Covid Risk Factors

People at high risk (clinically extremely vulnerable)

You may be at high risk from coronavirus if you:

• have had an organ transplant
• are having chemotherapy or antibody treatment for cancer, including immunotherapy
• are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
• are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
• have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
• have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
• have been told by a doctor you have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
• have a condition that means you have a very high risk of getting infections (such as SCID or sickle cell)
• are taking medicine that makes you much more likely to get infections (such as high doses of steroids or immunosuppressant medicine)
• have a serious heart condition and are pregnant
• have a problem with your spleen or your spleen has been removed (splenectomy)
• are an adult with Down's syndrome
• are an adult who is having dialysis or has severe (stage 5) long-term kidney disease
• have been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of your needs

What to do if you're at high risk

If you're at high risk from coronavirus, there are things you can do to help keep yourself safe.

See what to do if you're at high risk from coronavirus.

People at moderate risk (clinically vulnerable)

People at moderate risk from coronavirus include people who:

• are 70 or older
• have a lung condition that's not severe (such as asthma, COPD, emphysema or bronchitis)
• have heart disease (such as heart failure)
• have diabetes
• have chronic kidney disease
• have liver disease (such as hepatitis)
• have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis or cerebral palsy)
• have a condition that means they have a high risk of getting infections
• are taking medicine that can affect the immune system (such as low doses of steroids)
• are very obese (a BMI of 40 or above)
• are pregnant – see advice about pregnancy and coronavirus

Unlike people at high risk, you will not get a letter from the NHS.

What to do if you're at moderate risk

If you're at moderate risk from coronavirus, the advice for you depends on the rules where you live.

The advice is based on the level of risk in your area. These levels are called local restriction tiers.

Find out about local restriction tiers on GOV.UK

Tuesday December 15, 2020

Covid Update

Wednesday September 09, 2020

Covid 19 Update

Covid-19 and your care

Guidance as to what dental procedures we can safely carry out and at what stages during the pandemic we can do them have been released and refelcted upon.

Below is a summary of the guidance as we understand it:

• The government has set five different risk levels for the pandemic 1-5 (low to high). Today we are at level 4.
• The treatments that we can carry out safely in dental practice will change with the risk level.
• Treatments are significantly limited at level 4.

Practice doors will be locked at level 3, 4 and 5. Entry to the practice will be limited to pre-booked appointments.

A clear video has been put on facebook outlining the added steps we have put in place to maximise safety and social distancing.

The appointment diary will be structured to take into consideration those patients who are shielding, may have underlying medical issues and so on.

At level 4 we should be able to carry out the following:

• Dental assessment (initially restricted to patients who have current urgent need, or did and contacted us during lockdown).
• X rays but only for patients who tolerate them well.
• TEMPORARY re cementation of crowns. (We cannot dry the tooth effectively enough to cement a crown permanently with the restrictions we face).
• Fabrication or repair of removable dentures.
• Simple dental extractions. If a tooth breaks, it is probable we will have to leave the roots in place until we are at a lower level of risk. Naturally, we will assess the risk very carefully prior to treatment.
• Tightening of loose dental implants if possible, without using a high-speed handpiece (drill).
• Temporary fillings.
• Draining of a swelling/abscess.
• Provision of antibiotics.
• Trimming of sharp orthodontic wires (not reliable re cementation of loose brackets, or replacement of missing brackets).

Treatment is only to be offered after careful assessment.

Cosmetic orthodontics

At Dane Bank House we provide many of these treatments. We may now be able to progress some of our Invisalign and Inman aligner cases. We will be in touch with each patient shortly, but please allow us to contact you; we hope that it is understandable that we will be prioritising patients with urgent dental need.

The PPE (personal protective equipment) requirements for the above treatments have mainly remained the same and and we will not look too different to normal. As you are aware, the cross-infection control at Dane Bank House has always been exemplary.

We have sourced numerous gowns, FFP2 face masks and other added PPE.  As with most practices, none of the profession knew what we needed and what to order.  Even being organised well in advance is no guarantee of success.  All practices are attempting to source everything we need to keep you and us safe, but supplies are scarce and consequently very expensive.  Certain masks will need something called a fit test.  Every time a different type of mask is sourced, new fit tests will need to be booked for each team member (and there are over 20 of us).

Whilst we at level 4, we cannot use the high-speed handpiece (drill). We will be able to use the slow one in specific circumstances. We cannot use the 3 in 1 syringe (to wash and dry teeth) properly.

Once the threat level reduces to 3, we can start to use handpieces and the 3 in 1 again, albeit with some restrictions in place. One significant challenge is that the guidance suggests that a surgery may have to be left empty for 60 minutes after using a highspeed handpiece or the ultrasonic scaler used by the hygienist. This will clearly have a significant impact upon the number of patients we can see each day. The guidance on this is likely to change regularly depending on new research as it occurs.

At level 3 we hope to be able to return to providing

• routine examinations,
• permanent fillings,
• permanent cementation of crowns and bridges,
• removal of roots,
• straightforward implant placement,
• removal or fit of orthodontic appliances,
• root fillings,
• ultrasonic scaling (cleaning).

At this stage, whilst we will be able to provide more routine dentistry, we will still have the doors locked, closed waiting rooms and a significantly reduced volume of appointments available.  Certain at risk/vulnerable groups may need to be risk assessed on whether it is appropriate to enter the practice and also whether treatment is appropriate.  Safety is our priority!

We will be looking at changing practice opening hours and other flexible options to try and provide as comprehensive service as possible, but in the short term it is possible that each dentist will require two surgeries to be available to be able to work at greatest efficiency.  Even then, initially we expect only to be able to work at around 30-50% of normal capacity.

On top of these clinical challenges, each team member will require an individual assessment as to whether they are physically able to return to a clinical role, and additional training procedures will be required, for example in how to safely put on and remove the new PPE.  Not all faces adapt to the new masks, some team members may fail a fit test and not be able to assist in surgery.

This is going to be a whole new way of providing your care. You can rest assured that every action we take will be with the safety of both you and our team at the very forefront of our minds.

Please be patient with us as we put new protocols into place and refine them.

Please keep checking our website, and social media feeds for the latest updates.

Stay safe and stay alert.

Stuart, Karen, Emma and the team xxx

Tuesday July 21, 2020