The following article was published this week in The Times. At Far Headingley Dental Care we have invested heavily into our dental practice and our Covid-19 safety measures to ensure that we were ready to be open and offer a full range of services from 8 June.
Not all dental practices have taken the same approach as ours and many NHS dental practices (that are 100% funded by the UK Government), are only providing a fraction of their dental care (the target set by Government). These practices are also being provided with free PPE, when private practices like ours are now subject to full VAT on our essential PPE purchases. Please support the UK private dental health sector by signing this petition to the UK Government to remove VAT on PPE.
At FHDC we worked hard during lockdown to be ready for our patient and invested £000’s in PPE, training, IT and other Covid-19 safety measures. FHDC has been assessed by the Care Quality Commission (CQC) who were pleased about the approach that we have taken since June and are confident that we are managing the impact of the COVID-19 pandemic as well as possible.
At FHDC we thank all of our loyal patients who have been supporting our independent dental practice and we welcome the many new patients who have decided to join our practice to ensure their dental care. All of these people will have benefited from oral cancer screening, preventative advice and care, emergency dental access, dental hygienist access and restorative dentistry.
The original Times article can be found here.
What lockdown has done to your teeth (it’s not pretty):
December 7 2020, The Times
This has been a year that has wreaked havoc — to care homes, to pubs, to education. Yet one area, possibly overlooked, is the damage it has caused to our mouths.
Britain’s dental health has taken a battering, not just from many of us scoffing sweets and snacks while we worked from home, but mostly because so many have been unable to access a standard dentist check-up. According to the British Dental Association (BDA), 19 million fewer dental appointments have been undertaken this year than expected.
During the whole of 2019 there were 39.5 million dental appointments. This year it is expected to be considerably less than 20 million. “So at year end, Covid-19 will have more than halved access to care in 2020 — with real consequences for millions of patients,” says Ashley Dé at the BDA.
On top of this, a study from Tel Aviv University, published a fortnight ago, found that teeth grinding and jaw clenching rose considerably during lockdown.
So what has 2020 done to our teeth? Here, some leading dental experts spill the beans.
Possibly the most serious of all is the probable increase in oral cancers. “I’ve seen a few patients who have suspicious lesions or ulcers that have not gone away during lockdown and they’ve tried to manage it themselves, when normally they would have been picked up by a dentist,” says Natalie Bradley, a special-care dentistry registrar who works at Guy’s Hospital in London. At the height of the lockdown she was working in an urgent-care hub — undertaking emergency dental procedures for all those that couldn’t access a normal dentist.
She points out that the 19 million missed appointments might have been mostly routine check-ups, “but that’s also 19 million missed cancer screening appointments because dentists also check your soft tissues for possible lesions.”
The BDA adds that during the height of lockdown, oral cancer referrals fell by 80 per cent compared with normal levels. “Oral cancers are surging, and kill more in the UK than car accidents,” Dé says. “But we’ll have to wait on next year’s data to see how this has impacted on survival rates.”
Bradley explains that a mouth ulcer that doesn’t heal after two weeks, or one with red and white patches, is a warning sign, along with generally feeling unwell or swellings in the neck. “You should try to see your dentist,” she says. “Or your GP can refer you urgently if you can’t get a dentist’s appointment.”
If anything, it has been even harder to see a dental hygienist than a dentist because of fears that cleaning teeth can cause the Covid virus to be sprayed around a surgery. “Hygienists are still not doing procedures that cause a lot of aerosols. So they are doing a lot of hand scaling, rather than using an ultrasonic scaler,” says Phil Richards, based in Burton upon Trent, Staffordshire, who has been a dentist since 1998. An ultrasonic scaler is not just a fancy bit of kit. “As well as physically removing the tartar, the energy in water spray helps disrupt the bacteria, over and above what a hand scaler can do.”
Getting rid of this bacteria is crucial not just in delaying any cavities, but reversing gum disease. “You have bacteria in the mouth, some cause gum disease, some cause tooth decay,” explains Damien Walmsley, professor of dentistry at the University of Birmingham and the chief scientific adviser to the BDA. “It doesn’t matter how good you are with brushing, they just sit there quietly doing nothing until you feed them sugar. Then they get to work. They turn the sugar into acid, and that attacks the tooth.”
