The idea that good dental care is there when we need it is one that most of us take for granted.
In the past two years, nearly 22 million adults and seven million children sought the help of dental experts either privately or on the NHS, for everything from routine check-ups to emergency care for gum infections.
But what if the skilled dentists so many of us rely on simply weren’t there any more?
In a shocking statement, the British Dental Association (BDA), which represents many of the UK’s 12,000 dental practices, has warned that up to one in five of them could close permanently in the next few weeks because of the repercussions of the Covid-19 pandemic.
The alert comes after a BDA survey of 2,800 practices found a fifth said they didn’t have enough cash to survive beyond the end of April.
The British Dental Association (BDA) has warned that up to one in five dental practices could close permanently in the next few weeks because of the coronavirus crisis. (Stock image)
Most others estimated they had money in the bank to keep going for another three months at most if the lockdown — which is preventing the vast majority of dentists from providing anything but free telephone advice — continues that long.
The BDA says some dental surgeries are ‘weeks from a cliff edge’ and Britain’s dental service faces decimation.
The irony, of course, is that even before this pandemic arrived, many patients struggled to get to see an NHS dentist.
A 2019 survey by the BDA found that more than a million patients had tried and failed to get an appointment with a health service dentist at some point — and among those who succeeded, there were anecdotal reports of patients having to do 100-mile round trips.
Eddie Crouch, a dentist in Birmingham and vice-chairman of the BDA, says: ‘Some people are going to find it even harder to find a dentist when this is all over. There is no doubt that many practices will be forced to shut down due to financial pressure.
‘And it’s not just a case of starting up again afterwards, because so many people are going to be in debt that they may not want to pay for treatment or to carry on with monthly payments for dental plans.’
Worse still, says the BDA, there is a very real risk that some patients could die from untreated gum infections (which can lead to potentially fatal sepsis) because they are currently unable to get the emergency treatment they need, or are too scared to go to hospital to get help in case they catch Covid-19 during their visit.
Nearly 22 million adults and seven million children have sought the help of dental experts either privately or on the NHS in the past two years. (Stock image)
But even once the lockdown is over, it seems unlikely that the dentistry service available in this country will be anywhere near what it was.
The closure warning stems from the fact that nearly all the UK’s 33,000 dentists are self-employed, splitting their time between NHS and private work. Only a tiny minority exclusively do one or the other; most dentists combine the two.
On average, they earn between £60,000 and £65,000 a year, says the BDA. That means they exceed the Government’s £50,000 threshold for financial support for the self-employed during the coronavirus crisis — which leaves them with no cash lifeline.
But their monthly overheads — including staff, rent or mortgage payments — can often exceed £30,000, says the BDA.
Meanwhile, 90 per cent of those applying for special loans (where the Government pays the first 12 months’ interest) have been rejected by banks.
And while retail outlets forced to shut during the pandemic have been granted a business rates ‘holiday’ for 2020-21 to ease their financial problems, dental practices fall outside the ruling.
According to the BDA some dental surgeries in the UK are ‘weeks from a cliff edge’. (Stock image)
‘A lot of practices rely on private income to subsidise their NHS care,’ says Dr Crouch.
‘One thing the Government could immediately do to stop practices going under is raise the income threshold for self-employed people qualifying for financial help to £65,000 a year — that would cover most dentists.’
Even when the crisis is over, patients may struggle to get an appointment because of an unprecedented backlog.
‘Let’s say practices reopen in three months’ time,’ says Dr Crouch. ‘They won’t be able to see the volume of patients they could in the past because strict hygiene measures may remain in place for some time to come, to prevent a second wave of coronavirus infection.’
Since coronavirus, tough guidelines have been introduced on cleaning after a dentist performs any procedure that generates aerosol — tiny particles that circulate in the air.
This includes everyday tasks such as scaling with an ultrasonic device, drilling teeth or polishing teeth with a jet of air.
‘Before the coronavirus pandemic, most dentists saw about three patients an hour,’ says Dr Crouch.
‘But current guidance states that after any aerosol procedure you have to leave the room for 35 minutes to allow any droplets to settle, so that surfaces can be properly cleaned.
‘That takes it down to one patient an hour. And it means charges to patients may well have to increase as a result, because dentists only get paid according to the number of patients they actually treat.’
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NHS England banned dental care for vulnerable patients on March 20 and all patients five days later.
This means routine check-ups and minor problems such as lost fillings will have to wait until the Covid-19 outbreak is over.
Urgent treatment — for severe toothache that does not respond to painkillers, abscesses, facial swelling and fractured teeth — should still be available via a network of 165 pop-up centres.
But hardly any of these urgent dental care hubs are open yet, according to the British Dental Association (BDA), perhaps in part because of a shortage of personal protective equipment — a face shield or goggles and a visor, plus face mask — for dental staff.
If patients cannot contact their dentist, some surgeries may offer emergency appointments at short notice, according to the NHS. (Stock image)
‘Dentists are being bombarded with calls from patients in real pain but still have nowhere to send them,’ says Mick Armstrong, chairman of the BDA.
The NHS says 84 centres in England are open, with the remaining 81 expected to be able to treat patients soon.
NHS or private patients with serious dental problems should phone their usual practice for advice, as they may be able to prescribe painkillers or antibiotics. If the problem is considered urgent, your dentist should refer you to the nearest of the new centres.
The centres should treat patients whether or not they have coronavirus, and appointments cost £22.70 (which can be claimed back if you are entitled to free NHS dental care). However, aerosol or spray-generating treatments will be avoided where possible.
If you can’t contact your usual dentist, don’t have a dentist or think you have Covid-19, call 111 for advice. Some surgeries may offer emergency appointments at short notice, according to the NHS. Patients should go to A&E only in serious circumstances, such as uncontrollable, heavy bleeding from a tooth extraction.
For those with minor dental problems, Dr Richard Marques, a London dentist, recommends rinsing the mouth with salt water for 60 seconds several times a day to help remove bacteria and clear infection, dabbing clove oil on the affected area to help reduce pain, or taking painkillers.