Belgrave Dental Centre

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Newsletter 2 Covid-19 Update Amber Phase

Newsletter 2

August 2020


When will things get back to normal?

We are still a long way from returning to pre-Covid-19 normality. At present, dental services in Wales are in “Amber” phase. During Amber there is a gradual resumption of dental services. Services are likely to return to normal when the national Covid-19 alert level reaches Level 1, i.e. no transmission of the virus in the community. Unfortunately, if there is a second peak of virus cases in future then more restrictions could be re-imposed on dental services in Wales in order to keep the population safe.

At present the Practice is meticulous in its adherence to social distancing measures and compliance with enhanced cross-infection control measures. This means that we can protect staff and patients to the highest of safety standards.  However, the aforementioned measures dramatically affect the practices throughput of patients. Currently we can offer approximately 14% of the daily appointments that were available during pre-Covid times. That means that we still have to prioritize patients in pain and patients with dental problems.

What care is available now?

We are currently offering face to face appointments, where appropriate, to any of our patients who are experiencing dental problems. Please ring the practice if you are experiencing problems and a Dentist will ring you back for telephone-Triage. Triage enables the practice to gather information about you and your problem prior to your face to face visit at the practice.

What about drilling procedures?

We are able to offer both non-aerosol generating procedures (non-AGPs) and aerosol generating procedures (AGPs) at the practice. Please see the main newsletter column for details.

Belgrave Dental Centre

Covid-19 Update - Amber phase


We would firstly like to thank our patients for all of the warm messages of support and gratitude for the treatment that they’ve received during the “Lockdown” months. We have passed on their comments to the staff and it’s provided them with the motivation to continue to work tirelessly to deliver care to patients in the safest manner possible. It’s been a very challenging time for everyone and we hope that you are able to continue to stay safe in your day to day lives as lockdown restrictions ease gradually. We want you to know that we are doing our utmost to ensure your safety should you currently need to call on us and attend the practice for dental care.

It is our intention to reintroduce some of the more routine aspects of the practice (e.g. Hygiene visits) in the coming weeks. More on that later in the newsletter, along with why we still feel that the monthly practice plan payments are excellent value for money in the current climate.

Now that the Chief Dental Officer for Wales has moved dental practices in Wales into the “Amber“ phase we are now able to see any of our patients who are experiencing dental problems. I want to take some time to convey to you the impact of the vitally important cross-infection control measures that we are implementing. Currently one dentist is using two treatment rooms per day to maximize throughput of patients.

There are currently two types of appointments on offer at the practice.

1.    Appointment for a Non-Aerosol Generating Procedure (non-AGP)

These appointments are the majority of appointments on offer at the practice. During this type of appointment we can do treatments that do not generate an aerosol (a fine “mist” like spray that is generated by dental equipment during most dental procedures). Examples of treatments that can be provided during a non-AGP appointment include :-

·      Straightforward extractions

·      temporary fillings

·      Recementing crowns/bridges (but only straightforward ones)

·      Assessment and advice for soft tissue problems 

·      Hand scaling for urgent periodontal (gum) problems

Even something as straightforward and common place as drying a tooth with our compressed air-spray (a procedure that you’re all very familiar with) is not permitted during a non-AGP appointment. Following a non-AGP appointment enhanced cross infection control measures mean that we have to leave the surgery empty (with the door closed) for 15 minutes after the patient leaves, a process known as “fallow-time”. During all fallow time no one is allowed to enter the surgery. Following the fallow-time, 15 minutes is spent cleaning the surgery by a dedicated member of staff. The fallow time and decontamination time, coupled with a face-to-face time of 45 minutes means a non-AGP appointment takes up 75 minutes of surgery time. At the moment, gone are the days were dentists could “numb-up” one patient and see another for a quick problem whilst the first patient was going numb in the waiting room. 

2.    Appointment for an Aerosol Generating Procedure (AGP)

The practice is currently offering approximately two AGP appointments per dentist per day. During an AGP we can carry out all the procedures that we would have been able to in an appointment before the Pandemic. However, patients will notice a dramatic difference to the enhanced personal protective equipment that the staff are now required to wear to remain safe (see image below). Also, each treatment room has been stripped of all the non-essential items and will appear much barer than patients remember (no photos etc). This is to facilitate  stringent decontamination of the treatment room after each procedure. 

Members of staff in their AGP PPE (although it looks as though their going to be doing major surgery, this is what is needed to do a permanent filling)

The most disruptive element of providing AGPs at the practice is the fallow time that is needed after each AGP procedure. Current guidance stipulates that 60 minutes of fallow time is required between each procedure, followed by 20 minutes of cleaning. Including the 60 minutes of face-to-face time this means that an AGP appointment takes up 2hours 20 minutes of surgery time. To decrease the effect of the fallow time for the AGPs we have decided to carry out the AGP appointment at the end of the morning (to allow some of the fallow time to be taken up by the lunch break) and at the end of the day (when the fallow time can take place when we are closed. This will increase the numbers of daily patients that can be seen as critical surgery time isn’t wasted.

We are looking at ways that we can reduce the fallow times to allow for increased capacity. One way is to install “Operating theatre level” air extraction systems in all of the operating rooms. However, even with these systems fallow-time can only be reduced to 20 minutes plus the 20 minutes of decontamination (40mins as opposed to 80minutes). This is still a significant improvement and we will seriously look at the options open to us for air extraction.

The benefits of continued membership of the practice plan.

It has been natural for some patients to ask why they are still being asked to pay their normal monthly practice plan payments, when “routine” services are yet to re-establish fully. Many patients are concerned that they are missing their usual Hygienist visits, or check-ups.

We are likely to have capacity to re-introduce some Hygiene visits in the coming weeks (most likely in early September) and we will contact patients who had their visits cancelled in March and April initially. At present we feel that it is too early to book people in for routine check-ups at this stage, although we will constantly monitor the demand for our daily urgent/problem appointments and adapt accordingly. We are still in “Covid alert level 3” where there is ongoing transmission of the virus in the community. With all face-to-face visits the benefit of the visit has to outweigh the risk. This, coupled with the decreased capacity at the practice (shortest bookable appointment at present is 45 minutes of face to face time followed by 30 minutes of fallow time/decontamination) means that justifying check-ups is difficult at present.

Those of you who have been seen more recently during “lockdown” for an urgent problem and need to be seen for a permanent solution will be contacted in due course, the timing of the subsequent appointments will be governed again by urgent demand.

At present, the cost of a 45-minute non-AGP appointment for patients who are not on the practice plan is £220. The cost of a 60-minute AGP appointment for non-plan patients is £240. Both of these appointment types incur no additional costs (save for laboratory fees) for practice plan patients. We hope that our patients, who currently benefit from the practice plan, will realize that it represents excellent value given the current economic environment that dental practices have to operate in. Despite the effect of the current guidelines leading to vastly increased appointment times we wish to reassure you that there will be no increase our practice plan monthly fees for the coming year (2021).

For your Safety 

We have installed protective screens for patient and staff safety, this will enable us to avoid unnecessary contact between patients and staff members. We are discouraging cash payments and on-site card payments, but in the unlikely event that this will be necessary Contactless card payments are available at reception and card machines are wiped down with a sanitizer after each use, with or without pin input.

Should you need to make a payment for your treatment (e.g. laboratory fee for denture repair) we would urge all patients to make the payment remotely. Over the telephone prior to their visit.

Protective Perspex screens at reception to enhance social distancing and protect patients and staff.

On behalf of the team we wish to thank you for your continued support, and we want you to know that we are here for you should you need us. Please contact the practice if you have any problems at all and we’ll be happy to help.