Post COVID-19 Dental Treatment
This document outlines the modifications that we have made to our normal procedures for the re-opening of our practice following the current stage of COVID-19 outbreak.
Our #10 point back to safe dental treatment policy is based on the best available current scientific evidence and has been formulated in consultation with a wide variety of advice and guidelines from dental professionals and regulatory organizations.
This policy will be updated and modified as we gain more scientific evidence into COVID-19 to ensure that we offer the highest standard of SAFETY 1st FOR OUR PATIENTS & THE TEAM procedures in line with the recommendations and guidance published by the Public Health England (PHE).
SAFETY 1st FOR OUR PATIENTS & THE TEAM:
We have evaluated the scientific evidence and official advice and modified the way in which we deliver treatment in view of the lessons we have learned from COVID-19. The measures that we have put in place are practically designed to significantly reduce the risks of disease transmission to our staff and our patients, making use of the best practice guidelines and equipment.
The aim of this policy is to ensure the continued safety of our staff and all of our patients and we would appreciate your full cooperation in his matter.
How safe are we?
Scientific evidence has proven that dental practices have been at the forefront of prevention of cross-infection and spread of microorganisms and viruses (such as the AIDS and Hepatitis viruses) for years, employing the latest techniques, and procedures in specially designated cross infection, decontamination and sterilization rooms to ensure highest levels of patient and team safety. We believe that dental practices are some of the safest places one can visit during the current outbreak as we are well positioned to counteract the COVID-19 virus and prevent its spread to our staff and our patients through our highly developed and audited decontamination measures at our practices. We review and audit our cross-infection and decontamination procedures regularly which are examined by the CQC and use specialized equipment such as vacuum autoclaves, medical washer disinfectants and ultra-sonic instrument decontamination techniques. The sterilization cycles are electronically recorded and audited regularly.
Where appropriate we use germicidal UVC light disinfection within our surgeries. Our operating room and surgery are fitted with medical airborne infection isolation room (AIIR) /clean room air purification system using negative air pressure when appropriate to minimize the risk of aerosol contamination. Currently we have a dedicated small waiting room for our more vulnerable patients to use during their visit away from the main waiting room. Please discuss this with Mel before arriving at the Hospital if you are in a vulnerable group.
We have appointed a dedicated an environmental decontamination officer whose job is to look after all decontamination procedures and anti-viral measures, at regular intervals, throughout the day.
We will be carrying out daily staff monitoring and health checks to detect early signs of any possible Covid-19 virus infection amongst the team members. Staff will be asked to take their own temperature before setting off to work each day.
Moreover, we have categorized dental procedures (e.g. Aerosol Producing Procedures APG; non-aerosol producing treatments) and use appropriate PPE accordingly. Invasive surgical procedures are carried out in an operating room where the patients and the team are gowned with surgical attire to reduce the risk of cross-infection where the room air is purified using hospital grade HEPA filtration.
Initially we will offer urgent/emergency treatment to our patients, followed by completion of outstanding treatment and will return, in a phased approach, to provide full dental implant treatment.
Our centre has been selected as a new DenScreen COVID-19 antibody testing service (lead by a professor of Infectious Diseases at Global Health at University of Manchester). This antibody testing is now readily available for our patients to screen the presence of immunity or exclude any current COVID-19 infection prior to the commencement of dental implant treatment based on the results of pre-screening questionnaire. If you are interested in having an elective COVID-19 testing please discuss this with us.
Pre-appointment Screening and Patient Communication
We have identified the need to fully communicate our new policy and extra procedures to our patients, to ensure full understanding and cooperation before their arrival for treatment. We will be using, where possible, e-forms rather than paper forms and ask you to pay by contactless cards or BACS payments where possible. We will ask you to complete a Pre-appointment health screening questionnaire before arriving for your appointment. By screening the patient’s general well-being and their medical condition, we can determine a risk profile & vulnerability and schedule appointments accordingly to reduce the risk of possible transmission of Covid-19. Obviously, safety can never be absolute and the risk cannot be eliminated completely. However by putting in place, an evidence-based, robust multi-layered risk management strategy that makes use of the latest technology of air purification and disinfection systems, appropriate social distancing as well as use of the up to date PPE including when appropriate carrying out COVID-19 testing, we are highly confident that we can maintain one of the safest environments against COVID-19 to secure the safety and well-being of both our patients and members of our team.
Click here to download and complete our pre-appointment screening questionnaire.
Whenever possible, the appointments will be staggered and prolonged to allow time for these extra measures between cases. We thank you for your understanding and cooperation in these difficult times.
Arrival at the practice and the Check-in Process
To observe the social distancing rules, we will be reducing the number of patients in the waiting room, and so where possible appointments will be staggered.
