Word of mouth with Dr Paul O D’wyer  BDS MSc (Healthcare Mgmt)

Firstly, for this particular column, I hope that everyone reading this has managed to shelter from the storm that is COVID-19. The word “unprecedented” has almost lost any meaning at this point. And for those
of us with elderly, vulnerable or immuno-compromised relatives, friends and patients, it has been a particularly worrying time. The measures taken by the National Public Health Emergency Team (NPHET) – though drastic – have worked in the main. The community spirit evidenced throughout this time has shown that a united approach yields best results.

As the clouds begin to clear, and we begin to think of life after this extraordinary time, it is necessary to think about how clinical practice will look when we return to same. I am reminded of Cicero’s famous maxim: “Salus populi suprema lex esto” – “The safety (health) of the people shall be the highest law”. Never have words uttered more than 2000 years ago been more fitting than today.

Our duty has always been to our patients and staff. As a profession, we have been consistent in our dedication to same. Science, ethics, guidelines and expectations govern these tenets and responsibilities. The sharp clarity that has always surrounded these core duties will remain constant. However, I believe that there are three fundamental areas where the provision of dental service for the immediate future will change as we await a vaccine – they are patient screening, cross-infection measures and patient management.

Vaccine / therapy

At these early days, the hope is, of course, for a vaccine. We are still however, learning about the virus – its origin, behaviour and pattern. We can only hope that a vaccine will be found and perfected as soon as is safely practical. The immunologists tell us that this may take at least 12 to 18 months. Until such time as a trusted vaccine is available, we will all have to work under the assumption that every patient is a potential carrier of the disease. 

This is not new for the dental profession. Our levels of cross-infection control are, (I would suggest) second to none in healthcare provision. We are all trained and practiced in the highest levels of cross-infection – it is the very nature of our profession. The unique challenge here will be the infectious nature and transmissibility of the disease – with its implications for other patients attending our surgeries, and our staff.

Patient screening

This is the obvious first step in protecting our patients who attend, the public health at large and our own staff. This will mean a stringent and replicable process of patient screening. 

The guidance is clear – e.g. patients with higher temperature/fever/cough etc are advised to avoid dental surgeries. This important safeguard will help – although it’s longer-term practicality will prove difficult, particularly during “regular” flu season – thereby potentially discriminating against or jeopardising routine treatment for patients suffering from the relatively innocuous “common flu”. The pre-attendance checks – featuring some key questions to prospective patients, etc – will be central to this strategy. The days of the “drop in” dental appointment are a thing of the past (for now).

Infection control strategies

Aerosol generating procedures (AGP) will be yet another challenge in a profession whose very essence is interventive. Already we are seeing medical air purifiers coming to the fore as new safeguards for patients. The merit and science behind these are both worthy of considered study. The provision of “clean air” management venting within our surgeries is also among the options which we may now have to consider. The use of adequate personal protective equipment (PPE) for routine dental treatment is another area that may become a more regular feature of future treatment provision.

Patient management protocol

Aside from the screening of patients before their attendance – it is obvious that the tenets of ‘social distancing’ will have to be maintained in the absence of any proven vaccine. How will this affect our appointment books? How will it affect our waiting rooms – both layout and disinfection? How will this affect our turnaround times for our surgeries and cross infection control measures? 

Finally, all of the above measures will bring added cost to treatment provision. The very nature of how we do business will change – and change utterly.  This added financial pressure on top of an already challenging return to practice will require careful planning and government support.

But, as in previous generations that have faced adversity in the eye of pandemic, war, and recession, it is fitting to also end this month’s column with another apt Cicero quote. This one bears special resonance for those who have survived the virus – “Dum spiro, spero” – “While I breathe, I hope”.