cope, in addition to doing non aerosol producing emergency treatment for all during the week. However this is unpaid and with no help in sourcing or funding PPE. 

brook2jack2

ripplyuk said:

Thankfully my dentist is seeing people, though you have to pay a £150 fee on top of any treatment costs. It’s interesting that up until this virus, the NHS and many dentists (including on here) were adamant that antibiotics do not help at all with a tooth abscess. So many people were left in pain waiting for their appointment. In my friends case, it was 3 weeks and he was in so much pain he could barely eat. Now, with the lockdown, antibiotics are being handed out straight away for a tooth abscess, which I’m glad to see. Of course, it needs to be the right antibiotic or it won’t work. In my own case, I was given amoxicillin which was useless but Clindamycin worked very well. 

In normal times antibiotics are not the answer, they just subdue the problem for a while , they don't treat the root cause , and indiscriminate prescribing will increase antibiotic resistance , which is another major health problem which is increasing. 

However these are not normal times and dental treatment is recognised as being extremely high risk for all involved. Therefore the decision was taken , worldwide, that for these extraordinary times extraordinary measures would need to be taken and amongst these are the relaxing of antibiotic guardianship rules , however everyone being prescribed antibiotics is told these are not the solution and they will need dental treatment when it is safer to do so. These antibiotic regulations will be reimposed when things return to normal as for most dental problems antibiotics are not the solution and overuse leads to resistance which is an increasingly serious problem. Why do you think that two different antibiotics needed to be used for you? Amoxicillin is a broad spectrum antibiotic and until recently would have been effective on virtually everyone (if you're not allergic to penicillin) . More and different antibiotics need to be prescribed and we are running out of antibiotics to use. 

Don't confuse what is being done now , in very difficult and extraordinary circumstances, for what is good ,long term practice.

ripplyuk

brook2jack2 said:

ripplyuk said:

Thankfully my dentist is seeing people, though you have to pay a £150 fee on top of any treatment costs. It’s interesting that up until this virus, the NHS and many dentists (including on here) were adamant that antibiotics do not help at all with a tooth abscess. So many people were left in pain waiting for their appointment. In my friends case, it was 3 weeks and he was in so much pain he could barely eat. Now, with the lockdown, antibiotics are being handed out straight away for a tooth abscess, which I’m glad to see. Of course, it needs to be the right antibiotic or it won’t work. In my own case, I was given amoxicillin which was useless but Clindamycin worked very well. 

In normal times antibiotics are not the answer, they just subdue the problem for a while , they don't treat the root cause , and indiscriminate prescribing will increase antibiotic resistance , which is another major health problem which is increasing. 

However these are not normal times and dental treatment is recognised as being extremely high risk for all involved. Therefore the decision was taken , worldwide, that for these extraordinary times extraordinary measures would need to be taken and amongst these are the relaxing of antibiotic guardianship rules , however everyone being prescribed antibiotics is told these are not the solution and they will need dental treatment when it is safer to do so. These antibiotic regulations will be reimposed when things return to normal as for most dental problems antibiotics are not the solution and overuse leads to resistance which is an increasingly serious problem. Why do you think that two different antibiotics needed to be used for you? Amoxicillin is a broad spectrum antibiotic and until recently would have been effective on virtually everyone (if you're not allergic to penicillin) . More and different antibiotics need to be prescribed and we are running out of antibiotics to use. 

Don't confuse what is being done now , in very difficult and extraordinary circumstances, for what is good ,long term practice.

Yes, of course the abscess still needs proper treatment. My point was the often long waiting times for that treatment and patients being left in severe pain when an antibiotic could help a great deal. In a perfect world, no one would have to wait but that’s not the case even before this lockdown. 

Regarding the antibiotics I used, my dentist explained it was to do with aerobic and anaerobic bacteria. Obviously different antibiotics are chosen for different bacteria. Clindamycin worked almost instantly. He also said that almost everything is now resistant to amoxicillin. 

onwards&upwards

You're being very patient brook2jack2!

brook2jack2

Quite and things are resistant because we have overused antibiotics. 

Dental treatment is not popular and often people want to put it off. Dentists who run out of hours on call services will say it can be very difficult to persuade people to come in , they want antibiotics as they see it as an easier and cheaper option. 

GPs also report many patients phoning who want antibiotics for dental problems , gps are not experienced or qualified to diagnose dental problems. 

Yes access to NHS dental treatment is an issue in many places but education that antibiotics are not the solution to dental problems is also important.

Rosa_Damascena

Good to see you back brook2jack. What doesn't change is that you can't argue with stupid so I wouldn't waste any more time on people that still think there is scope for circumventing the system.

Takedap

MoneySeeker1 said:

But people in previous centuries must have found some way somehow before modern dentistry - so worth a google. 

Yes.  It was often called "Dying in agony"