CGDent & FGDP(UK) update COVID-19 guidance synopsis

The Faculty of General Dental Practice UK and College of General Dentistry have published an updated synopsis of their guidance on the implications of COVID-19 for the safe management of general dental practice.

The synopsis highlights key recommendations at each step of the patient journey, and supports dental professionals to take a risk-based approach to providing safe care regardless of the national COVID-19 threat level.

The new version reflects the recently-revised guidance, which includes updated and additional recommendations on fallow periods, air ventilation, the 3 in 1 syringe, dental headpieces, air cleaners, decontamination, the protection of vulnerable staff, and the relevance of the R number and prevalence rate.

It is available at https://cgdent.uk/standards-guidance and https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide . Production of the synopsis has been supported by Sensodyne.

College of General Dentistry endorses FGDP(UK) and PHE revised guidance on radiation protection

The College of General Dentistry is endorsing revised guidance on radiation protection in dental practice, published by the Faculty of General Dental Practice (FGDP[UK]) and Public Health England (PHE).

The second edition of Guidance Notes for Dental Practitioners on the Safe use of X-ray Equipment sets standards of good practice for the safe use of X-ray equipment in dental practice.

The guidance is freely available on the FGDP website, where hard copies are also available to purchase from the online shop, and FGDP members based in the UK will shortly be receiving a complimentary hard copy.

Presenting definitive, detailed and comprehensive recommendations in a logically ordered and intelligible format, Guidance Notes for Dental Practitioners on the Safe use of X-ray Equipment, 2nd Edition is designed as a reference for the whole primary care dental team.

The guidance covers both administrative and practical matters, taking into account developments in dental X-ray equipment, imaging technology and legislation since the first edition, which was published in 2001 by the National Radiological Protection Board (now part of PHE’s Centre for Radiation, Chemical and Environmental Hazards).

It was produced by a working party led by Public Health England and consisting of regulatory bodies, professional bodies representing dentistry and radiation protection, consultant dental radiologists and general dental practitioners.

The new publication includes:

  • Existing guidance on dental cone-beam CT (CBCT), hand-held dental X-ray equipment and digital imaging systems
  • Updated guidance on:
    • Radiation controlled areas
    • The training of referrers, practitioners and operators with respect to dental CBCT
    • Acceptance, commissioning and routine radiation safety tests for all dental X-ray equipment and the recommended intervals (extended to every three years for most dental CBCT equipment) between routine tests
    • A simplified system for image quality rating and analysis
    • A simplified approach to quality assurance of digital imaging systems and viewing screens
  • New guidance with respect to the requirements:
    • For dental practices to register with the HSE (or HSENI)
    • To investigate the circumstances when contingency plans are activated, and on the need to rehearse contingency plans
    • To monitor radiation levels at the boundaries of controlled areas
    • To assess doses to persons who need to enter controlled areas
    • For employers to co-operate when employees work with dental X-ray equipment on another employer’s premises, including arrangements for the formal handover of responsibility
    • Regarding what should be expected of service engineers who undertake the installation, testing and servicing of dental X-ray equipment
    • When disposing of or selling-on X-ray equipment
    • For record retention
  • Detailed practical guidance on how to achieve the optimisation of patient dose
  • Template documents, including a radiation risk assessment and the employer’s procedures relevant to dentistry

The guidance supports compliance with the Ionising Radiations Regulations 2017 (IRR17) and the Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER17), but does not impose any requirements on employers beyond those required by legislation.

Ian Mills, Dean of FGDP(UK) and Trustee of the College of General Dentistry, said:

“The core function of the FGDP is to raise the standards of care delivered to patients through education of the dental profession and the provision of evidence-based guidance, and we have been delighted to work with Public Health England to publish a second edition of the Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. For almost two decades, this has been an important text in setting standards for the safe use of X-ray equipment in dental practices, and this updated edition will undoubtedly continue to be a key reference document for the whole primary care dental team.