The seating will be arranged according to social distancing rules so please respect as much as possible the personal exclusion zone. At certain times, we may ask you to wait outside or in your car, and we will call you by phone when we are ready for you to enter the reception area.
Restricted Practice Entry
Entry to the practice will be restricted to essential staff only. We have developed an open delivery policy for deliveries from the suppliers and dental laboratories. We would like to ask you to attend on your own whenever possible.
Removal of non-essential staff and clutter of equipment
We have carried out an audit of our facilities and removed all non-essential clutter and equipment. Unfortunately, this also include the removal of tea and coffee making and reading material such as newspapers from the waiting room.
All deliveries to the practice from suppliers and dental laboratories will be collected outside the building and will be cleaned with disinfectants before bringing any such items into the practice.
Identify Risk Categories and contain Aerosol Generating Procedures (AGP)
We have categorized the dental treatment to aerosol generating vs non-aerosol generating procedures and put in place additional measures when AGPs are carried out. Similarly, patient’s treatment needs and vulnerability have been categorized in order to deliver treatments in the safest and most efficient manner. Please excuse us if you see us wearing heavy duty PPE gowns, large respirator masks and visors. This is done to ensure that we maintain the highest level of patient and staff safety and well being.
New Role: Environmental Decontamination Officer
We have appointed a dedicated an environmental decontamination officer whose job is to look after all decontamination procedures and anti-viral measures, at regular intervals, throughout the day and work closely with our decontamination lead.
Second Preop Screening and preparation for treatment
When you arrive at the hospital you will be greeted by one of our reception staff and be given a mask to wear which you must dispose of when leaving the hospital in the bins provided. There will be hand sanitizers at the reception area. Whenever possible we would advise the use of contactless electronic forms and pre-payment by BACS/online banking. However, our credit card terminals will be disinfected after each use at the reception.
You will be taken to the treatment room where we would help you to place your overcoat or jacket into a plastic container where it will be kept during your treatment.
Before your treatment you will be given a disposable bib, goggles and asked to rinse your mouth with hydrogen peroxide or iodine or hypochlorous (HOCL) mouth wash for 1 minute. If necessary, a nasal swab disinfectant might also be used.
During your treatment we will wear the necessary PPE which will vary slightly depending on the type of AGP or non-AGP procedure you will require. For most non-AGP treatment we will wear a surgical mask, our usual scrubs and goggles/glasses. For AGP procedures we may don a disposable gown and a filtered mask (known as FFP2 or FFP3 or N95). We may also wear a face shield over our masks.
The treatment room will be equipped with medical isolation room air filtration units which unfortunately could give higher background noise produced by the high-volume extractor fan. We apologize for this and thank you for your understanding in these unprecedented times.
In some cases we may choose to use an extra-oral air extraction hose near the operating field to capture reduce the percentage of aerosols/ droplets produced during the treatment. This may be supplemented with use of rubber dam or mouth shield.
After the completion of your treatment you will be asked to wash your hands, put your mask on and leave the room to put your jacket or overcoat on (outside the treatment room).
Please read this document and kindly observe the necessary protocols we put in place in order to keep the safety at its highest level.
Decontamination and cleaning of the room and the instruments after your treatment
Current evidence shows that Covid-19 and similar pathogens can stay in the room after and AGP procedure at least up to 1 hour. Therefore, time will be taken to allow the filtration of the air in the treatment room and disinfection procedures. We step up the rate of air changes, using our hospital grade, medical isolation room air purification equipment (AIIR) in order to capture and kill any viruses in the atmosphere. We also use additional multi-layered virus control measures including powerful germicidal ultraviolet light (UVGI)and Hypochlorous steamers for air and surface disinfection. The room is decontaminated by a member of staff who dons the required disposable PPE.
We have opened our practice starting from 8th June 2020.
We have spent the first few days to address the urgent needs of our patients who have encountered dentally related problems during the lock down period. We will resume normal treatments in a phased approach. Mel will be available to help to arrange a suitable appointment for you as usual.
Furthermore, patients that are currently under treatment, which has been delayed or postponed, will be prioritized for the first three months.
Before your appointment:
- You will be asked to fill in and sign a new medical history and Covid-19 pre-appointment screening questionnaire, it would be ideal if you could fill this form (no earlier than 3 days before your appointment) and send it to Mel by email- alternatively you could complete the form online at Covid-19 screening questionnaire
- If you have any COVID-19 symptoms we will ask you to delay treatment by 4 weeks.
- If you have urgent/emergency dental treatment needs you will be asked to contact your normal dentist or the NHS 111 triaging for referral to the NHS Urgent Treatment Centres as we do not provide routine dental care at our centre
- If you are in a high-risk group, unless your treatment is urgent, we recommend you delay treatment until the Covid-19 alert level is reduced further.
