Scottish dentistry, what's going on and where can I be treated?
Thread.

There remains a lot of confusion over what dentists currently can and can't do. This thread tries to explain the current restrictions. This refers to the current situation within Scotland only. (1)

NHS practices are currently working under the guidance of the CDO and Scottish Government. We are operating a phased return to work, having been advised to cease routine dentistry in March. (2)

2 main issues facing dentistry: PPE & Aerosol Generating Procedures (AGP): Anything that uses a drill/water/air creates an aerosol. Whilst we are used to wearing PPE, enhanced measures are now required for patient/dental team safety. This is difficult to acquire & very costly.(3)

At the beginning of lockdown, dental practices (both NHS and private) donated PPE to hospitals and care settings as required. Dental practices buy their own PPE so this was out their own pocket. (4)

Many dentists volunteered for the Urgent Dental Care Centres (UDCC) and a specific NHS 24 Dental Team was put in place. Dentists were asked to man the practice phones and triage as necessary. (5)

In Phase One, NHS dental practices were triaging calls and worked under AAA guidance. If a patient called with a dental issue, we could give advice, advise analgesics or prescribe antibiotics where appropriate. (6)

If the scenario arose that AAA could not effectively help the patient, we could refer to the UDCC. Due to limited PPE/huge demand, these centres were limited to what treatment they could offer (mostly extractions/limited AGPs). (7)

In June, NHS dental practices were advised they could enter Phase Two. Practices must enter Phase 2 by 31st July. Most practices are currently in this phase. (8)

Phase Two means practices continue to triage but only ONE dentist can see a maximum of TEN patients in a day for URGENT NON AEROSOL care only. PPE is distributed from central source and provided for practices. (9)

As we cannot complete AGP's, we are still limited to mostly extractions in practice. To place a filling or repair a broken tooth requires air to dry the tooth and water to clean it, which under Phase 2 is currently not allowed. (10)

UDCC’s continue to see emergency AGP treatment, but this is under huge demand. A broken filling or lost crown does not qualify for UDCC referral. NHS practices can attempt to temporarily treat these issues but no permanent solution can be currently be offered. (11)

Practices are in limbo. Receiving a % of NHS funding but 0 private income. Almost all practices are mixed NHS/Private, so the total loss of private income has affected everyone. Practices cannot currently charge for any NHS treatment, even denture repairs that have a lab bill. 12

Last week, we were advised that from Monday 13th, practices could enter Phase Three. It was specifically mentioned by the First Minister that routine examinations and denture work could be carried out. (13)

NHS Practices are still not allowed to do any AGPs. To complete an effective examination, we require to dry teeth, which is an AGP. Denture work can also create aerosol. Therefore most practices currently remain in Phase Two. This has created confusion for patients. (14)

The end goal is to return routine AGP care to general dental practices but this currently requires additional PPE/reshape of funding model. This is why private practices are able to offer treatment that NHS practices currently can't. (15)

Private Practices do not work under the NHS guidelines and therefore can proceed with AGP care. They have had to source their own PPE and may have to charge additionally (There's a thread that explains that too!) (16)

Here's one I made earlier... (17) https://twitter.com/ecm_242/status/1279353448107040768?s=19

Currently your NHS dentist will be able to see you for a dental emergency but may need to refer on to a UDCC if any drilling is required. There's strict criteria and you may be advised an extraction is the only option. (18)

NHS dentists cannot complete any routine treatment such as fillings or scale and polishes. We do not have a date for this and the reality is it will be at the minimum weeks, possibly months. (19)

Private dentists have been able to source enhanced PPE. Whilst they are still seeing Urgent cases, they can place permanent fillings/start root canal treatments or even repair crowns/veneers. (20)

This obviously creates a two tiered dental system. If you can afford private dentistry, you can access treatment quicker and that is not available of the NHS currently. (21)

Some of the messages on social media or in the mainstream media regarding dentistry can be demoralising. Practices have been pushed to the brink and are eager to be running at full capacity as soon as possible. (22)

Whilst you may not have been able to access routine dental care during lockdown, we've been triaging, working in UDCC's and getting practices safe for patients to return. It's been incredibly frustrating for the dental team and patients alike. (23)

Please bear with your dental practice at this time. The guidelines are changing quickly and it is hard to effectively communicate this with patients. We are severely restricted and working within set parameters. (24)

I hope this clears up why your NHS dentist may not be able to see you currently, but why private practices can, plus the difference ein treatment provided. We look forward to getting back to normal as soon as it is safe to do so. (25)