“We are grateful to PHE and the many contributors who have spent considerable time and effort ensuring that it is informative, accessible and highly relevant, and are indebted in particular to Dr Keith Horner FFGDP(UK)(Hon.), whose analysis of the revised regulations three years ago was the catalyst for this project, and who has been involved throughout as the Faculty’s representative on the working group.”

New Ambassadors appointed by the College of General Dentistry

The College of General Dentistry is delighted to announce the appointment of two new Ambassadors – Dr Wendy Thompson and Dr Yewande Oduwole.

Those Ambassadors of the College who are dental healthcare professionals are drawn from across the spectrum of dentistry. They support the mission and vision of the College and encourage inclusive professional engagement in the development of the College.  Ambassadors help the College promote dentistry as an important element of general healthcare and wellbeing. Ambassadors support the College’s mission to promote life-long, preventatively orientated, minimum intervention, personalised, holistic dental care. 

More Ambassadors will be appointed in the coming months as the College works towards its historic, formal launch, rescheduled for early 2021, COVID restrictions permitting.

Chair of the College Board of Trustees, Professor Nairn Wilson, said: “I am delighted that both Wendy and Yewande have accepted the invitation to become Ambassadors for the College. With their help and support, it is hoped to engage many more early career members of the dental team in the further development of the College, which, as key elements of its mission, aims to provide all dental healthcare professionals with new leadership and much-needed career pathways. The Board of Trustees looks forward to working with Wendy and Yewande in realising the College goal of being valued by a large diverse, inclusive membership.”

Commenting on her appointment Wendy Thompson said: “The College of General Dentistry is a fantastic opportunity for the dental profession to come together. Together we can speak with one voice for the benefit of patients and dentistry. It is a huge honour to become an Ambassador at this exciting moment in the history of UK dentistry. I look forward to supporting the College as it works towards putting oral health at the heart of the nation’s health.”

Yewande Oduwoli said: “I am incredibly honoured to become an Ambassador for the College of General Dentistry. It is paramount that young dental professionals like me have an independent college that focuses on providing us with much-needed leadership and support throughout our careers. This of great importance to the further development of postgraduate training and to the  provision of integrated, holistic team care to meet patients’ needs and expectations.”

Wendy Thompson PhD MFGDP(UK)

Wendy is a National Institute for Health Research Clinical Lecturer in Primary Dental Care at the University of Manchester. She is a general dental practitioner, practising in Kirkby Lonsdale, Cumbria. Wendy is an honorary consultant to the Office of the Chief Dental Officer (England) and advisor to the FDI World Dental Federation on tackling antibiotic resistance.

As a special advisor to National Institute for Health & Care Excellence (NICE), Wendy has been involved with guideline and quality standard development on antimicrobial stewardship and shared decision making. She is co-chair of the Society for Academic Primary Dental Care’s special interest group on academic primary dental care, a member of the British Dental Association’s Health & Science Committee, a Council member of the British Society for Antimicrobial Chemotherapy and a member of the British National Formulary’s Dental Advisory Group.

Wendy is passionate about equality and diversity across the profession.

Yewande Oduwole BDS

Yewande graduated as a dentist from Peninsula Dental School and is currently completing her Dental Foundation Training.

She was the winner of the 2020 FGDP (UK) Dental Student of the Year Award, which she received for her demonstrable passion for oral health and dentistry. This includes mentoring prospective dental students and the online delivery of oral health advice to the public through her YouTube channel.

Yewande enjoys engaging in community outreach, focusing on oral health promotion in both schools and in her local community. She received a student scholarship from the Afro-Caribbean Dental Association in her third year of dental school. This then led to her embarking on a project in Ghana to provide free dental care and oral health education to communities, schools and orphanages. She has contributed to various articles for Dentistry.co.uk and Young  Dentist Magazine and been a guest on online podcasts.

Yewande has been a student representative for various dental organisations, including the British Dental Association (BDA), British Academy of Cosmetic Dentistry (BACD), African & Caribbean Dental Association (ACDA-UK) and is currently an Editorial Board Advisory Member for Dentistry Online and a part of the FDGP (UK)/ College of General Dentistry Equality, Diversity and Inclusion Programme Board.

