The UK’s dental schools and dental hospitals join forces to find innovative solutions to the complex challenges presented by COVID-19
These fine clouds of water spray are known as aerosol and contain both substantial amounts of water from the drills that dentists use and smaller amounts of patients’ saliva. The risk of infection by SARS-CoV-2 posed by the small amounts of saliva in these aerosols and the precise dilution of the saliva in the clean water used by the drill is yet to be determined.
Aerosols are therefore a problem in primary (high street) dentistry and are being actively managed by leaving long gaps between patients (‘fallow’ times of up to one hour after procedures). The problem is exacerbated in dental education, however, because dental students are taught how to drill in open-plan, multi-chair clinics – magnifying the amount of aerosol potentially produced if all chairs are in action at once. Dental students treat over 400,000 volunteer patients each year but have not been allowed to treat patients since March. This reduction in clinical experience could affect their ability to graduate and enter the workforce to the anticipated timescale.
Current solutions include: active research by dental academics to quantify and mitigate the risk posed by aerosol so that clinics can be reconfigured to provide care appropriately; more simulated activity on mannequins; using different drills; improving air flows in clinics; anticipating changes to and/or extended hours of teaching once dental schools begin the new academic year; and ensuring sufficient supplies of personal protective equipment.
However, if lack of practical experience means that the required competencies have not been achieved, then students will not be able to graduate to work as dentists, dental therapists or dental hygienists. Work has been undertaken with the UK’s dental regulator, the General Dental Council (GDC) and the three following solutions are being progressed to ensure the flow of new dentists and dental therapists into the workforce:
1. Returning to clinics and qualifying final year cohorts before the start of dental foundation training in September 2021:
This requires an extension of the tripartite agreement between the dental schools, the Statutory Education Bodies of the four nations (HEE, NES, NIMDTA and HEIW) and the GDC. This agreement would enable qualification with a personal development plan, for those students who had met the GDC learning outcomes, but who, in the opinion of the dental school would benefit from further targeted experience prior to independent practice. Flexibility would also be sought to allow students the maximum time to graduate before entering the workforce in September. This would also be applicable to dental therapists who enter foundation training. For dental hygienists/dental therapists who do not enter foundation training, a personal development plan (if required) would be supervised by a suitable registrant within their first position of employment.
Option One is the preferred option of the Dental Schools Council but will only be achieved with additional resources.
2. Returning to clinics with an extension of six to 12 months to the period of training and an associated delayed entry into the workforce:
This is the worst-case scenario and would have significant implications for both students and dental schools. It would be unreasonable to expect students to self-fund this additional clinical training time and discussions with the relevant funders in all four devolved nations would be required, as dental schools would not have the resources to address this cost.
3. Provisional registration with the General Dental Council, which would change to full registration when all elements have been completed as assessed by a joint UK Committee of Postgraduate Dental Deans and Directors (COPDEND)/Higher Education panel:
This option requires a change in legislation and so urgent action would be necessary if it were to be implemented. The lack of a mandatory foundation training year for dental hygiene/ dental therapy graduates restricts this option for this group. The rollout of additional and mandatory foundation schemes for dental hygienists/dental therapists should therefore also be considered. While the majority of dental students do undertake dental foundation training, this option does not provide a solution for overseas students returning to their country at the end of their undergraduate course.
Whilst the unpredictable course of the pandemic creates uncertainty about when dental hospitals will return to normal, the long-term resilience of dental services relies on maintaining the number of dentists able to join the NHS annually. Dental schools have prioritised student, patient and staff safety throughout the pandemic and will continue to do so. The potential extension of courses is intended as a last resort and dental schools will continue to work towards creative solutions in collaboration with the wider sector.