DENTISTRY CLINGING ON BY THE SKIN OF ITS TEETH
Patients in agony, emergency hubs struggling and thousands of small practices on the brink of bankruptcy
DENTISTS banned from working, patients left in pain for months, small practices facing bankruptcy and a health system at risk of collapse – this is dentistry in lockdown. As routine dental work is halted under Covid-19 rules, thousands of patients and dentists suffer the consequences. Experts warn the outcome for UK dentistry and the NHS will be disastrous if problems are not tackled soon. British Dental Association chair Mick Armstrong told the Daily Express: “Without help, this service may not survive this pandemic. Thousands of small businesses, serving millions of patients are in dire straits. The public are starting to see what life is like without dentistry. It risks becoming permanent unless we see action from the Government.” We speak to the dentists and patients struggling in lockdown…
‘I NEEDED ROOT CANAL BUT COULDN’T GET IT’
MOTHER OF TWO ANGELA WOOD, 49, FROM SHEFFIELD
Angela developed a toothache in her bottom left-hand side jaw on the first day of lockdown. She grinds her teeth and had just bought a house so put it down to stress. Three weeks later the pain was unbearable.
“I couldn’t focus on life,” she says. “I was popping pills day and night.”
Angela’s dentist referred her to one of the NHS urgent dental care (UDC) hubs set up to treat patients during lockdown. There are 420 in England, 56 in Scotland, 38 in Wales and five in Northern Ireland. Their locations are a closely-guarded secret. “The first thing they say is we can only offer extraction,” Angela says.
Current health regulations prevent dentists from conducting aerosol-generating procedures (AGPs), which produce saliva or blood, as they risk spreading the virus. Extractions are the reality given many hubs lack personal protective equipment.
Angela, right, was given an X-ray and told she had an infected crown, possibly treatable with antibiotics. But she returned
48 hours later, still in agony. She required a root canal but the dentist could not do it.
“I thought I can’t sit here in pain for much longer so I had it taken out,” she adds. “It was horrific. He was pulling and tugging at this tooth for nearly an hour.”
Later she suffered excruciating sensitivity in the surrounding area. “I was told I would have to have another tooth out if I came back in,” Angela says in disbelief.
She declined and had the area cleaned at a private practice, costing £95. “I suffered from anxiety before this but it’s made it 100 per cent worse,” she says.
HOW IT WORKS AROUND WORLD
DENTISTS in Denmark and Norway reopened on April 20 for routine treatments. They must meet strict guidelines, keep AGPs to a minimum and social distance.
The American Dental Association (ADA) supports dentists reopening after a widespread shutdown but states have the final say – 42 out of 50 have reopened.
Germany did not close practices during lockdown except in a few exceptions. Guidance continues to be updated but stringent infection control measures are believed to have kept infections low.
‘EXTRACTION WAS ONLY OPTION, THE CLINIC WAS OVERWHELMED’
RETIRED DAVID WALSH, 64, FROM CHICHESTER, WEST SUSSEX
David’s toothache has lasted eight weeks. He underwent a root canal last year, which flared up briefly in January, but then lockdown arrived.
“I have been in constant pain and now have numbness in the face and nosebleeds,” he says. He has had three rounds of antibiotics and phoned an emergency out-of-hours clinic to be told extraction was the only option.
“I got the impression they were overwhelmed,” he says. “I was told for every 50 calls they received they could only see five people.”
David has taken painkillers since. “It’s tiring, wearing, upsetting, and difficult,” he says.
“The silence is deafening from the Government on dentistry and when it will be reinstated. It’s been airbrushed out of the national dialogue. Patients are in absolute misery. We are going to be collateral damage in the war against Covid-19.”
’IF I LOSE MY DENTAL PRACTICE THEN I LOSE THE HOUSE TOO. I FEEL TERRIFIED ABOUT THE FUTURE’
DR JACY CLEAL, 38, OF THE WINDMILL DENTAL PRACTICE IN WEST SUSSEX
Dr Cleal and her husband were four months into owning their business when lockdown made them close to 1,800 patients and 12 staff. “I was just finding my feet, and was loving it so much – the best thing I’ve ever done – so having this happen completely floored us,” she says. “I feel terrified about the future. It’s the worst luck and timing.”
