8 June marks England's return to dentistry

In an update, Sara Hurley also suggests practices 'may wish to consider patient priorities, practice pace, proximity and levels of protection required for the safe delivery of dental care' before they resume services.

The 'prompt to prepare' guidance, she says, is designed by dental practitioners for use in primary care settings. 

She writes: 'The profession’s appreciation of the risks and compliance with the public health measures has contributed to setting the conditions for further easing of lockdown and we can reasonably anticipate the resumption of dental care in all settings, in England. 

'As we transition from the current COVID-19 peak, and a continued reduction in risk of sustained community transmission of COVID-19 is maintained, our plan for the longer term recovery can commence. The immediate focus is on increasing access for patients and supporting practices as they manage the on-going risks in delivering dental care, notably aerosol generating procedures'. 

She added: 'There will be inevitable changes with regards to pace, proximity and levels of protection that are required for effective risk management and the safe delivery of dental care. This is the time to review and make the appropriate adjustments to protocols, procedures and practice infrastructure for the safe and effective resumption of routine dental care.'

She also said that further guidance covering urgent dental care and alternative (non-AGP) evidence-based care planning will follow. 

Practice considerations 

Patient flow/practice layout in order to comply with social distancing measures throughout the practice.

• Measures to separate and minimise the number of patients in practice at any one time
• Establishing single entry and exit points for patients, with alcohol hand gel available for patient use 
• Consider areas in the practice that could be utilised as PPE donning and doffing stations.

Communal areas 

Reception:

1. Consider fitting physical barrier (e.g. perspex shield)
2. Allow for 2m distancing, ideally marked on floors
3. Consider measures to limit patient presence at reception area
4. Set up contactless/card payment where possible
5. Consider using single-use pens or ask patients to use their own

Toilets:

1. Ensure availability of products for cleaning and disinfection
2. Ensure availability of paper towels for hand drying
3. Make hand washing signage visible

Waiting areas:

1. Remove unnecessary items (e.g. magazines, toys, TV remote)
2. Consider measures to limit use of waiting areas e.g. protocols for patients to wait outside until the time of their appointment
3. Allow for social distancing measures (chairs spaced 2m apart, ideally marked)
4. Make hand hygiene and toilet hygiene posters available.

Supplies

1. Check inventory of stock
2. Ensure process for future procurement (contact your contracted suppliers)
3. Order in advance supplies required to reduce potential spread of COVID-19 (e.g. appropriate PPE, hand sanitisers, digital thermometer etc
4. Consider availability of PPE fit-testing 

Equipment 

1. Adherence to good practice to maintain dental equipment
2. Refer to manufacturers’ guidance HTM 01-05 and CQC guidance
3. Refer to Faculty of General Dental Practice (UK) guidance in closing and re-opening dental practices.

Staff considerations 

Training: 

Consider additional training for staff, such as rubber dam placement, four-handed dentistry, donning and doffing of PPE, COVID-1  infection prevention and control guidance and updated resuscitation guidelines.

Staff screening:

1. Consider staff screening on initial return to work and on daily basis thereafter 
2. Establish risk assessment for staff
3. Consider drafting a staff screening log to assist with maintenance of screening records 

Health and wellbeing:

1. Planning for returning to the workplace on up-to-date Government and Public Health England (PHE) COVID-19 guidance
2. Information for staff regarding the measures to reduce risk of transmission
3. Assessing impacts of lockdown on staff and explore management options.

Work scheduling (rota) considerations:

1. Assess availability of staff
2. Staff with childcare requirements or vulnerable adults
3. Staff redeployed, e.g. UDC
4. Staff who are of increased risk or shielded, or live in the same household as those of increased risk or shielded
5. Annual leave commitments
6. Social distancing measures in staff areas/facilities – if not possible consider staggering breaks 

Patient considerations 

Patient communications: How to communicate key differences to patients (e.g. new measures to support infection prevention and control, social distancing, and screening and triage). For example, using posters or a 'welcome back' email/text/letter.

Patient and care plan identification and prioritisation: Consider identifying and allocating patients and care plans into one of the following groups: 

1. Shielded patients
2. Patients at increased risk from COVID-19
3. Patients with urgent dental care needs
4. Patients who have contacted the COVID-19 UDC system and already been triaged for urgent dental care or require follow up care
5. Patients with incomplete care plans
6. Patients with frequent recall according to NICE recall guidelines (e.g. children, high oral disease risk, those who have been through stabilisation and need review)
7. Patients with routine dental care needs, not applicable to any of the above cohorts.

In identifying and prioritising patients, consider methods for logging practitioner/practice time and resources expended on patient record triage together with the outcome of any remote patient consultation and pre-appointment screening. 

Patient journey 

Consider: 

1. Review of options for appointment scheduling 
2. Review of options to undertake remote risk assessment/triage/consultation
3. Process for screening patients including shielded and at increased risk patients 
4. Drafting a screening questionnaire for both virtual and check-in screening 
5. Sanitising stations for patients (e.g. alcohol hand gel before or at entry point); 
6. Reception interactions – measures to minimise reception use; e.g. digital appointment booking (online, email), receipts.