Dental Fallow Time Calculator launched

A new free-to-use Fallow Time Calculator has been launched to enable dental professionals to determine, justify and record the fallow period necessary following dental procedures carrying a higher risk of exposure to potentially-infectious aerosols.

Built by digital consent platform Flynotes, supported by Practice Plan and Wesleyan, and endorsed by the Chief Dental Officer for England, the new tool complements the COVID-19 guidance published by the the College of General Dentistry (CGDent) and the Faculty of General Dental Practice UK (FGDP), the recent update of which incorporates the Scottish Dental Clinical Effectiveness Programme (SDCEP) recommendations on fallow time.

Public Health England guidance currently recommends a fallow period of 60 minutes in a treatment room with less than 10 air changes per hour from the point that an aerosol-generating procedure is completed. The CGDent-FGDP guidance recommends that practitioners justify any decision to stray from this, record factors which allow reduction of the time, and include details in the clinical record for each patient.

The Fallow Time Calculator is designed to facilitate this process, and is based on SDCEP’s multifactorial approach to determining fallow time. Set out in its recent publication, Mitigation of Aerosol Generating Procedures in Dentistry – A Rapid Review, this sets a ‘benchmark’ time of 15-30 minutes, which will vary dependent on the type and length of procedure, the employment of procedural mitigations such as high-volume suction and rubber dam, and the availability of environmental mitigations such as air ventilation.

Available at https://myftc.co.uk, the Fallow Time Calculator also offers a full audit trail, updated regularly in accordance with the guidelines, which practices can use to aid diary planning, allowing efficient patient treatment flows whilst ensuring necessary fallow periods are implemented. Register at https://myftc.co.uk/register.

Ian Mills FFGDP(UK), Dean of FGDP(UK) and a Trustee of CGDent, said:

“I’m proud and delighted to launch the new Fallow Time Calculator, which is the result of a fantastic collaborative effort. I particularly want to thank two fellow members of our guidance task group for their work in developing it – Flynotes CEO, Govin Murugachandran, and Faculty member and Deputy CDO for England, Jason Wong – as well as Wesleyan and Practice Plan for their generous support, which has enabled both the development of the calculator, and its free publication for the benefit of the whole profession.

“The tool is based on the recent SDCEP recommendations, which provide a sensible, pragmatic and safe approach to managing fallow time and the potential risk from bioaerosol. I am confident that the Fallow Time Calculator will be seen as a significant aid to the dental team and will support dental practices to continue their transition back towards delivering routine care.”

CGDent & FGDP(UK) COVID guidance update reduces fallow times

The College of General Dentistry and Faculty of General Dental Practice UK and have updated their guidance on the implications of COVID-19 for the safe management of general dental practice, incorporating the reduced ‘fallow’ times recommended by the Scottish Dental Clinical Effectiveness Programme.

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The guidance, first published on 1 June, supports dental professionals to take a risk-based approach to providing safe care, whatever the national COVID-19 threat level, at each step of the patient journey.

Among the distinguishing features of the document was its consideration of the risk of exposure to potentially-infectious aerosols arising from dental procedures as being on a continuum, rather than defining some procedures as ‘non-AGPs’ and treating all ‘AGPs’ as if they carry equal risk.

Members of the guidance task group felt compelled at the time to accept the 60-minute fallow period recommended by Public Health England following higher risk procedures. However, they also felt it would be more appropriate to adopt a more nuanced approach which also considered the length of procedure, as well as the potential to employ procedural and environmental risk mitigations, and suggested that reduced fallow times based on such factors might be justified.

The SDCEP review of aerosol-generating procedures in dentistry, published last week, takes just such factors into account in recommending context-specific fallow periods of between 10 and 30 minutes. While the FGDP-CGDent guidance has been thoroughly reviewed in light of the latest evidence and the experience of dental practices over the last four months, the most significant change is therefore the adoption of SDCEP’s fallow time recommendations, which have also been incorporated in an accompanying Fallow Time Calculator, which will be launched soon.

