For the first time, experts at Newcastle University have studied how urgent dental services have coped, and the pressures faced by the sector, at the start of the pandemic.

Findings, published today in the British Dental Journal, focus on the Urgent Dental Care Centre (UDCC) based at Newcastle Hospitals’ Dental Hospital, which covers a population of more than three million.

It is hoped that the experts’ data may be used for those planning patient services during this and future pandemics.

Hundreds of dental practices closed

The study shows that setting up urgent care during the pandemic was a challenge as dental services were told to shutdown overnight – approximately 400 practices in the North East closed - and plans for urgent dental care provision had to quickly adapt to deal with the situation.

Newcastle Hospitals’ UDCC had to be set up immediately to deal with the crisis, acting as a safety net for the most in need, and evolve quickly in response to changes and challenges throughout the period.

In the first six weeks, there were more than 3,000 patient consultations and almost half were seen for clinical consultation and treatment. Some patients travelled as far as 126 miles to be seen.

The majority attending the service were suffering from typical toothache symptoms, which weren’t responsive to oral pain relief or antibiotics. More than half of the consultations resulted in tooth extractions.

Dr Richard Holliday, NIHR Clinical Lecturer in Restorative Dentistry at Newcastle University’s School of Dental Sciences, lead researcher on the paper, said that in the future preparedness was essential to cope with the surge in demand.  

He said: “Our research shows that lack of preparedness was a key issue as dental services were told to shut down overnight, leaving Newcastle Hospitals’ UDCC as the only provider of face-to-face dental services for almost a month across the North East and North Cumbria.

“National guidance recommended that dentists should provide advice, analgesics and antibiotics, where appropriate (AAA), in the first instance. As time went on, more patients had to attend our UDCC with failed AAA and definitive treatment was required to treat the infection or toothache.

“Contingency planning for a worst-case scenario of a second COVID-19 wave, organised with PPE stock for specific dental practices across the region, is essential going forwards.

“We hope that the data from our study can be used for future pandemics to help prepare so that urgent dental care can be set up quicker should the need arise.”

Redesign of services

Previous systems and patient pathways had to be rapidly redesigned by the UDCC to provide safe and effective service for emergency patients and staff during the pandemic.

Telephone triage appointments were successful in deciding who needed to be seen, and to then separate out patients who were possibly COVID-19 positive, from those who were not showing any symptoms, and also from the most vulnerable ‘shielding’ group where high numbers required treatment.

All patients attending the centre had to confirm their COVID-19 status and got their temperature checked on arrival. Symptomatic or isolating patients were told to avoid attending, unless the issue involved trauma, swelling or bleeding of the mouth.

Dr Charlotte Currie, NIHR Clinical Fellow at Newcastle University’s School of Dental Sciences, is a co-author of the study.

She said: “Our data gives an insight into the patient characteristics, including urgent dental care requirements, of a lone regional provider during COVID-19.

“Embracing different ways of working has been very important during the pandemic to provide a good quality of care during this period.”

In the final two weeks of the study, other urgent care centres were set up around the North East, which allowed patients to access care closer to home and the average distance travelled reduced to 10 miles.

During the six week study period there were no known staff COVID-19 infections which were caught during frontline dental care of patients.

Emily Carter, Clinical Trainer in Dental Emergency at Newcastle upon Tyne Hospitals NHS Foundation Trust, a co-author of the study, said: “We were pleased to see that the service proved to be successful, bridging the gap while local urgent dental care centres were set up across the region, providing the care patients need closer to home.

“It is important that if you have a swelling or feel unwell with toothache, you seek urgent care. You should contact your own dentist or NHS 111 in the first instance.”

Dr Richard Holliday and Dr Charlotte Currie are researchers funded by the National Institute for Health Research (NIHR).

Reference

The first 6 weeks – setting up a UK urgent dental care centre during the COVID-19 pandemic.  British Dental Journal. Emily Carter et al. Doi: 10.1038/s41415-020-1708-2