How can dentistry recover from COVID-19? New study suggests top-down reform is needed

The findings are based on the experience of dental staff providing urgent care during the pandemic.
Dentistry image

All areas of life are fighting back post-lockdown – but dentistry, with long NHS waiting lists and limited access to emergency care even before the pandemic, is on a particularly challenging road to recovery.

Now a study by academics from the University of Plymouth has investigated the experience of dental staff providing urgent care during the pandemic, and identified potential priority areas as the sector moves forward.

The background

At the start of the COVID-19 pandemic, access to all face-to-face dentistry was suspended. Urgent and emergency dental treatment was provided from Urgent Dental Care centres (UDCs) that were rapidly established across the country. Dental practices in England were allowed to reopen in June 2020, but access to treatment was still restricted and UDCs continued to play an important role in providing dental services on the slow route to recovery.

The findings

As part of this study, academics interviewed 29 dentists and nine dental nurses from UDCs across England. The findings, which were published in two papers in the British Dental Journal, suggest that reform is needed across the dental sector to help ensure appropriate and effective care is available for all.

The findings from the first paper, which examined perceptions and psychosocial experiences of frontline staff, suggest that:

  • Dentistry needs to be effectively integrated into wider healthcare infrastructures to improve communication and patient care.
  • Negative experiences from working during COVID-19 included stress and anxiety, often caused by concerns over safety and operational UDC challenges, which included fragmented communication and guidance, poor PPE availability and overwhelmingly high workload.
  • Sustained efforts are needed to support and improve dental teams’ mental health and wellbeing, supporting findings from earlier work led by the University revealing that more support focus was needed on the mental health of dental professionals.

The second paper, which explored the future of dentistry post-COVID-19, highlighted recommendations of:

  • ‘Levelling up' NHS dental access, with the need to prioritise the most vulnerable.
  • A desire from the dental profession for progress in transforming dental services, particularly dental contract reform in England.
  • Replacement of the Units of Dental Activity (UDA) system – a measure of the amount of work done during dental treatment – as part of dental contract reform, with a focus on prevention.
  • Mental health wellness support.

What the experts say

Professor of Community Dentistry at the University of Plymouth and Chief Executive of Peninsula Dental Social Enterprise, Rob Witton, co-led the new study, and said: 

“The pandemic, and particularly lockdown, have provided some really challenging times for the health sector, and this study shows how tough it has been in dentistry. Rather than looking at how we can return to ‘normal’, though, these studies enabled staff to really analyse their experience and reflect on if and how things could change for the better in future, including better access to dental care and preparedness for any future pandemics."

Professor Witton continued: 

“Waiting lists are long, lots of people struggle to access health care – we need something revolutionary. And the focus on levelling up health inequalities is something that we pride ourselves on at Peninsula Dental Social Enterprise. 
"We hope these findings will be of interest to professional bodies and commissioners in order to explore further how we can change dentistry for the better from the very top.”

Robert Witton
Dr Ian Mills

Dr Ian Mills, partner at Torrington Dental Practice in North Devon, Associate Professor of Primary care Dentistry at the University of Plymouth and study co-author, added: 

“From an academic and a clinical perspective, the study findings support our experience within primary care. Dentistry faces many challenges as we attempt to deliver high quality oral health care to the population. Patient need, and demand, massively outstrips capacity and this is particularly acute in Devon and Cornwall.

“We desperately need a radical reform of the way oral health services are delivered in England if we wish to maintain a viable NHS service for patients. It is hoped that the findings of this study will have highlighted some of the current issues and will inform future decisions on dental contract reform.”

Roz McMullan, Co-Chair of the Mental Health Wellness in Dentistry Working Group and Past President of the British Dental Association, said: 

“These papers by the Plymouth team show just how much the SARS-CoV-2 virus has shone a light on a profession which was stressed before the pandemic. They also demonstrate the need for wellness to be at the centre of all we say and do in the commissioning and delivery of dental services in the UK.

“Wellness, and its considerable impact on underlying mental health problems, is everyone’s responsibility: individual, the organisation an individual works for, and the system they work in. The work being done by NHSEI in England to support wellbeing in healthcare staff must extend to support primary care dentistry, and a new dental contract in all four UK countries, which puts wellness at its centre and values the brilliant work committed dental teams do each and every day, is long overdue.”

Along with Professor Witton and Dr Mills, the studies were co-led by Anastasios Plessas and Dr Martha Paisi, and co-authored by Dr Rebecca Baines, Dr Hannah Wheat and Maria Bernardes Delgado from Peninsula Dental School and Peninsula Medical School at the University of Plymouth.

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