The dentist’s chair: lockdown in the life of a local dentist

Our guest blogger is Dr Jiten Raval, a general dental practitioner for over 33 years. He runs Raval Dental, a mainly NHS practice, in Cromer Street, King’s Cross. Dr Raval is a member of the Camden & Islington Local Dental Committee and British Dental Association.

Many of you will have seen the news on Thursday 28th May announcing that dental surgeries can reopen from Monday 8th June. The general public will be wondering what dentists have been doing since dental lockdown measures were introduced on March 25th. Let me give you an insight into my time.

From day one, I have been offering a telephone service for all enquiries and emergencies, regardless of whether someone was my patient or not. This was not restricted to normal surgery hours. Thus, I received calls early in the morning, late at night and at weekends. Several were from key workers, all working irregular shift patterns. For instance, from nurses who had been seconded, from far away, to work at University College Hospital and housed at hotels in the King’s Cross area. Their regular dentist would be inaccessible, necessitating me to step in to offer advice, analgesics and antibiotics, called “triple A”.

The first weekend after lockdown, I had a call from a long standing patient reporting he had lost the front tooth from his upper denture. This gentleman, in his nineties now, is an ex-special forces soldier who during the war was part of the detail that would escort the then Princesses Elizabeth and Margaret to Balmoral upon landing in Scotland. Some two years ago this same gentleman had gone to the rescue of a mugging victim in Kentish Town, fighting off five assailants.

His act of bravery was commended at Buckingham Palace with the Queen remembering his close protection work all those years ago. Though I was not allowed to offer treatment, weeks later on VE Day I felt compelled to call him. He lives alone so we spoke for half an hour about all things non-dental. At the end, I enquired about his denture, to which he nonchalantly remarked he had simply mended it with superglue; true war-time spirit.

The pandemic has forced Camden residents working overseas or in other UK cities to return to our borough. Since they ordinarily access healthcare elsewhere, they are unaware of the procedures here. Thankfully, NHS 111 have been putting several in touch with me such that “triple A” can be imparted. I urge anybody in this dilemma to contact their local practice or NHS 111.

With emergencies, to help with diagnosis, I request patients send photos via WhatsApp. However, during these financially trying times many have abandoned their data contract. Here, I have resorted to carrying out 2 metre consultations at the surgery. At times I have left temporary dressing material to repair a lost filling on a tray, moved away for the patient to take and instructed how to apply.

Since dentists are versed in cross-infection protocols, many have been redeployed within the NHS. For instance, my wife, an ITU Sister, has had several dentists working with her on Covid Wards assisting during proning (turning over a patient on a ventilator to face downwards); a very challenging and intricate manoeuvre.

PPE has entered the domain of common parlance. As dentists we hold large stocks of these items. When the news announced hospitals were running short, many of us donated our supplies. Residing in Hertfordshire, mine went to Watford General. Now reopening has been date stamped, we are busy replenishing our cupboards.

When dental surgeries reopen, this will not be simply a resumption of services as per before lockdown. Instead, each individual practice will carry out a risk assessment and determine which treatments it is willing to offer. Certain treatments, called Aerosol Generating Procedures (AGPs), will still need to be carried out in defined Urgent Dental Care Hubs, to which your dentist would refer. An AGP is any treatment where water from instruments working at high speeds produces a spray. These include the use of the high-speed drill for fillings and crowns, and the cleaning of teeth with ultrasonic scalers.

In my own surgery, I have been busy making adjustments, such as removing alternate waiting room chairs, removing magazines and installing a sink where patients can wash their hands before climbing into the dental chair. Patients will find receptionists sat behind plastic screens with the initial consultation being carried out at 2m distance. We will still be wearing the same PPE of apron, mask, goggles and gloves for treatments. Patients will be requested to touch as little as possible on the premises with everything wiped down after their visit. All this will take a lot of time, meaning fewer appointments will be available. We sincerely ask you to be considerate. After all, this is for all our safety.

As a profession we have longed for this return to providing our patients with active treatment. The first patient I invited back?…..The soldier for a new denture; on the house of course.