The consequences of COVID-19 in the dental practice

COVID in the dental practiceWe speak to Affan Saghir about how COVID-19 is changing the way he practices dentistry and the importance of planning and an attention to detail.

Please introduce yourself

My name is Dr Affan Saghir and I am a general dentist. I have been working since 2013 in the same dental practice.

The practice where I work is a relatively simple general dental practice. It is predominantly NHS based and it’s where I offer private cosmetic dental care to patients in addition to general dentistry.

Over the last few years, I have heavily invested in my dental education. I have now completed my postgraduate diploma in clear aligner therapy. Along with a postgraduate diploma in advanced aesthetic and restorative dentistry.

I am part of the teaching panel for Aligner Consulting, teaching about Invisalign Go. Invisalign Go is a safe form of orthodontic anterior alignment system for general dentists.

I also regularly teach for companies discussing tooth whitening (most recently for Philips about Zoom whitening), composite bonding, communication skills and consent.

How have you found going back into practice?

From a general dentist’s perspective, it is so lovely and refreshing to be back in my dental practice. You start to forget how much you rely on dentistry. For me it is a passion. I have my hobby back. I can help and reassure patients and create beautiful smiles. This is what drives me.

So, from my perspective, it is going back to something that means so much to me. I can pursue my passion – providing healthy, beautiful, lifelong smiles.

What new procedures have you introduced to help limit the spread of COVID-19?

To start off, we have taken onboard all guidelines.

The day before, the treatment coordination lead contacts the patient and undertakes a COVID risk assessment. They make sure that the patient is a suitable candidate for dental treatment within a dental practice setting.

On the day of the appointment, we welcome one patient into the waiting room at a time. We have a runner nurse who collects the patient and checks their temperature.

When we are ready for the patient, the runner nurse collects the patient and brings them into the waiting area.

We have two rooms. The donning room and the doffing room.

In the donning room, we have the equipment. So if the appointment is for an aerosol generated procedure (AGP), we use the equipment for the AGP session; if it a non-AGP session we use a different room set aside for non AGP procedures.

Once in the correct room, the runner nurse brings the patient and introduces them into the room and closes the door. All the instruments are placed in the room before the patient comes in.

We complete the treatment and have a fallow time of one hour. So when the patient leaves we start the donning procedure.

We are lucky to have a second surgery that we can use during the one-hour fallow period. The runner nurse will use the protocol to correctly decontaminate the room ready for the next patient.

It is a teamwork exercise; everyone is working together.

In our team we have the TCO, making sure the patient is appropriate to be treated outside of the building. The runner nurse escorting the patient from outside to inside of the surgery. And then we have the dental nurse and the dentist within the surgery, doing things under rubber dam, making sure they are using all the precautions needed, making sure they use the donning and doffing protocols.

After that, the patient is escorted back. And after the visit, we contact every single patient to make sure they had a good, safe visit. To ensure there haven’t been any issues. And check if they have any guidance or advice for us to continue to go in the right direction.

What new equipment (if any) do you use now in the practice?

I think it is more about the workflow.

We have used the last three months of lockdown to sit down and reflect on how to make our processes efficient, effective and compliant with the guidelines.

We now have a specialised donning area and a specialised doffing area, we have a runner nurse. And we try to do more things outside the practice and are contacting the patients a lot more.

So it is more protocol based changes rather than equipment based changes. We were lucky to already have a good array of equipment. In terms of the actual equipment we wear; we now have AGP masks from 3M, surgical drapes and gowns.

Have you seen a drop in patient numbers since coming back/how are you hoping to increase patient numbers?

On the contrary, we have a waiting list booked for the next six months. We have a constant supply of patients and I can only see it getting bigger and bigger.

We are also getting 20 to 30 brand new patient enquiries on a daily basis. It is also word of mouth.

When you complete someone’s smile and the patient places photos on social media, that’s how more people get in touch with you.

I have lengthened every single appointment. So if I was doing comprehensive care, orthodontic treatment or finishing, I would only see four patients a day.

It has significantly reduced our capacity, but I think it is the right thing to do to help the nurses set down the surgery. People understand that we are doing our best.

What’s the strangest thing that happened since going back?

Nothing strange. But I would say that I really appreciate dentistry a lot more. Being able to discuss, treatment plan, and provide the care that I do.

What one piece of advice would you give to other practices/dentists/therapists?

The one thing I have learnt is the importance of checklists and protocols. I implemented my own checklist. Every member of the team understands what their roles and priorities are.

Dentists need to make sure that you have a checklist and a workflow. That you are auditing and you are sure it is working.

What one piece of advice do you give to patients when they come back?

The advice I give, before the patient visits, contact the dental team and explain what needs doing.

For example, if a patient has a wire placed on as a fixed retainer and that starts to become loose. Before an assessment with the dentist, it is important to tell them beforehand over the phone as they can set up an AGP session where we can correct the wire. Rather than come in for a non-AGP session and have to rebook a second visit.

This avoids the patient having to wait for a very long time.

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