Public attitudes on returning to dentistry post COVID-19 – the practice

As practices start to open their doors for face-to-face treatment, Michael Heffernan discusses what practices need to do to reassure patients of safetyAs dental teams start to open their doors for face-to-face treatment, Michael Heffernan discusses what practices need to do to reassure and communicate.

In our first article we discussed the potential impacts on hygienists of the recent survey by Dr. Heff’s Remarkable Mint. 

Anybody with an interest in dentistry will find this survey of significance as almost 75% of the survey sample visits the dentist regularly so this is our key demographic. In this article we intend to look at the wider dental practice.

Key points from the survey include:

  1. Due to concerns regarding coronavirus, twice as many patients would delay their routine dental appointments than attend
  2.  1 in 3 UK adults will visit their dentist less frequently after ‘lockdown’
  3. Half of UK adults will cancel or delay planned treatments if dental fees increase due to the cost of personal protective equipment (PPE)
  4. 80% of adults think dentists and hygienists will have to work hard to reassure patients that their practice is safe and hygienic
  5.  Adults are split 50:50 on whether they would want dental check up online via video.

Important considerations

As of 8th June 2020 dental practices in England have been given the go ahead to start seeing patients.

However, every dental practice will need to demonstrate adequate infection prevention control (IPC) and source personal protective equipment (PPE). They also need to fit-test all chair-side dental practitioners and nursing staff for the appropriate level of respirator masks.

They must also train staff on the patient journey from pre-assessments, through the dental procedure and then consider long fallow periods before safely disinfecting the surgery (1).

Unfortunately, this will result in greater costs for the practice. This includes PPE, staff training and fit testing, investment in protection for reception, greater supplies of disinfectants and disposables, and time consumed contacting patients for pre-assessments.

But to add to this there will likely be less income generated. Time will be required to don and doff protective gear, as well as fallow time following AGPs and disinfection time on top. All of this will no doubt challenge the timetabling of patients and the use of dental personnel and surgery space.

There is no doubt that costs will increase and income will decrease. But what do patients make of this?

Financia survival

From the Dr Heff’s survey it is clear they want to see the steps being taken to protect them. A massive 80% need reassurance that the practice is safe. This has to be included in any messaging to patients that your practice is now “open for business”.

This has to be borne out by all members of the dental team, reinforcing the positive steps the practice has taken in IPC. Given the concern with patients coming to the practice and the restraints of the new dental experience, this will need to be done in communications in the run up to the appointment day.

Let’s assume we can get our patients to walk back through the door. The next thorny question is how can practices survive financially with the added cost burden of PPE for most income-generating procedures, which tend to be the aerosol-generating procedures?

Added ‘PPE levy’?

Does the practice put up prices overall to cover the cost? Impose a ‘COVID PPE levy’? Or take on the added expense? From the survey, 50% of patients would both delay coming in for routine consultations and also put off planned dental treatment. This is usually more income generating.

And if we look into greater detail at the responses, it is not just half that feel this way. The responses are three to four times more ‘strongly’ in favour of delaying dental appointments due to costs of PPE being placed on the patient rather than a moderate reaction.

From my point of view as a specialist dentist – seeing only a few patients but for numerous treatments – this might feel like a ‘nickel and dime’ approach if we need to charge £40.00, for example, as a PPE levy on each visit. How will this added charge work out for hygienists who might see periodontal patients every three months? At the end of the day, the money needs to be found somewhere. As a result, each practice will need to decide what suits them best.

Value in technology

Over the lockdown there has been much made of video technology to meet and keep in touch. There are a number of very progressive apps touted for dental consultations. Certainly this can be of merit within the orthodontist community and likely of benefit with motivation in oral hygiene. But it is questionable if this will replace a proper dental examination with light, loupes, soft tissue palpation and probing for periodontal disease.

It also appears from the Dr. Heff’s survey that patients are equally split on their enthusiasm for this type of technology interaction. As we delve into the data, we find the people who most need the on-going support from home – those over 65 years old – are the ones who are least comfortable with this technology.

However, there does appear to be more enthusiasm for a dental app that would help with daily oral hygiene measures. This could be a useful resource if linked to risk factors identified by the dentist, hygienist and therapist from previous appointments. However, whether this can be utilised in the longer term and how this changes the financial situation of the dental practice is unclear, unless part of a capitation scheme payment.

Loud and clear

We are reminded by how quickly new approaches have been adopted as a result of the pandemic. It does appear we are moving more into the preventative dentistry age that is visualised by minimal invasive oral care and touted by the chief dental officer England (2, 3). In the Dr Heff’s survey, there is a demonstrable increase in awareness of dental health in the general public. We need to continue this wave of motivation.

Therefore, dental practices will inevitably need to change to accommodate patients’ expectations of infection control. Perhaps we did not previously make enough of the strengths of dental infection prevention before the pandemic.

We need to tell our patients loud and clear what we are doing. We need to tell them the added cost burden and make decisions on how this is paid for. As we look to the future, it might be that financial incentives will lay in the preventative rather than restorative-driven dental practice.

In our third article we will take a look at the patients. Using the survey, it will throw light on what can be done to help them with their post-lockdown oral health.

Additionally, the full survey is available on our website www.drheffs.com.


References

Implications of COVID-19 for the safe management of general dental practice. A practical guide 1st June 2020. College of General Dentistry and Faculty of General Dental Practice 2020.

Hurley, S. Why re-invent the wheel if you’ve run out of road?. Br Dent J 228, 755–756 (2020). https://doi.org/10.1038/s41415-020-1646-z

Banerjee A. ‘MI’opia or 20/20 vision? Brit Dent J 2013; 214: 101–105.

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