UK dental schools and hospitals have been working in partnership to find innovative solutions to the complex challenges presented by COVID-19.
Of the clinical professions, dental education has been one of the most severely affected by the COVID-19 pandemic. This is because of the fine water clouds that drilling teeth can sometimes create. These fine clouds of water spray are known as aerosol and contain both substantial amounts of water from the drills that dentists use and smaller amounts of patients’ saliva. The risk of infection by SARS-CoV-2 posed by the small amounts of saliva in these aerosols and the precise dilution of the saliva in the clean water used by the drill is yet to be determined.
Aerosols are therefore a problem in primary (high-street) dentistry and are being actively managed by leaving long gaps between patients (‘fallow’ times of up to one hour after procedures). The problem is exacerbated in dental education, however, because dental students are taught how to drill in open-plan, multi-chair clinics – magnifying the amount of aerosol potentially produced if all chairs are in action at once. Dental students treat over 400,000 volunteer patients each year and a reduction in clinical experience could affect their ability to graduate and enter the workforce to the anticipated timescale.
Current solutions include: active research by dental academics to quantify and mitigate the risk posed by aerosol so that clinics can be reconfigured to provide care appropriately; more simulated activity on mannequins; using different drills; improving air flows in clinics; anticipating changes to and/or extended hours of teaching once dental schools begin the new academic year; and ensuring sufficient supplies of personal protective equipment.
Guiding principles to mitigate risk
With appropriate and planned mitigations in place it is possible to return to the open plan clinical environment and undertake both non-aerosol and aerosol generating procedures. Investment will be required to allow the required mitigations to be implemented across all UK and Irish Schools.
Together with the Association of Dental Hospitals, the Dental Schools Council has outlined a set of guiding principles to support UK and Irish dental schools and hospitals towards the safe return of educational placement provision within open plan clinics.
The overarching guiding principles of this document include:
- Patient, student and staff safety and well-being is a priority.
- Appropriate social distancing and associated risk mitigation measures should be in place. These should include movements of patients, staff and students.
- To mitigate the spread of splatter and AGPs students must not work without a chairside assistant.
- No vulnerable patients will be exposed to AGPs on an open plan clinic.
- There should be adherence to government guidelines at all times.