CDO letter - cessation of routine dental care - further advice

Letter from Tom Ferris, Chief Dental Officer, on the cessation of all routine dentistry due to the current coronavirus pandemic

Please download the letter of the Chief Dental Officer & Dentistry Division OR read below:

Population Health Directorate
Chief Dental Officer & Dentistry Division
T: 0131-244 2302

NHS Dental Services

Our ref: POL/33888

23 March 2020

Dear Colleague

Last week I wrote to you to phase out aerosol generating procedures and to cease routine dental care for people in vulnerable groups (older people, those with underlying health conditions and pregnancy) where there was a need to reduce their inter person and close personal contact. I thank you for your support in implementing such a difficult decision.

I have had l lot of feedback from colleagues that many people are deciding to defer their dental care and ‘normal’ dental practice is no more. Now that schools, colleges, hospitality and leisure outlets are closed and the importance of social distancing becomes ever more important;
dentistry needs to move on to our next phase of COVID-19 preparedness. Therefore, from close of play today:

  • All routine dentistry should cease.
  • Dental team members who are pregnant or otherwise immunosuppressed should not provide or assist in the direct care of patients.
  • It may be helpful for practice staff to split into teams so that the full staff complement is not in the practice at any one time.
  • We have already stopped Aerosol Generating Procedures (AGPs) in dental practice, with an exception for ‘open to drain’ in urgent circumstances; this exception should now cease too. Practices should operate on an Advice: Analgesia: Anti-microbial basis. Where an extraction is not indicated an anti-microbial will provide relief until the tooth can be opened and drained by an urgent dental care team wearing appropriate PPE in a designated clinical environment.
  • Practices should work together in localities through ‘buddy arrangements’ to ensure that people can make contact with a dental professional during normal working hours.

  • This contact should be by telephone to avoid patients presenting at a practice, to minimise any contact whilst travelling or in the practice. Practice teams should make every effort to triage, advise and reassure patients who have a dental problem.

  • There may be instances where an assessment in person is required, practice teams should use robust standard PPE procedures, only see patients who are asymptomatic and try to keep face to face assessments to an absolute minimum.

  • Patients identified through telephone consultation, who do have an urgent dental need that cannot be delayed should be directed to your NHS Board designated PDS/HDS urgent dental care centre.

  • No patient should attend the practice or urgent centre in person without a pre-agreed appointment.

  • NHS Boards will work with local practices to understand the locality based ‘buddying’ arrangements in place and ensure that practices have details of the referral pathway to urgent care centres. 

  • In the event of a significant and rapid escalation of COVID-19 NHS Boards will move to a centralised urgent care only service for people who are asymptomatic for COVID-19. They will require assistance from dental team members in practices to contribute to the staff rota at the centre.

  • NHS Boards must ensure that PDS/ HDS dental teams at the designated urgent care centres have been trained in the use of and access to FFP3 respirators.

  • FFP3 is a limited resource and it is not practical or desirable to train, fit test and supply to every dental practice team. It will be available at the designated centres where patients, positive or asymptomatic COVID-19, are being assessed and treated. 

Financial sustainability measures

Finally there has been significant concerns raised by those practitioners who are more reliant of the NHS patient charge for practice sustainability. I want to reassure you that the CDO team is working tirelessly to source additional NHS funding to address these concerns.
Additionally, I would ask that you and your professional organisations explore other avenues of COVID-19 support for small businesses.

These are incredibly challenging times and I value your continuing support and appreciate the
tremendous dental team efforts taking place across GDS practices, PDS and HDS services
and NHS Boards in Scotland.

Together we will get through this.

Yours sincerely

Tom Ferris
Chief Dental Officer


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