Spotlight on: Dental Care and Practice
As we take a look at the impact of dental practices during the pandemic in our latest spotlight feature, two key areas come to light - the potential for patients to experience sub-standard treatment and that good-will may soon fade.
Our dental expert witness working on quantum and liability reports believes that whilst COVID-19 made dental care difficult and more expensive, it cannot be to blame for substandard treatment and didn't alter the duty of care owed to patients by the dental profession.
In his view, most dental practices and services worked extremely hard to get back to being able to deliver all necessary dental care. However, some practices took the approach of doing temporary treatments which require less costly PPE and room cleaning, and this is where many problems have arisen.
Whilst there was a distinct lack of PPE available throughout the first lockdown, at the start of July 2020 it was widely available, as demonstrated by so many dental practices. Consequently, after the first lockdown rules eased, it was difficult to argue against providing dental treatment that required Aerosol Generating Procedures. As such, the practices that failed to do the necessary treatment may struggle to defend why this was the case.
Liability cases will be brought by Claimants who feel they were provided with sub-standard dental care and where avoidable harm was caused and we expect an increase in these cases when patients begin to get back to their pre-COVID lives.
Aerosol Generating Procedures - Sub-standard treatments became the solution
Throughout the COVID-19 pandemic, dentists were faced with two options in terms of Aerosol Generating Procedures (AGPs); invest or avoid altogether. Whilst many practices worked hard to get back to a position of being able to deliver all necessary dental care (which will require AGP's to be performed), patients report there are many practices that chose to avoid the procedures altogether.
On the surface, this may have been an equally safe route but the long term effects of temporary treatments, requiring less of the costly PPE, room ventilation and cleaning is likely to have contributed significantly to the backlog of more than 30 million* missed appointments. it can be argued this this temporary route will do more harm than good.
Alexander Michael, Dental Expert Witness, says "After lockdown for dental practices was lifted and from the beginning of July 2020 onwards, essential dental treatments had guidelines to ensure where necessary they safely resumed. As such dental practices may find it very difficult to defend why AGP's were not taking place and temporary treatments continued. In my view, this type of situation does not constitute reasonable dental care."
"What I find difficult to understand is with the ability of dental practices to provide AGP's, many patients experienced sub-standard treatment and why so many temporary procedures are continuing, with no justifiable reason."
*British Dental Association June 2021
The British Dental Associations call for a road map - Good-will will fade
The UK's dental practices, both within the NHS and private provision right now are trying to balance the needs of continuing increased practice cross-infection control, with the challenge of getting to see the millions of patients without access to dental care, both in terms of patient appointments and financially.
In this scenario, both the NHS and the private side of dentistry has been affected. Both have seen considerable reduction in income, increased practice investment and, like all other healthcare workers, increased fatigue and stress with accompanying reduced morale. This is likely to get worse as time goes by.
The British Dental Association (BDA), along with other representative bodies, has lobbied for dentistry to be better supported in many ways, one being financially. Many practices have invested thousands in terms of Covid and its related provision of care, many practices feel they cannot invest to this level and many have questioned the almost non-existent level of government support.
The recent survey of the BDA (along with general comments of dental forums and the personal experience of our dentist expert witness) shows that one of the biggest limiting factors to dental throughput is caused by the 'fallow time'. This is the time the rooms must be left empty for after an Aerosol Generating Procedure. It varies depending on many factors, the room size, ventilation or air cleaning, procedure carried out, suction used, and so on. Many feel the fallow time does not necessarily reflect proven science (although it is recognised how we are in unprecedented times). Then for others they feel the fallow time does not seem to be flexible enough. Should it be different in different areas with differing infection rates? Should it now, more than one year on , be more science-driven? Is the vaccination status of patients a factor? Many feel that dentistry cannot get back to the capacity it previously had without a major rethinking or removal of the fallow time.
Alex Michael, Dentist Associate Expert Witness, says "This pressure of working under COVID will continue to take its toll on the profession and the guidelines produced on 16th July by the Chief Dental Officer still require AGP PPE to be used; at a time when the country is opening back up, restrictions are easing and the capacity of dental care is still catching up."
"The likely increase in stress may contribute towards sub-standard treatment provision, but most worryingly, there is a real risk that our patients' view of the dental profession will start to change. The 'honeymoon' period of good-will, felt by the public regarding treatment during COVID, is likely to start to fade. Whilst people will always be grateful for the dental services provided and the impact of the pandemic, there will come a time when many will struggle to understand the reasons for any continuing limitations in the provision of full dental care."
Meet our dentistry expert witness
Alexander Michael is a dentist and associate expert witness working with Bush & Co. He is experienced in providing private dental care, practice management and regulatory compliance and, as registered CQC manager within his practice, is experienced in quality assurance and safety standards within his practice.
In particular, Alexander is experienced in all aspects of restorative dentistry including restoration of dental implants. He has experience of cosmetic and clinical dentistry, periodontal disease treatment and oral surgery and is able to comment on dental standards, assess liability and causation, condition and prognosis.
As an associate expert witness working with Bush & Co, Alexander is able to analyse dental records and review standards of care. He is able to provide objective opinion on medication, nerve damage, failure to refer for specialist treatment and damages resulting in pain and injury both now and in the future. He will assess patients in either a clinical or private setting, depending on client need and level of assessment required.
In private practice, Alexander has experience of treating a wide range of patients with congenital and developmental disabilities and illness. He also has experience of treating those within the Deaf and Blind communities, those with paralysis and patients with dementia. He also has experience of treating patients following road traffic and occupational injuries.