Lessons from Houston, Texas, as dental practices reopen

Houston, Texas dental practices reopenAs Houston, Texas reopens its dental practices, what can we learn for our practices and patients in the UK?

Yesterday saw the reopening of dental practices for clinical appointments across Houston, Texas USA.

New American Dental Association (ADA) guidelines are changing the way clinicians practice dentistry. Post COVID-19 guidelines in Texas say:

  • Full PPE for all dental teams, safety is the first priority of all staff
  • Installation of reception screens to prevent spread of the virus
  • Practices should pass all the cost of PPE on to patients
  • Scaling only by hand – no use of ultrasonic scaling
  • Extensive practice cleaning between patients.

Here in the UK, as clinicians and practice owners watch and wait for lockdown to lift, could we be following Houston’s lead? If so, how do we prepare?

The ADA says practices should pass the cost of PPE on to patients. If the UK follows this model, what impact could this have on funding NHS appointments?

In principle and in practice

Dr Andrea Ubhi is chairing ‘preparing for the end of lockdown thinktanks’ with practice owners throughout the UK.

She says: ‘The dental industry is going to change. Until we know the guidelines for the UK we can only anticipate what our model will be.

‘Looking at the Texan approach, if we were to pass on the costs to patients of PPE this would have a huge impact. This could have disastrous consequences in particular for NHS funding, which could in turn mean less appointments for less patients. All at a time when access will already be a challenge.

The true cost of PPE

‘How we charge patients, in my opinion, will have to change,’ Dr Ubhi continues. ‘Will practices face the choice of charging for the additional PPE costs and extra time or bearing the additional costs and facing possible bankruptcy?

‘For patients, this could mean they can’t afford to see their dentists, even for routine appointments. This leaves our intervention to when they have an emergency. Ultimately leading to a rise in lost teeth and unhealthy dentition.

‘It could undo so much hard work we have done to instil the importance of regular check-ups. A disaster for the nation’s oral health, and of course the impact this could then have on their overall health.’

Cleaning could be costly

‘The focus on making clinics as sterile as possible with extensive cleaning measures will have a huge impact,’ Dr Ubhi says. ‘After the use of procedures using aerosols, we will need to leave 30 to 60 minutes for surgery disinfection between patients. That’s a lot of fallow time. It could mean 50% less patients seen each day and therefore 50% less revenue.

‘For everyone, PPE is imperative. Getting the right protection means we can work effectively. Lots of suppliers are innovating but currently as we can see from NHS front line workers, PPE can be cumbersome and uncomfortable to wear and can make clinicians over-heat.

‘Purchasing of and budgeting for PPE will hit practices financially. Forecasting this should be done in my view now, but also for the long term. Increased PPE is here to stay.

Waiting game

‘We will also have review the physical layout of our practices and adapt to ensure both staff and patients are protected,’ Dr Ubhi points out. ‘Screen installations for example may need installing at reception – another cost that will need considering. But vital for operations.

‘Practically, doing your research now and getting advice on how and where you can kit your clinic out is hugely important. If we don’t plan now we face losing time when we do get the go-ahead to treat patients.

‘How we see patients and welcome them into the practice will also change. Pre-visit medical histories and temperature checks for everyone’s protection is the most obvious procedure. It’s vital before admission.

‘The Texan way provides a very logical approach when it comes to banning the use of the ultrasonic scaling or polishing. Aerosol increases the risk of pathogen transfer. Until we have an alternative or full PPE, it makes total sense to not use them.

‘This would mean hand scaling would become the norm, taking us back 30 years. It will result in longer hygiene appointments and possibly reduced therapeutic effect.

‘Although these changes will cost financially and bring dramatic changes to how we operate in business, we have to be realistic and brace ourselves, our teams and clinics for what is about to come.

‘Whilst we are in lockdown, some of us might have the benefit from the time to research, forecast and scenario plan. I know some have had significant challenges of parenting and home-schooling. But I strongly recommend we dedicate time to plan.

World view

‘I would say that keeping a close eye on Houston would be wise, along with the other countries emerging from lockdown,’ Dr Ubhi concludes.

Collaborating with colleagues from across the UK and the globe has been a focus for Dr Ubhi during lockdown as well as members of her team from outside the UK.

Dr Remo Costi, a specialist Italian orthodontist, one of Dr Andrea Ubhi’s associates who commutes from Italy, says that: ‘The new normal of dentistry has opened in Italy this week. The changes are significant here, and like Texas, my biggest concerns are the increased cost of additional PPE and how this is going to be met.’

Andrea has launched a series of interviews entitled ‘Andrea Ubhi meets’, which Andrea plans to continue once lockdown comes to an end.

She says: ‘Sharing knowledge during lockdown has been invaluable. Learning from each other and being collaborative means we grow and learn.

‘We are in this together and as an industry we have never needed that support network so much. Looking globally at practices in Italy who have come out of lockdown, China and now Texas is vital.

‘We need to learn lessons from other countries and feed these into the government as they plan a strategy for the UK.’


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