Providing dental care amid Covid-19

 

Sir, – While I appreciate this an exceptionally busy and stressful time for Minister for Health Simon Harris and his Government colleagues, it is also a very stressful time for members of the public and the dental profession. I am a general dental practitioner (GDP) with a small practice in Drogheda, Co Louth, providing family dental care. Unfortunately due to Covid-19, despite being listed as an essential service, I like may of my colleagues have been forced to close my dental practice leaving my patients who have supported me over the past 21 years, stranded.

This is not an easy decision for me to make but the reasons for this are two-fold, the first being economic and the second being infection risk.

On the economics front, I have somewhere between one and four patients contacting me every day seeking emergency dental care. The range of treatments I can safely provide during this crisis is very limited. It is advised that a greater interval than normal be allocated between each appointment to facilitate more in depth surgery decontamination. This allied to severely reduced footfall through my practice means the fee income generated would not cover my costs, and any business that is trading as a loss making enterprise should seriously consider its position.

My hope is that if I can shore up my outgoings now, I may be in a position to commence trading again once restrictions are lifted (if I have any business to return to). This brings me to my second point, infection risk.

The advice from the HSE and our Chief Dental Officer (CDO) is that dentists may continue to provide dental treatment simply by ensuring our normal cross-infection protocols are adhered to. However, a serious contradiction arises whereby we are advised to maintain a social distance with patients at reception, in our waiting areas and perhaps to ask patients to consider waiting in their cars until called. I cannot marry the fact that social distancing is required in all aspects of dealing with our patients except for the delivery of care, which is within inches of our patients mouths.

I am also concerned that our CDO does not see any requirement for the use of any additional PPE. In my opinion this is a requirement for both dentist and nurse operating in such close proximity to the patient.

This also raises the issue of cost.

Is it cost effective for both my nurse and I to don a full set of PPE to see such limited patient numbers? Would patients be willing to absorb this cost or would the HSE be willing to provide PPE in order that DTSS/medical card patients might access care?

I have heard mutterings of the establishment of centralised hubs for the provision of emergency dental care provided under the auspices of the HSE, staffed by DTSS contract holders. This I believe is the only workable solution.

However, should this be rolled out it must be for the provision of care to all patients not simply medical card holders, similar to the current provision of medical care to our population.

Otherwise our dental patients will be turning up at general medical practices and our hospital A&E departments, and I as a GDP am powerless to prevent this. I urge Minister Harris give this some serious consideration. – Yours, etc,

ANGELA KEARNEY,

Drogheda, Co Louth.