Most of the UK’s 12,000 dental practices combine NHS and private work but many are private only. NHS services are still funded but practices rely on private income to subsidise costs and it has gone overnight.
Staff are furloughed but practices are still paying for mortgages or rent, utility bills, and business rates – among the few High Street businesses to do so, the BDA says.
In a poll on April 12, it found 70 per cent of dentists faced collapse within three months, while one in five would not survive a month.
Dr Cleal’s income has dwindled to zero. When furlough ends she will be responsible for wages but social distancing will keep patient numbers low.
“The figures are so risky if I really think about that I’ll never sleep again,” she says. “You don’t buy a dental practice with the money you have. You mortgage it to the absolute maximum. My house is the guarantee for my business so if I lose this place, I lose the house too.”
Dr Cleal, right, is equally concerned about her patients. “Most dental emergencies are broken teeth, lost fillings or crowns which equals an enormous amount of people not suitable for hubs so they’re lost at sea and there is little we can do for them,” she says.
Oral cancer is normally identified in check-ups, and she warns of “an exponential rise in delayed diagnosis, leading to a poorer prognosis long term”.
The Government must trust dentists, she says. “We lead the way in healthcare with an outstanding level of cross infection and cleanliness, with an even higher level now,” she says. “We need uniform guidance to get back to work quickly and safely.”
‘IF THESE PRACTICES WENT BANKRUPT TOMORROW, HOW WILL THE NHS COPE?’
DR KANWAR RATRA, 45, OWNS 2 WEST MIDLANDS PRACTICES Dr Ratra’s Lansdowne House Dental Practice in Bromsgrove serves 13,000 patients and 85 per cent of its income is private.
“Our finances are going to run out soon,” he says. “We’ve had to double overdraft facilities and beg for capital repayment holidays from the bank. We do not qualify for small business rate relief or the Self-Employment Income Support Scheme because our earnings are over £50,000.”
He believes it’s unfair private practices are carrying the burden of risk. “If they went bankrupt tomorrow, then how is the NHS going to cope with all those patients?” he says. “There are not enough practices to cater for them and there isn’t the funding either.”
Some 101 MPs wrote to Chancellor Rishi Sunak last month urging him to intervene before dental services collapse and Dr Ratra agrees that the £50,000 SEISS threshold must be raised. He wants Government grants too.
A Department of Health and Social Care spokesperson said it is “working closely with Public Health England and the dental profession to see how routine dental care can safely be restored” and “unprecedented funding” had been given to support dentists during the crisis.
‘IF YOU’RE NOT BLEEDING OR GOING GREY IN THE FACE, THEN YOU CAN’T GO TO A&E’
FINANCIAL SERVICES WORKER ANTHONY FOSTER, 39, OF ESSEX Anthony was refused the root canal work he needed and told that losing an infected front tooth was his only option.
He was prescribed antibiotics and told to call his dentist a week later but the pain worsened within days, spreading to five teeth.
“I panicked and went on social media,” he says. “There were hundreds of people with the same issue.”
BDA Vice Chairman Eddie Crouch was online dispensing advice and told Anthony he had “severe erosion” and “pulpitis” requiring immediate treatment.
He was referred to an UDC hub but was told it was extraction only. “I wanted a firm diagnosis first,” he says.
Anthony spent days “going round in circles” between his dentist and 111, taking morphine-strength pain relief.
“I was in bed shivering, my temperature dropped to 35.1C and I was preparing to go to A&E,” he says. “I rang 111 at 1am and said, ‘I need you to tell me where I need to go for treatment’ and they couldn’t help. There was a symptom checklist.
“If you’re not bleeding or going grey in the face, then you basically don’t need to go to A&E,” he says in exasperation.
He called 20 dentists across London and the South-east. “All of them had the same message,” he says. “We’re closed until further notice.”
Luckily, a Liverpool dentist who saw his conversation with Eddie Crouch suggested Anthony try the Eastman Dental Centre at University College London Hospital. He emailed its top professor and received root canal work for dead pulp within 24 hours.
“Were it not for that Liverpool dentist, I probably would have lost my tooth,” says Anthony, who had barely slept for 10 days.
“It should never be up to the patient to scramble around to find treatment.” He is calling for the publication of an official list of dental centres offering AGPs.