SERVICE DETAILS
Please find the latest guidelines on Service Provision
Night Dental are currently providing ONLY Urgent Care services in all clinics:
Key principals of Urgent Dental Care services during COVID-19
1. Flexible arrangements, rapidly developing
2. Care limited to Emergency and Urgent dental care
3. Best interests of patients
4. Protecting the population and dental team
5. Protecting NHS frontline staff
6. Dental teams to keep up to date with current guidance
7. All patients who will benefit from treatment will be able to access it and those who will not benefit will not access it
Patients are managed according to
1. Severity of dental needs
2. Covid-19 status
3. Treatment required
4. Capacity
Only patients in Urgent Dental Needs and avulsion cases are managed.
Patients with Dental Emergencies other than avulsions are sent to A&E/MaxFax to be seen in less than an hour.
Patients with routine dental need are advised to contact their own dentist or find a new dentist. VIA>>>>>>
The management should be according to the most appropriate patient, in the most appropriate place at the most appropriate time
PATIENT GROUP
~GROUP 1: COVID POSITIVE PATIENTS/ EXPOSED -RED
~GROUP 2: SHIELDING- AMBER
~GROUP 3: VULNERABLE- AMBER
~GROUP 4: FIT AND HEALTHY- BLUE
What Is Urgent Dental Needs?
Urgent managed within our service within 2-24hours:
• Trauma such as dento-alveolar injuries or avulsion of a permanent tooth
• Oro-facial swelling that is significant and worsening but does not present realistic threat to life
• Post extraction haemorrhage that is not controllable by local measures but does not present realistic threat to life
• Dental conditions that have resulted in acute and severe systemic illness
• Severe dental and facial pain: that is pain that cannot be controlled by the patient following self-help advice or the use of appropriate antimicrobials.
For further information see Appendix 2.
• Fractured teeth or tooth with pulpal exposure
• Dental and soft tissue infections without a systemic effect
• Oro-dental conditions that are likely to exacerbate systemic medical conditions
• An avulsion, if direct face to face care for patient will be <1hr
What Is A Dental Emergency?
Emergency: REFERRED TO A&E/MAX FAX <1 HOUR
• Life threatening emergencies, e.g. airway restriction or breathing/ swallowing difficulties due to facial swelling
• Uncontrollable dental haemorrhage following extractions that cannot possibly be dealt with within the Urgent Dental Care Centres;
• Rapidly increasing swelling around the throat or eye which causes immediate threat to life;
• Trauma to head and neck to include dental arches that requires maxillofacial services.
MANAGEMENT
ADVICE / ANALGESIA / ANTIBIOTICS [AAA]
Patients must be managed in the first instance remotely via AAA if possible and appropriate
REFERRAL FOR FACE TO FACE
1.SUCCESS OF AAA- Only those who could not be successfully managed using AAA including allowing antibiotics time to become effective >48hours unless a situation has exacerbated into a dental emergency
2.PATIENT GROUP- Group 1 must be referred to a RED site, we can see group 4 and groups 2/3 referrals should be patient specific. Where possible shielded seen in morning and temporal/spatial separation.
3.URGENT NEED- how severe is the need. Can it be deferred wait for treatment post COVID-19. Tx Emergency sent to A&E immediately, type of tx AGP- HOT PULPS referred mostly for anterior
4. TYPE OF TREATMENT- Is there a high risk of aerosol generation
5.COMPLEXITY- Only straightforward simple XLAs managed. Where appropriate Secondary/ Speciality/ IMOS for complex such as surgicals that cannot wait
6.CAPACITY & AVAILABILITY- Contact with service manager. Very limited, other options exhausted ahead of F2F . PPE Dependent
SUMMARY OF COVID-19 PREPARATIONS
Please see a summary list of extra measures we have in place for how these are implemented refer to treatment page.
The introduction of adjuncts should be risk assessed and considered and this will vary clinic to clinic however here is a list of additional measures that may be considered please follow latest guidelines where these change. Not all have evidence to back their use so use at your own discretion please order your COVID-19 supplies, PPE supplies and floor signs via www.themedstock.com :
- Posters reminding patient of instructions e.g washing hands/ social distancing/ staying at home if displaying COVID-19
- Patient instruction sheets/videos
- Hydrogen peroxide 1% /iodine mouthwashes no longer advised
- Using rubber dams for all teeth that are opened
- Trolleys
- Screens for reception
- Touch free thermometers [NB: Can be unreliable on its own as risk assessment in determining patient status]
- One way system and signage with separate entrance and exit where possible
- Walkie-talkies or intercoms from surgery to runner staff communication
- Wipeable door label
- Floor signs to mark where patient should be waiting
- 1000ppm Chlorine based disinfection or alternate disinfection effective against enveloped viruses
- Mechanical ventilation extracting at a rate of 6 air changes an hour or above
- Donning and doffing stations with posters and instructions
- Videos showing patient flow/ donning & doffing
- Maps with patient walkthrough
- Resus UK posters for COVID-19 Protocols
- Treatment must be efficient
- PPE according to latest guidelines
- Keeping area ventilated close surgery door and open windows
- Do not use A/C do not use fans that recirculate the air
- Digital clinical records may be completed in the surgery while wearing PPE, or in a clean area following doffing of PPE and hand hygiene. If not washable, the keyboard and mouse should be covered with single-use cling film.
- EYE PROTECTION AND RESPIRATORS SHOULD ONLY BE REMOVED OUTSIDE SURGERY
- One hour "fallow time" following cessation of high risk AGEs
- Only use approved reusable gowns
- Where reusable gowns are used please use washer/dryers on site
- Surgery decontaminated after every patient interaction
- Toilets use out of use except for hand washing and patients with disability requirements and must be cleaned regularly (patient advised before hand)
- Wiping down door handles
- Reception and waiting rooms out of use where possible
- Shielding/vulnerable patients first thing & advised to wear a mask
- The type of treatment needs to considered and appropriate PPE planned
- Emergency stations are outside clinical rooms please make yourself familiar with drugs and dosages
- Reusable masks with appropriate filters are available, however, it is important that doffing and disinfection of these masks is carried out following a strict protocol to prevent contamination.
- [ Use of antibody/antigen screening may be considered in the future as aspiration ]
