What is classed as 'emergency dental work'? 1 September 2020 at 4:29PM in Health & beauty MoneySaving 31 replies 1.4K views

Conrad3000

Hi.

Is it basically anything that causes you pain? Be it minor or major?

Thanks.

brook2jack2

It depends who is classifying dental emergency 

if it is a health service definition it is
swelling that compromises the airway
bleeding after an extraction that won't stop
trauma
pain, no matter how severe , is not classified as a health service emergency . 

Individual surgeries will then prioritise ,alongside the above ,pain in order of severity. In covid times dentistry dental surgeries can only see around 20% of their normal patients because of the precautions that need to be taken, particularly for procedures that involve drilling or creation of aerosols. 

Conrad3000

brook2jack2 said:

It depends who is classifying dental emergency 

if it is a health service definition it is
swelling that compromises the airway
bleeding after an extraction that won't stop
trauma
pain, no matter how severe , is not classified as a health service emergency . 

Individual surgeries will then prioritise ,alongside the above ,pain in order of severity. In covid times dentistry dental surgeries can only see around 20% of their normal patients because of the precautions that need to be taken, particularly for procedures that involve drilling or creation of aerosols. 

Thanks. So what about a crown on the front tooth that needs replacing? The stump underneath is causing some pain  because over time the crown has shifted about 4mm. Now there's a gap to contend with too.

brook2jack2

In the present covid emergency it is very unlikely any NHS dentist and quite a few private dentists are unlikely to be able to replace a crown. 

A many laboratories are not open
B it needs a long appointment to prepare a crown and there is a legal limit on how long the dentist and nurse are allowed to wear their PPE which makes it difficult to prepare a crown
C from your description it is difficult to see how this would qualify as an emergency and catapult you over the considerable waiting lists most dentists have of people with eg abscesses , infections and severe toothache as well as outstanding treatment. 

onwards&upwards

A legal limit?  Which law is that?

brook2jack2

Yes there is a limit on wearing fp3 masks for no more than an hour before you should have a break. Particularly important when a dentist is doing microsurgery requiring high degrees of hand eye co ordination and concentration. See page 18 hse guidance on PPE https://www.hse.gov.uk/pubns/priced/hsg53.pdf dentists have to follow this guidance. 

onwards&upwards

So no law that tells dentists how long to wear their PPE then.  Thanks, good to be clear on these things. 

Of course, it is possible doff then re-don in order to continue caring for patients.  This happens in hospitals a lot. 

brook2jack2

Yes it does , if you read the document fully. Under  h and s legislation we have to follow hse guidance on wearing of PPE for staff, Not to do so would result in a prosecution by HSE and staff would have legal recourse against  the employer . We would also be liable for disciplinary proceedings by the GDC if we did not follow the guidance on PPE.  The sops (standard operating procedures) produced by each countries chief dental officer also clearly states dentist have to follow hse guidance on fp3 masks and each dentist has had to sign to confirm this. So the one hour wearing , before a rest , of fp3 masks is a legal requirement. 

Whether other employers chose not to follow the clearly stated guidance is up to them. Dentists work in a small , highly regulated team and infringement of any regulation is heavily punished.

Besides which my own personal experience is there are many restrictions to doing complex microsurgery in PPE , visualising and accessing the mouth is physical and mentally difficult at the best of times , wearing PPE for aerosol procedures plus loupes etc is extremely physically and mentally tiring , by the end of an hour session you are at your absolute physical and mental limits . You then have to decontaminate and go straight into seeing another patient and this , for most dentists , for ten hour days to try to catch up with outstanding treatment, day in, day out. 

It is in a patients best interests that the dental team are physically and mentally able to provide them with the best care at all times. Following HSE guidance helps to ensure this which is why dental teams are legally obliged to follow the guidance. 

onwards&upwards

brook2jack2 said:

Besides which my own personal experience is there are many restrictions to doing complex microsurgery in PPE , visualising and accessing the mouth is physical and mentally difficult at the best of times , wearing PPE for aerosol procedures plus loupes etc is extremely physically and mentally tiring , by the end of an hour session you are at your absolute physical and mental limits . You then have to decontaminate and go straight into seeing another patient and this , for most dentists , for ten hour days to try to catch up with outstanding treatment, day in, day out. 

Gosh I wonder how those staff on ICUs and respiratory wards have coped for the last 6 months!!  I suppose at least they didn't also have to cope with looking after multiple patients at once, managing the ventilators and all the other devices, their patients dying on a regular basis, communicating with family members and loved ones unable to visit even in the final hours and so on.

Oh wait... 

Honestly, dentists can cry me a river.  They really need to start stepping up somehow and actually providing an acceptable level of care again, they are healthcare professionals providing an absolutely vital and occasionally lifesaving service.  

Gers

onwards&upwards said:

brook2jack2 said:

Besides which my own personal experience is there are many restrictions to doing complex microsurgery in PPE , visualising and accessing the mouth is physical and mentally difficult at the best of times , wearing PPE for aerosol procedures plus loupes etc is extremely physically and mentally tiring , by the end of an hour session you are at your absolute physical and mental limits . You then have to decontaminate and go straight into seeing another patient and this , for most dentists , for ten hour days to try to catch up with outstanding treatment, day in, day out. 

Gosh I wonder how those staff on ICUs and respiratory wards have coped for the last 6 months!!  I suppose at least they didn't also have to cope with looking after multiple patients at once, managing the ventilators and all the other devices, their patients dying on a regular basis, communicating with family members and loved ones unable to visit even in the final hours and so on.

Oh wait... 

Honestly, dentists can cry me a river.  They really need to start stepping up somehow and actually providing an acceptable level of care again, they are healthcare professionals providing an absolutely vital and occasionally lifesaving service.  

Gosh, you sound so intransigent. It's been explained to you very clearly the constraints under which dentists MUST work. There is no comparison with the conditions in ICU and respiratory wards, procedures aren't all the same. 

In late July I was hospitalised with a collapsed lung, this needed a chest drain inserted - an AGP. It took over two hours to find, sterilise and prepare a pressurised room for the procedure. The medics had to fully gear up in heavy duty PPE, the portable equipment was sterilised and covered up apart from working parts. Midway, and at the end of the procedure a covered X-ray machine was brought in, radiographer all in same heavy duty gear. After all was done the room was again sterilised and left fallow for an hour before bring used again. 

Same for dentists. 

You are now just being rude and completely failing to comprehend that dental work is tightly legislated with punitive measures in place. Dentists would love to 'get over themselves' and work normally again. 

brook2jack2

I'm not sure , given the regulations that dentists have to work under , what more they can do to step up. If a surgery has to be left fallow for an hour after each aerosol procedure before it can even be cleaned , waiting rooms cannot be used, only one patient going through the practice at a time , the rigamarole over covid checks when someone enters the practice etc then obviously capacity is only going to be a fraction of what it was. If capacity is 20% of what it was then obviously some people will have to wait for treatment . 

That's without the problems of trying to source PPE . We have a new NHS trainee dentist started this month. The health board have fit tested him for a mask , we are not allowed to. The only problem is the health board cannot supply the mask and the trainee can only wear that mask, neither can we source that mask privately as stocks are reserved for the NHS to buy. So until the health board supplies , that dentist cannot do any aerosol procedures at all. 

Short of the government stepping in ,and building tens of thousands of new surgeries with negative pressure ventilation , whilst dentists are obliged , by law, to follow fallow times there will continue to be a disparity between dental need and capacity, which was already bad pre covid and now is at crisis point.