Dentists during COVID-19Rachel Sommerville discusses how COVID-19 has completely changed her vocational training year working in Scotland.

In what can only be described as the biggest plot twist to 2020, coronavirus has certainly made for a very unique year working as a vocational trainee dentist in Scotland. Never again will I take for granted the opportunity to do a routine composite restoration or crown preparation!

I have no doubt every other dentist will have their own individual story on how COVID-19 has impacted their working life. This is mine.

Life in lockdown

Although my dental practice was still open during the third week in March, it certainly felt very different. Not only the physical difference of wearing visors, hair nets and disposable aprons. But also the newfound ‘eeriness’ of a once busy building. One that is now only welcoming a handful of patients each day for urgent non-aerosol generating procedures.

Then came the big announcement from the Prime Minister on the 23 March 2020. This sent the UK into complete lockdown. Ironically, this was the day before my 25th birthday, which made for perhaps the quietest year of celebrations yet.

Due to a household member shielding, there were concerns about the possible effects should I contract and asymptomatically carry the virus. As such, I was advised to avoid clinical contact as much as possible.

Whilst there was talk of my potential redeployment to the NHS coronavirus helpline or the hospital pharmacy department, nothing came from it. This was because the incidence of COVID stayed relatively low in my rural county.

Therefore, over the next 12 weeks, I became remarkably familiar with the four walls of my home in south-west Scotland. I maximised the use of this inevitable down time by engaging in the extent of online educational content available.

First-class webinars

A personal favourite included the lockdown 2020 charity webinars, covering topics such as anterior composites, surgical extractions, and tooth whitening. This fantastic series, organised by Dr Clive Schmulian, was hugely beneficial to the dental community. And even more so to the Prince and Princess of Wales Hospice in Glasgow, who received an impressive donation of over £31,000. This will go towards the palliative care of patients.

As a profession we have also been very fortunate to have opportunities to receive first-class virtual teaching from the comfort of our own homes. All by renowned experts in their fields, such as Paul Tipton, Basil Mizrahi and Jason Smithson.

In addition, my own VT study day programme moved from hands-on teaching sessions at the Glasgow Dental Education Centre, to an entirely online learning platform.

It has felt strange missing out on the opportunity to catch up with colleagues over a break time coffee about life in practice. However, I am grateful our educational programme could continue in this adapted format.

Transitioning into practice

Whilst dental practices in England were given the green light to re-open from 8 June, we had to wait slightly longer to move out of phase one in Scotland.

We continued to operate a telephone triage system. This ‘extra time’ was certainly not wasted. It allowed capacity for the extensive planning and risk assessment process. All completed ahead of our re-opening.

The phase two remobilisation of NHS dental services commenced in Scotland on 22 June. Here practices were permitted to open a single surgery and see patients for urgent, non-aerosol generating procedures.

Dental teams were recommended to operate in clinical bubbles. Therefore, in order to work alongside my VT trainer, I frequently took on the roles and responsibilities of a dental nurse. This involves assisting turnabout with the provision of a mainly extraction-based service.

The opportunity allowed an excellent period of mentorship by working so closely alongside my trainer. I certainly picked up some valuable advice and techniques in the management of extracting retained roots and fractured teeth.

Phase three

Phase three, on 13 July, means we can now to extend services and see NHS patients for routine care. Although still avoiding the use of aerosols. With the process of carrying out a high-quality examination relying heavily on the use of the currently prohibited three-in-one, the value in performing these at the present time remains controversial.

For any patient requiring an urgent AGP, this is possible by liaison with the local urgent dental care centres (UDCC).

Arrangements are slightly different between individual NHS health boards. However, our protocol in south west Scotland is to treat the patient with their own dental team at the dedicated ‘hub’.

Of course, this can pose issues, including potentially long journeys depending on where your individual practice is. It also brings up the logistical issue of managing patients already booked in to be seen at the practice.

However, speaking from my own experience, the UDCCs have all the equipment to facilitate visiting dentists treating their own patients. They benefit from access to the correct enhanced PPE, including FFP3 respirator masks. These are currently very tricky to source for individual dental practices.

The photograph above shows my VT trainer and myself working at the UDCC. We successfully relieved a patient’s pain by performing a pulp extirpation and dressing for an abscessed premolar, and caries removal for a canine with acute pulpitis.

A great deal of satisfaction was felt by all following this visit. I have certainly noticed patients in general displaying more gratitude for dental services at this time.

COVID-19 challenges

The harsh reality of COVID’s impact on NHS dentistry concerns the financial aspect. With the patient charge currently set at £0.00 for every item of treatment listed under amendment 145 of the SDR (Statement of Dental Remuneration), practices are suffering immensely and are under significant pressure regarding both their sustainability and survival.

These difficult times result in a scarce and particularly challenging job market, especially for younger dentists.

Many dentists currently undertaking their vocational training year face a number of unique challenges. All due to the unprecedented times COVID creates. However, these have offered opportunities we may otherwise not have had.

In my case, these have included extended clinical mentoring and enhanced online webinars with industry leaders. We hope the challenges and opportunities as a result of COVID-19 prepare us well for whatever the future may hold for dentistry in Scotland.