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Important Cronovirus (Covid 19) Information
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UPDATE 27/10/2020 Thank you for your patience during these challenging times and we are still here at your service! We have continued to provide Emergency Care for our patients since the Practice closed to routine care on 18th March. Many of you have visited us during this time and hopefully these emergency or interim treatments have been effective and we can provide more permanent solutions as required in the future. In the recent months, when we have seen you for these emergencies, we have also carried out the routine Oral Cancer Screening, Examinations with scaling and Oral Hygiene reviews. We will be starting to contact you shortly to arrange your routine Oral Cancer Screening and Examinations so we can prioritise any treatment you need. (New Lockdown measures allowing.) Unfortunately, we have limited surgery time due to our Coronavirus safety procedures as we want to keep everyone as safe as possible. Therefore appointments will be offered at slightly short notice but at your convenience. Our major concern is the transmission of the virus by unavoidable close contact and especially by the aerosol route – ie by saliva and breath vapour being spread by the air currents created by rotating instruments and the blowing of pressured air - Aerosol Generating Procedures (AGP). Our protection measures include (but are not limited to): Monitoring the Coronavirus Alert Levels for our area. Checking medical and travel history of Patients before they are seen and restricting Care to only our Patients. Asking patients to wait in their cars or outside before being invited in at their appointment time. Patients are required to wear masks and sanitize their hands on entry and before leaving. In-between patient appointments, our usual routine of cleaning all surfaces continues but is enhanced to remove the potential of Coronavirus droplet and fomite transmission. For ‘Non AGP’ face to face appointments and procedures we can provide a high level of protection by the wearing of the appropriate PPE – masks, visors, gloves and aprons. We have upped this protection further by wearing the FFP2 (filtering face piece) face masks which gives a significantly higher level of confidence that we can protect against a potential risk both to you from us and us from you. Because this virus can spread by close contact and can be present in the air even without ‘AGPs’, we are changing the air in the surgery between patients and you may have seen our orange extraction tubing in place. The machine moves 1500 cubic metres of air per hour and so in 10 minutes carries out about five changes of surgery air. After this the enhanced routine cleaning of the surgery can start. For ‘AGPs’, our PPE is again enhanced to FFP3 (filtering face piece) facemasks and full gowns, high volume external aspiration of any spray and the Surgery air is extracted for 20 minutes ( 10 air changes) when the patient leaves. After this the enhanced routine cleaning of the surgery can start. The downside of these procedures is the longer time interval between patients and hence our limited number of appointments each day. Please be in touch if you have any dental problems and we look forward to seeing you soon Hopefully, this message will find you safe and well during this difficult and unpredictable time. I very much appreciate how supportive and understanding you have been when we have spoken. During the coronavirus lockdown we have been able to offer appointments to care for our patients who have had emergencies by using telephone triage and minimal intervention techniques. The main transmission of this virus is by airborne droplets from the respiratory system and is present in the mouth. But now, new evidence suggests airborne transmission can occur and not just from droplets which means a wider area of contamination. Aerosol Generated Procedures or the creation of large volume moisture clouds, containing saliva, are high risk procedures for patients and staff but especially to other Patients, so I do not feel we can risk the use of drills and air drying procedures at present, This severely limits what treatment we can offer at this stage. The concern is that the risk of being infected with SARS CoV-2, causing the disease known as COVID-19, which, for some of us, carries a high risk of hospitalisation and serious long-term illness, or even death. The reopening of NHS dental practices, announced by the Government, on Monday 8 June is to allow only limited treatment similar to what we have been providing during lockdown. This is some considerable distance away from the normal routine procedures we have been able to offer in the past. The new requirements to prevent the transmission of this SARCoV – 2 virus, involves the assumption that all patients and staff are potential carriers. However, the risk of transmitting SARS CoV-2 during dental procedures is greatly reduced by not carrying out aerosol generating procedures. They occur during some examinations, the ultrasonic cleaning of the teeth and cutting and shaping the teeth to provide fillings, crowns and root canal treatments. With no aerosols, our usual Personal Protective Equipment [PPE] with the addition of higher filtration masks, visors and disposable aprons will reduce the potential transmission of this virus from staff to patients and from patients to staff. Using no aerosols and extending the interval between patients will allow for the completion of the required additional cleaning processes for the surgery as well as ensuring that patients do not come into contact with other patients. This will minimise the risk of the patient to patient transmission, but it will reduce the number of patients we are able to care for in a session. The provision of safe routine aerosol generating Dentistry will be challenging but with the safety of our staff and patients being paramount, we, at the Nyewood Dental Practice, have decided not to carry out any aerosol generating procedures at present. We will be continuing to provide care for our Patients, as we have done throughout the crisis, either by telephone consultation with advice and/or provision of medication or with face to face treatments. For the treatment that we can provide, we have adopted new protocols and have the correct Personal Protective Equipment to keep you and ourselves as safe as possible. We will be contacting you to arrange new appointments in due course and we are starting to use our small garden area as an outside clinic, similar to my Nepal experiences, to improve our capacity see our patients for examination and to assess problems they may have. {Provided it is not raining!} This is a situation that will be closely monitored as returning to providing the full range of care options for our patients is the ultimate target. The dental profession has successfully reduced the risks in coping with viruses in the past and will hopefully develop a low risk method of providing treatment for this particular thought-provoking virus.
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