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8 Jun 2020

Routine dental care resumes, but you may struggle to get an appointment

Just over a third of dentists are able to reopen as the BDA warns coronavirus is an extra blow to an already beleaguered NHS service

Last updated: 23 July

Dentists in England, Northern Ireland and Scotland can now start offering routine care. But re-opening poses challenges for many, and the coronavirus pandemic has exacerbated pre-existing issues with NHS dentistry.

Dentists are now able to offer routine care, but there are caveats.

Practices in England and Northern Ireland are required to close for an hour in between any aerosol generating procedure (including fillings, polishing, and mechanised scaling) and Scottish practices cannot yet offer these procedures.

An aerosol generating procedure is one that involves high speed machinery which can cause aerosols from the patients mouth to disperse in the air, spreading particles that may carry the virus.

These are fairly common and are part of the reason that dentists may find it difficult to re-open fully.

The level of PPE needed for these procedures, along with having to close for an hour between providing aerosol treatment is expected to have a big impact on the number of patients that can be seen, and the financial viability of many practices.

A survey conducted the British Dental Association (BDA) in June revealed that only 15% of dental practices in England are in a position to offer a full range of treatment, and 60% of practices estimate that they will be able to treat less than a quarter of the patient numbers they saw pre-COVID-19.

This is especially concerning given that our research earlier this year revealed that NHS dentistry in some parts of the UK was already struggling with issues including lack of access, annual price hikes and long waiting lists.

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When are dentists reopening across the UK?

England and Northern Ireland practices can now offer routine care, but must close for an hour in between aerosol generating procedures.

Scotland practices can offer routine care, but aren't able to do aerosol generating procedures.

  • Wales practices can see patients for urgent, non-aerosol care, with the return of routine appointments set for January 2021.

Long waits for appointments feared as dentists reopen

Part of the reason so few dentists are ready to reopen, according to the BDA, is because they had very little advance notice, so some practices need more time to put safe distancing measures in place.

Problems with access to NHS dentistry were already rife in England and Wales, and it's feared that with the added pressures of the pandemic, things will get worse.

Northern Ireland and Scotland operate on a different model, and problems have not previously been in evidence to the same degree. But the impact of the coronavirus crisis presents new challenges and is plunging dentists across the UK into financial strife.

PPE shortages and enhanced safety measures reduce capacity

Only a third of practices in England said that they had the right personal protective equipment (PPE) to provide face-to-face care in the BDA survey and only a quarter had been fit-tested to use it. Dentists we spoke to said this was the most important issue they faced.

Reduced capacity, due to social distancing, and heightened cleaning and protective measures, plus a backlog of people who were unable to see the dentist during lockdown, could also contribute to long waiting times for patients.

And while emergency dental care has been available during lockdown, many people have experienced dental problems that don't qualify for urgent care and have had to wait.

The BDA has warned that 'the whole business model that the service is based on could change unalterably upon reopening, with social distancing and cross-infection control reducing capacity and potentially access levels by as much as two thirds'.

Patients struggle with dental problems during lockdown

During lockdown, Urgent Dental Care centres (UDCs) were set up across the UK to treat patients with emergency dental problems that need to be attended to in person.

But with delays in setting these centres up and a limited list of treatments that qualified for care, many patients have been left struggling.

When we asked people about their experiences of needing dental care during lockdown, many felt let down by the system, and some had been left to deal with chipped or broken teeth and bad dental pain at home.

Pharmacists told us many people had been asking for dental repair kits on the advice of their dentists - but these were hard to get hold of due to the surge in demand.

Find out more about getting dental care during lockdown.

What will dentist appointments be like after lockdown?

Dentists told us that patients will see big changes at appointments as they reopen:

  • When you call to make an appointment, you'll be asked some screening questions. Most practices will be operating at a reduced level and will have to prioritise patients according to need.
  • You might have to wait in your car or outside the building until you're called in for your appointment.
  • There will be hand sanitiser as you enter and other hygiene measures are likely to be in place: no touchscreen check-ins, receptionists behind Perspex screens and toilets closed for use.

Aerosol generating procedures won't be possible if your dentist doesn't have the right PPE to hand, as they are more prone to spreading the virus.

These procedures will need to be done at the urgent dental care hubs that were set up to provide emergency care during lockdown instead.

Private and NHS dental charges - get clued up on what things should cost so you don't get caught out

Why your oral health matters

Aside from dental problems often being painful and unpleasant, or affecting your ability to eat normally, poor dental health can have ramifications for your wider wellbeing.

Gum disease has been linked to an increased risk of stroke, diabetes and heart disease, according to the NHS.

On average, people are living for longer, too, so preventative dental care and access to NHS dentistry is more important than ever.

Public Health England says good oral health is vital for continued social participation and enjoying a varied diet as you age, both of which significantly affect quality of life.

How to look after your oral health at home:

  • Brush with a fluoride toothpaste for two minutes twice a day
  • Floss or use interdental brushes regularly
  • Try to avoid too many sugary drinks (including fruit juice, fizzy pop and alcoholic drinks) or snacks between meals
  • If you have concerns, contact your dentist for advice.

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Video: NHS dentistry under strain

The coronavirus pandemic has added to the challenges facing an already struggling dental service.

Dentistry is one of the few NHS services where patients pay at the point of use and where clinicians are bound by treatment targets.

NHS dentists in England and Wales work under a contract that effectively caps the number of procedures they can perform in a year.

This creates a system that puts government targets at the heart of dental care, rather than patient needs, and earlier this year dentists told us this has a huge impact on the care they are able to offer.

If a dentist carries out more procedures than they've been commissioned to, they aren't paid for the extra work. This can deter dentists from offering NHS treatment and the target-based approach leaves little room for preventative care.

In January 2020, the BDA surveyed more than 1,300 dentists about the state of NHS dental care for our research. Some 90% of respondents said that the current contract limited the time they could spend with patients. Almost all said it affects their ability to treat patients who require multiple or complex treatments.

One dentist told us: 'Because you have targets to hit, chatting with patients, spending time listening to their problems or carrying out preventive work can be counterproductive as it doesn't generate [treatment targets]. The current system is all about hitting targets and not doing quality work, which can be time-consuming and complex.'

There's a knock-on effect on availability, too. Three in four dentists surveyed said the contract limits their ability to take on new patients.

Dentistry system needs reform

It's clear things need to change.

When we surveyed Which? members in late 2019, many told us of struggles to find a new NHS dentist after theirs switched to private practice. This finding was echoed by the 2019 GP Patient Survey, which found that 1.4 million people had struggled to find an NHS dentist.

The BDA has been pushing for a reformed funding system, which aims to shift the focus to preventative care.For example, by funding dentists based on the number of patients registered to their practice and treated in the past three years, rather than treatment targets.

It also says increases in patient payment charges (which typically rise by 5% every year) should be scrapped, to encourage patients to seek treatment.

When we challenged the government about its plans to ensure patients have access to affordable NHS dentists, the Department of Health and Social Care said it's working with NHS England to improve NHS dental provision with 'an increased focus on prevention and improving oral health', but gave no further detail.

New Health and Social Committee chair, Jeremy Hunt, said he felt the committee could have valuable impact by relaunching its inquiry into dentistry services, which closed last year with the change of Parliament.

The fear from the BDA is, with COVID-19 looming large, dentistry could once more be pushed down the agenda.

For more on NHS dentistry, plus private vs NHS dental charges, see our dentistry advice