Why are we closed? Why are we only seeing urgent emergencies? Why won’t we carry out regular treatments?
It said on the TV news last night that it was fine for dentists to keep working as normal. The Irish Chief Dental Officer says there is no need for dentists to change things, so what’s going on?
Well, rather a lot as it happens.
After the closure of schools and the beginning of more significant social distancing actions over the last week, we took the decision to cease all routine treatment. Why? Well, firstly it’s hard to social distance if we are working in someone’s mouth! And yes we take universal precautions, but in the face of this virus, those measures are very unlikely to be effective enough.
Most dental procedures generate an Aerosol, or spray. Once this corona-virus is released in an aerosol form, it can persist in the air for up to three hours. It can survive on hard surfaces for up to three days. But most importantly this virus is likely shed when the patient is asymptomatic.
So lets look at the advice given by our Chief Dental Officer. It states that “There is no current scientific evidence to justify denial of dental care to members of the public who have neither fever nor respiratory symptoms.” And if this were the SARS outbreak of 2003 that would be true. That outbreak was ultimately controlled.
But this one is very different.
In a few months it’s global. Why? Well it’s quite simple: “Emerging evidence suggests that people infected with SARS-CoV-2 might be spreading virus without recognizing, or prior to recognizing, symptoms.”
https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces
So if the virus can be shed in an asymptomatic patient, and I generate an aerosol by cleaning their teeth, the air in that room could be contaminated by virus suspended in the air for up to three hours. And then you walk in next (and my team and I probably get infected too, and bring it home to our families as well).
But it gets worse.
While our Chief Dental Officer is telling independently practicing dentists to “get on with it”, the State Dental service operated by the Health Service Executive (HSE) are operating to a completely different (and much more sensible) set of rules. Their rules clearly state that Aerosol and all routine procedures are to be avoided. So we have completely different rules for two groups of dentists.
So no. I won’t follow the advice of our Chief Dental Officer. Nor will lots of other dentists. Mark, Carla and I, along with over 300 other dentists, signed an open letter calling for a change to this policy, to at least harmonise the rules between independent and state sector. The Chief Dental officer simply ignored us, and restated her advice.
Mark, Carla and I will not act in a way that endangers our patients, ourselves, and the wider public. We consider the Chief Dental Officer’s advice dangerous. We have no idea what the way back to “normality” is at this point for dentistry. Our business may or may not survive all this, but we will still put our patients, put you, first. No matter the cost.
We will endeavour to see urgent emergencies for our existing patients and their families, but please understand we will be very limited in terms of what treatment we can offer.
One last thing. You don’t need take our word for it. Dental authorities and regulators from many jurisdictions also disagree with our Chief Dental Officer. All over Europe and elsewhere, dentists are being instructed to stop carrying out routine treatment, and avoid aerosol-producing procedures.
The list below is far from exhaustive, it’s really only a cross section, but I think it makes our point.
Stay safe.
Useful Links:
Scottish and Welsh Chief Dental Officers restricts most routine and aerosol procedures.
Northern Ireland Chief Dental Officer restricts most routine and aerosol procedures.
Dutch Dental Association stops all routine care and aerosol procedures.
French Regulator shuts all Dental Offices completely apart from telephone consultation
American Dental Association advises nation-wide Postponing all non-emergency work
Canadian Regulators advise emergency treatment only in (among others):
Alberta
Click to access Guidelines-on-Emergency-Treatment.pdf
Ontario
https://www.rcdso.org/en-ca/patients-general-public/covid-19–novel-coronavirus-for-patients
Quebec:
http://bulletin.odq.qc.ca/T/OFSYS/SM2/786/2/S/F/6469/950627/ZQSbLugG/698101.html
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