1.0 OBJECTIVES

  • The purpose of this document is to act as a reference point for staff and patients. Its purpose is to act a general policy of Centre of Dental Excellence relating to there-opening for the routine opening and operating processes after Covid-19 pandemic.

  • The amount of information in the online and media is diverse, and this document will collate as far as possible all available evidence and regulatory advice. This document will provide accurate information and easily referenceable.

  • This document will be maintained up to date will all guidelines issued by the monitoring bodies and government.

  • All staff is required to work in a team for the safety of our patients and colleagues, therefore it is mandatory to allocate sufficient time to read this document.

2.0 INTRODUCTION AND BACKGROUND

  • Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus (SARS-CoV-2).

  • The current national approach is to ensure that social distancing measures are observed to reduce social interaction between people in order to reduce the transmission of coronavirus (COVID-19)

  • Stringent social distancing measures are required for those at increased risk of severe illness and shielded population groups.

  • Human coronaviruses can survive on inanimate objects and can remain viable for up to 5 days at temperatures of 22-25°C and relative humidity of 40-50% (which is typical of air-conditioned indoor environments).

  • During the time of writing there is no vaccine or approved medicine that is proven to be effective against COVID-19 though clinical trials are being conducted on various medication combinations.

  • As per government decisions it has been necessary to cease practicing routine dentistry for more than two months upon advice from our regulators.  

  • The closure period of time has led us, dental professionals, to entirely rethink of how to modify our practice procedures, to continue to provide the safe environment we used to have before COVID-19, to maintain staff and patients safety.

  • The re-opening strategy of our practice has started from the first day of closure, evaluating literature available of the time of writing this procedure, clinical studies from international bodies, advise from the World Health Organisation.

  • Endless research, international and national forums have approached dental industry and different standard operating procedures have been produced. The promotors of these procedures have been approached by Urgent Dental Care Centres, the ones that had to “meet” the virus via patients who had to be treated. 

  • On multiple occasions the information obtained was contradictory, open to interpretation and unclear in certain areas.

  • The novelty of Covid-19 was its behaviour. Symptoms were from mild to moderate, from barely detectable to high morbidity and certain groups of people had higher risks than others.

  • Our duty is to ensure the our environment offers protection towards staff, as well as patients and that everyone has in depth understanding about the actions and procedures that have been put in place to protect everyone.

  • Although the guidelines have not been clear, this document has been created after reading as much of the available evidence and is forming the basis of Centre of Dental Excellence policy in an realistic approach or reducing risk  of cross infection between all persons that attend CODE

  • As further advice and knowledge will develop, our SOP will adapt accordingly.

 

2.1 Current regulatory advice for dental practices in the UK

 

3.0 PRINCIPLES OF RISK REDUCTION RECOMMENDATIONS (RRR) AND MEASURES TAKEN

  • As the research develops and accurate information becomes available, it is clear that the COVID-19 will continue to exist amongst us and will not be eradicated. It will go on the list with common flu viruses.

  • There is no current medication to cure this disease and there is a need of further research and years to develop an efficient vaccine.

  • This means that there will always remain a risk that coronavirus infection can be contracted during normal day-to-day activity and it is impossible for CODE to control the environments in which our patients and staff circulate outside the practice. However, we can do a considerable amount to reduce the risk of exposure to this virus at CODE itself. 

  • There have been many suggestions to reduce risk and we have adopted as many of them as possible while still allowing us to carry out dental procedures to a high standard. We have also questioned and researched rationale behind advice given. 

  • We often read that many of these additional procedures have no evidence to support their efficacy in reduction of cross infection. However, absence of evidence is not necessarily evidence of absence, especially for a disease that is so new. We must keep an open mind and learn from similar outbreaks.

  • Our starting point is the list of the government’s basic social distancing and personal precaution guidelines on https://www.gov.uk/coronavirus which all team members and patients should be familiar with and comply with for day to day protection.

  • Further measures taken by Centre of Dental Excellence:

  • Risk assessment of our entire team prior to commencing reopening 

  • Pre-appointment triaging of risk levels for individual patients o reduction in incidences of contact between staff and patients as far as possible

  • Video assessment before consultation appointment

  • Reduction in risk of transmission whilst on our premises. 

  • Our protocols that provide safety to patients and staff alike are already in place and are tried and tested over the years. A dental practice is one of the best controlled and cleanest environments alongside operating theatres and food production facilities due to high infection and prevention control, supervised by a practice manager, infection control nurse and scrutinised periodically by the governing bodies ( CQC).

  • Please be assured that this document represents many days of work and consideration and will hopefully relay to the reader that we take this issue seriously. 

 
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