- More information on whether you are in a high-risk group may be found at https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/
- We would advise that you pay our fees with contactless card payments, or if you know the cost of your treatment, by BACS transfer prior to your appointment.
- The bank details are T C Ucer Ltd., Sort Code: 09 02 22 Account Number: 10865479. Please put your name as a reference.
- Please feel free to call Mel (0161 237 1842) if you require further assistance as to the cost of your treatment.
- Please carry hand sanitizer with you at all times, use regularly and avoid touching your face, mouth and nose. Please wash your hands thoroughly at every opportunity. Wearing a face mask or a cover has been shown to be effective in public.
On Arrival at the Practice:
- To observe the social distancing rules, we will need to reduce the number of patients in the waiting room, and so where possible appointments will be staggered.
- The seating will be arranged according to social distancing rules so please respect as much as possible the personal exclusion zone.
- At certain times, we may ask you to wait outside or in your car, and we will call you by phone when we are ready for you to enter the reception area. Please ensure that all your contact details are accurate on the attached medical history form. It would be helpful if you could call Mel on 0161 237 1842 on arrival at the ICE Hospital to let her know if the entry to the waiting room is restricted.
- When you attend the practice your temperature may be assessed, and if your temperature were to be elevated you will be asked to return home and self-isolate. You may monitor your temperature at home, before travelling for your appointment, and let us know if you think it may be above the normal.
- If necessary COVID-19 antibody test will be offered to you at the practice.
In the Surgery:
- We will ask you to disinfect your hands.
- Carry out an antiseptic mouthwash (e.g. Corsodyl or Hydrogen peroxide, or povidone-iodine gargle) and. Our clinical staff will be carrying out the same process regularly.
- If you have any concerns or allergies regarding Iodine or similar products such as Corsodyl please let us know.
- For procedures that involve the use of the high speed dental turbine (drill), scaling equipment or anything which involves generating an aerosol (APG) we will wear an appropriate special mask and PPE visor. We also may wear a gown and a hat when necessary.
After your appointment:
- We may recommend that future appointments are made by telephone or email, to avoid patients staying in the waiting room longer following their treatment.
- You may be able to pay using CC or by BACS transfer
What will we be doing:
- Unfortunately, tea/coffee-making facilitates have been removed and there will not be any reading materials, newspapers or magazines at the waiting room.
- We have removed all non-essential items so that we can effectively disinfect all surfaces. So, forgive us if the practice looks sparse.
- We will be continuously wiping the door handles and surfaces with appropriate anti-viral agents such as hypochlorous and may use steamers or air misting equipment. This kills the virus within a minute or two as hypochlorous acid is shown to be at least 100 times more effective than bleach (Domestos).
- We have increased the time we allow for each appointment and the spaces between appointments. This is to increase social distancing and to allow more time for cleaning.
- Any staff that show symptoms or are a potential risk for transmission are asked to self-isolate.
- We carry out staff COVID-19 tests in-house when necessary in order to identify and limit the spread of SARS Cov2 virus transmissions at the practice.
What are the risks of attending for your dental treatment?
- It has been shown that viral transmissions can be reduced significantly by hand washing, wearing gowns, protective masks and gloves. Use of anti-viral nasal swabs and mouth rinses are also highly effective measures. We have very high standards of cross-infection and decontamination which have been further augmented by using all the measures we highlighted in this document
- Aerosol that may be produced when talking, sneezing and during some dental procedures can suspended in the air as a potential source of infection which we wish to keep to a minimum, however:
- Our normal dental suction reduces aerosols by over 90%
- Our normal face masks filter 60% of remaining particles, and the protective masks (FFP2 and FFP3) filter 94-99%. We will wear the mask appropriate to the category of procedure.
- Our hospital grade isolation room air filtration & purification system (AIIR) is rated to achieve >12 ACH (air changes per hour) to filter viruses and contaminants from the atmosphere in the treatment rooms.
- We use hypochlorous which is much more stronger then domestos or bleach and a strong germicidal UV light (UVGI)
- When appropriate we use high-volume, at source extra-oral suction devices to eliminate the spread of aerosols during delta procedures
- Scientific evidence has shown that modern dental practices, thanks to high levels of cross infection control, are extremely safe places to prevent disease transmission provided that these measures are vigilantly applied.
- Our decontamination procedures are audited and our practice is regulated and monitored by the Care Quality Commission (CQC) who carry out regulatory inspections periodically.
We acknowledge and thank all our patients and staff for their understanding and patience at this time.
Professor Cemal Ucer, BDS, MSc, PhD, FDTFEd. (RCSEd)
Professor of Dental Implantology, University of Salford
Specialist Oral Surgeon
Fellow of the ITI
Fellow of British Association of Oral & Maxillofacial Surgeons
Fellow of the Faculty of Dental Trainers, Royal College of Surgeons, Edinburgh