All experts agree, however, that regular and persistent cleaning of your teeth with a fluoride toothpaste can reverse gum disease. And remember: spit, don’t rinse. “By not rinsing, the fluoride toothpaste sticks to your teeth and stops the bacteria doing its work,” Walmsley says.
DIY dentistry gone wrong
During May and June, when a mere 3 per cent of normal dental treatments were being undertaken, some patients resorted to drastic measures.
In Portsmouth, Chris Savage, 42, a labourer, yanked out two loose front teeth using some pliers because he was in agony, having first downed eight pints of Stella Artois in a rather misguided attempt to numb the pain.
“We don’t want to go back to Victorian times, and people doing their own dentistry,” Walmsley says. “Doing stuff in the mirror is not particularly easy. Even I would find it hard to do. It is much better to get someone else to do it for you, but some people are driven to distraction by the pain.”
Dentists say the most common DIY dentistry undertaken in lockdown was people mending their dentures with superglue, which is not advised. “It can cause gum damage, and make matters worse,” says Bradley, though she adds that many people found they were quite handy. “I’ve seen people use denture fixatives to stick their crowns back on, or even Blu Tack. It was surprisingly effective.”
More teeth extracted
The most common problem spotted by dentists in recent weeks have been cavities caused by nine months of snacking and grazing — combined with not getting a check-up. Worse is when a simple cavity has started to infect the root, requiring root canal work or, as the dentists like to call it, endodontic therapy.
“I have had patients who have ended up having a tooth extracted and it could have been prevented if they’d been seeing a dentist on a regular basis and having it checked,” Walmsley says.
Some patients are choosing to have their teeth extracted because of the fear of having to make multiple trips to the dentist, according to Richards. “Some people will shift heaven and earth to save a tooth, some don’t care at all. Covid hasn’t changed that, but some people are still very anxious about Covid and if I say to them it’ll take four visits to save the tooth and the extraction will take just one, they go with extraction.”
Children’s oral health has collapsed
Even before Covid, the state of children’s teeth in the UK was pretty dire. Lockdown, with many children allowed to snack on biscuits throughout the day, has almost certainly made it worse, dentists worry. “The government had made a commitment to expanding supervised brushing schemes in schools. That’s gone by the by,” Walmsley says.
“Children’s enamel is weaker, so things can progress quicker in children,” explains Bradley, who adds: “The number one reason for general anaesthetics given to children under seven is the removal of rotten teeth.”
This is a depressing enough statistic, but the concern is that many of these rotten teeth cannot be pulled because of the pressure hospitals are under. Dentists have not been allowed to administer general anaesthetics in dental surgeries since 2002. “There are now waiting lists for up to three years in some parts of the country for children to get a general anaesthetic for dental work,” Bradley says. She adds that some parents have resorted to trying to yank out their children’s teeth because they are in pain. “They’d already been waiting for a hospital appointment a long time, and then it was cancelled.”
It is hard to know if the anxiety of covid and lockdown has caused a surge in tooth grinding, or bruxism, because it is mostly self-reported — if you don’t share a bed with someone do you even know you are doing it? Tel Aviv university found the prevalence of grinding rose from about 35 per cent pre-pandemic to 47 per cent during Israel’s lockdown; the prevalence of jaw-clenching in the daytime rose from about 17 per cent to 32 per cent.
Richards believes there has been a direct link between the stress of lockdowd and bruxism. “Just at the end of lockdown I was getting a lot of complaints about diffuse, undefined pain, aches in the face. But as people got used to being out and about that seemed to go away. Then, as lockdown 2 hit, it started to go up again. I don’t know if it’s because of lockdown, or the normal stresses and strains of Christmas.”
A splint, or properly fitted mouth guard, can stop the effects of grinding, which can cause your teeth enamel to be stripped away and fillings to become dislodged.
But the most immediate solution is to avoid caffeine before bedtime and cut down on your alcohol intake.
Hard to do at Christmas, perhaps. But since securing an appointment at a dentist is still as tricky as getting your hands on Playstation 5, it may be worth considering.
If you would like to join our patient focused dental practice you can register for a new patient consultation using our online booking portal via our website. Alternatively please call our reception team on 0113 275 1323.