Rapid Review of recommendations for re-opening dental services

Posted by: Nicole Alterado - Posted on:

Coronavirus

A group of researchers and clinicians from a range of UK institutions has conducted a rapid review of internationally produced guidance to support decision-making for re-opening dental services closed or reduced across the world as a result of the COVID-19 pandemic.

Professors Jan Clarkson and Craig Ramsay led the review group which included the Scottish Dental Clinical Effectiveness Programme (SDCEP), NHS Education for Scotland (NES), the Universities of Aberdeen, Dundee and Manchester, and Cochrane Oral Health.

Professor Clarkson explained:

“Now, with attention focussed on planning the re-opening and restructuring of dental services, there is an urgent need to map out how dental services are to return to providing wider patient care. Given that we have only really known about COVID-19 for about 120 days, robust evidence to inform how to approach re-opening is scarce or non-existent. The same concerns exist across the world and therefore we decided to formally review the recommendations being produced in different countries as a resource for decision makers.”

Professor Ramsay, Professor of Health Care Evaluation and Director, Health Services Research Unit (HSRU), University of Aberdeen added:

“We identified sources from eleven countries and found relevant recommendations fell into five themes: practice preparation, personal protective equipment, management of the clinical area, dental procedures, and cleaning and disinfection.

“The review collates the range of recommendations related to each theme from the various sources identified. I would like to stress that this review is not guidance but, in the absence of robust evidence, it should assist policy and decision makers in producing national guidance for their own settings.”

While the review does not itself make recommendations for reopening of dental services, its key messages include:

  • Most guidance sources recommend patient triage by telephone; some recommend temperature screening at reception.
  • Most sources recommend avoiding aerosol generating procedures (AGPs), if possible.
  • Sources include recommendations on how to reduce the risk of transmission (e.g. use of pre-operative mouthwashes; high volume suction; rubber dam; and Personal Protective Equipment [PPE]).
  • All sources emphasise the need to focus on activities that minimise risk (to staff/patients/public) but still support high quality clinical care.

Jan Clarkson added:

“Conducting this review has been a hugely collaborative international effort and I’m extremely grateful to all those involved for working so hard to complete it in such short time.”

The rapid review entitled “Recommendations for the re-opening of dental services: a rapid review of international sources” can be accessed at https://oralhealth.cochrane.org/news/recommendations-re-opening-dental-services-rapid-review-international-sources

This rapid review is one of several ways that NES has been supporting dental services during the COVID-19 pandemic (https://learn.nes.nhs.scot/27993/coronavirus-covid-19). NES’s Scottish Dental Clinical Effectiveness Programme (SDCEP) has provided resources for managing dental problems and practice closure during the pandemic. These are available at www.sdcep.org.uk/published-guidance/acute-dental-problems-covid-19/, and have proved very popular and downloaded in Scotland and in several other countries.