The new norm, for as long as it takes: getting out of the (dental) confinement

Somehow, to me, the term used in France, le confinement, seems to describe what we have all been going through appropriately as (other than the meaning that we previously associated it with, namely, deliverance or childbirth), it can be roughly translated to captivity, detention or indeed confinement. The majority of readers of Dental Update are general dentists, so they will not need to be reminded about the profound consequences of the confinement, social distancing and so forth, all of which have prevented the operation of dental practices in the way that we used to consider normal, with the various financial sequelae to that, notwithstanding the inconvenience to, and in some cases suffering by, patients. Despite the mixed up way that the announcement was made, the good news is that a date has been set for the re-opening of dental practices in England.

There is no doubt that the coronavirus is highly contagious and that additional steps, over and above the old norm, now have to be taken and these will necessarily disrupt the throughput of patients. Dentists, however, are adaptable and, to some extent, the profession has been here previously. Before the advent of AIDS and increasing awareness of hepatitis B and C, customary practice was to carry out treatment, including extractions, while not wearing gloves or mask. It was generally only for surgical extractions that gloves were considered desirable – tell me the logic of that! I changed to routine glove wearing when my attention was drawn to a paper published in 1982, results of which indicated that blood products were present under the fingernails of dentists (attending a conference) who had not seen a patient for five days,¹ the inference being that such blood products could readily harbour blood-borne viruses. The cartoon in Figure 1 was drawn in the early days of glove wearing by dentists, when there was significant opposition to the practice. With the arrival of HIV and hepatitis B and C, however, we started taking infection control more seriously, sheathing air and water lines: the photograph in Figure 2 was taken by me in the 1980s when we started doing this. There was no evidence that this would be beneficial to the safety of patients or clinicians, in a similar way that dental surgeries in the UK were closed in March 2020 when there was little or no evidence that they would be a vector for transmission of the coronavirus. At the time of writing, when the easing of the lockdown is proving to be more difficult than its introduction, the re-opening of dental practices seems to be causing great soul-searching. At the time that I alluded to above, when an awareness of HIV and hep B dawned, changing the surgery between patients began to take increased time: no longer could a surgery be changed around with a quick rub with an alcohol wipe (which was probably of little or no value anyway), but the dental team adapted to the new norm then. We realized that the hot air oven was not a sterilizer, and we bought and used autoclaves and changed gloves between patients. Readers will not be surprised to learn that there was no enhancement of NHS fees for the increased time required for the various procedures. The dental team have always been at risk to infections carried by patients, so we used PPE to reduce the risk, although it was not possible to reduce the risk to an absolute zero. Now is the time for a further adaptation for the dental team, a further stepping up of PPE, although, again, it may never be possible to reduce the risk to zero.