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Guidance for dentists

Any legal requirement for social distancing in our community has now been removed. Social distancing and PPE requirements will however be maintained in health and care environments.

NHS Dental and NHS Orthodontic Provision

Update 25 June 2020
Dental Services 
From Monday 29 June 2020 the Island's residents will be able to access their usual dental practice as they normally would. The emergency dental service is available at weekends and bank holidays between the hours of 9am and 11am. There will still be some differences that patients should be aware of and this information is available below.

Orthodontic Services 
Regent Dental Care has re-opened and will continue to provide orthodontic treatment to patients assigned to that service. For orthodontic patients assigned to the Consultant Service at Noble's Hospital, there is a delay on re-starting this service. The Department will be in touch with patients as soon as possible but in the meantime if there are any queries or concerns you can contact ortho@gov.im.

Dental practices providing both NHS and private services are now able to open to provide both non-aerosol generating procedures and aerosol generating procedures in relation to urgent dental care to their patients. No routine dental care will be allowed to take place.

During this phase:

  • The Community Dental Service will continue to see patients who do not have regular dentists but who have urgent dental needs
  • Special care urgent dentistry will continue
  • Special care domiciliary will recommence
  • Paediatric surgery will be able to commence

General guidance

Social distancing, workplace hygiene and good hygiene practices

Practices will be expected, within their premises, to adhere to the social distancing guidelines currently in place. Guidance can be found online

Providing treatment to patients

Every patient will need to be triaged and the most appropriate treatment provided. Face to face treatment should be provided where necessary and clinically safe to do so.
Aerosol generating treatment can take place, with the appropriate risk assessment, cleaning procedures and personal protection equipment (PPE) in place.

Risk assessment

Each Practice will carry out and document their own risk assessments in line with their insurance and regulator guidance for all elements of the Practice. 

PPE

Appropriate PPE will need to be used. Practices will be able to receive PPE from the Department at cost, under contract.

Specific guidance

Practices need to adopt a strict no patient walk in service.

Where required, face to face consultations can be arranged with strict guidance on access by the patient and spacing of any concurrent patients - which includes an allowance of time in-between patients to ensure the surgeries are appropriately decontaminated. The safety of both patients and staff should be of paramount importance to contain any further spread of the virus, bearing in mind that patients may be asymptomatic for COVID-19 and may still be infected or infectious.

Face to face consultations can be offered for urgent dental care.

Where a patient requires emergency hospital treatment they can be referred to the Oral Surgery Department at Noble’s Hospital.

The general principles for managing dental provision will be:

  • Stop and defer all routine dental treatment and care
  • Ensure all members of staff observe social distancing measures with regards to symptoms and/or in contact with those with symptoms
  • Ensure any vulnerable and shielded members of staff are isolated and protected
  • Observe social distancing measures by minimising face-to-face patient contact
  • Provide remote triage for all patients to assess risk
  • Provide urgent dental care, as appropriate
  • Observe stringent infection prevention and control measures

Triage and referral

Management of all patients should initially be through remote triage.

The Practice should have evaluated themselves against a recognised Quality Assurance declaration and the appropriate operating procedures should be put in place for the safe management of patients and staff with regard to appointment times, patient access and infection Control Standards (HTM01-05).

Practices must:

  1. Establish themselves as an urgent dental care service – clearly stating that they do not offer a patient walk in service.
  2. Adopt a full triage-first model that supports the management of patients with urgent dental needs remotely where possible. This should be the first point of access by all patients. In practice, this means using telephone, video and online consultation technology where possible.

    For further information on remote triage see: BMJ article, Information Commissioner’s guidance and GDC guidance

  3. Undertake a COVID-19 assessment for all patients and provide self-isolation advice to those with the following
    •  a temperature of more than 37.8C (100F)
    • OR, a new and persistent cough - this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
    • OR, anosmia – this is the loss of or a change in your normal sense of smell. It can also affect your sense of taste as the two are closely linked
  4. Determine if patient is within vulnerable or shielded group or is self-isolating*.
  5. Obtain relevant medical history.
  6. Make safe arrangements for patients to collect any prescriptions, or assisting with getting medications to a patient if they are unable to collect their prescription themselves (or have someone collect it on their behalf).
  7. Advise patients that treatment options remain restricted at this time; no routine treatments may take place .
  8. Keep appropriate records of all patient contacts, including care management and onward referrals.
  9. Ensure any onward referrals are made via the appropriate electronic referral template to CDS. This will require patient details, medical history, medications and COVID-19 status plus the presenting complaint, diagnosis and treatment request. Appropriate radiographs and photographs can also be added to the referral.
  10. Ensure, if face to face consultations take place at the practice, that strict decontamination policies have been followed and adhered to, before and after every patient has attended.
  11. Ensure all dentists and nurses are equipped with the appropriate and correct PPE if undertaking any face to face consultations.
  12. Put a system in place to ensure, on arrival for a face to face consultation, patients are able to comply with social distancing measures.
  13. In addition, HTM01-05 and NICE guidance on infection prevention and control measures should be used by all staff, in all settings, always, for all patients.

*Should a patient be classed as vulnerable or shielding steps should be taken if the patient requires a face to face consultation to ensure consultations are at a time when patients will not cross paths with each other whilst at the practice – an appointment early in the day prior to other patients having accessed the practice

Daily situation reports

All NHS contractors must provide a daily ‘situation report’ using a form of data collection provided by the Department.

Quality assurance documentation

Each Dental Practice must provide a copy of their quality assurance documentation prior to opening.

Practice quality assurance visit

Each Practice will need to be visited prior to opening and will be assessed against their quality assurance document (attached as Appendix 1). The visit will be undertaken by:

  • A member of the profession
  • A member of the infection control team
  • A representative of the primary care team

The team will make a recommendation to the Department whether the Practice should be allowed to open, on the basis of having all the appropriate quality assurance measures in place. The Department, through its primary care team, will make a decision based on the recommendation of the team.
Re-assessment can be undertaken at any stage with prior notice to the dental practice.