SDCEP’s review also divides dental procedures into groups according to their potential to generate aerosols, and to avoid any confusion over which procedures require fallow time, the FGDP and CGDent have ensured that those they classify in their guidance as posing a ‘higher exposure risk’ correspond to SDCEP’s highest-risk ‘Group A’ categorisation.

Available free of charge at https://cgdent.uk/standards-guidance and https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide, the revised document also provides additional detail and updated guidance on:

  • air ventilation and air cleaners
  • the use of the 3 in 1 syringe
  • the risk of aerosolisation from dental handpieces
  • decontamination of the surgery
  • the relevance of the R number and prevalence rate
  • the protection of vulnerable staff

Dental professionals are invited to learn more by joining two related webinars, which will be free to view live through Prodental. On Monday 5 October at 7pm, representatives of FGDP, SDCEP, the BDA and the Office of the CDO for England will discuss The Mitigation of Aerosol Generating Procedures in Dentistry, and on Monday 19 October, Mythbusters 2 will look at the latest changes and challenges of COVID-19 in light of the recommendations of SDCEP, FGDP and CGDent.

Onkar Dhanoya FFGDP(UK), Vice Dean of FGDP(UK) and Chair of the task group which developed and revised the guidance, said:

“Our revised guidance, incorporating the fallow time recommendations arising from SDCEP’s thorough review of evidence on the generation and mitigation of aerosols in dentistry, will enable general dental practices to increase delivery of patient care while maintaining the safety of both patients and members of the dental team. “This in turn should help improve access to dentistry, addressing some of the unmet oral health need which has built up in recent months, and support the viability of dental practices as the pandemic continues. Thanks are due to all the members of the task group, which represents a huge range of organisations and professional disciplines, for once again pulling together for the benefit of our profession at this critical time.

CGDent & FGDP(UK) to update COVID-19 guidance following SDCEP AGP review

The College of General Dentistry and Faculty of General Dental Practice UK have welcomed the Scottish Dental Clinical Effectiveness Programme’s review of the mitigation of aerosol-generating procedures, and will be issuing updated COVID-19 guidance shortly in view of its recommendations.

The SDCEP document, published today, represents the agreed positions of a working group comprising dental professionals from across primary care, secondary care, academia and public health, in addition to expert opinion from subject specialists in particle physics, aerobiology and clinical virology. The consensus report was compiled following a review of the currently-available evidence on the generation and mitigation of aerosols in dental practice, and the associated risk of coronavirus transmission.

Among the key positions, and in contrast to those adopted to date in official protocols, the report divides dental procedures into three categories of aerosol generation potential according to the instruments used, with fallow periods recommended only for the highest risk procedures, and suggests the determination of fallow time using a multifactorial approach with a ‘benchmark’ of 15-30 minutes.

The CGDent-FGDP guidance, published in June, also set out a more nuanced approach to considering the generation of aerosols in dental practice, and while allowing for potential adjustment of fallow time, accepted a 60 minute period following procedures carrying a higher risk of exposure to potentially-infective aerosols.

Ian Mills, Trustee of CGDent and Dean of FGDP(UK) – and a member of the SDCEP’s review group – said:

“SDCEP’s review of dental AGPs has been extremely thorough, and followed a rigorous and methodical approach. Its publication is potentially a very significant moment in the recovery of dental practices in the midst of the coronavirus pandemic and I commend the SDCEP Team for the hard work and dedication they have shown in producing this report.  

“We welcome in particular the more refined stratification of the transmission risk inherent in types of dental procedure; the allowance for fallow time to be calculated from the cessation of the procedure; and the sophisticated approach to calculating fallow time, which considers both procedural and environmental mitigation factors such as high-volume suction, the use of rubber dam and provision of adequate air ventilation.

“These approaches align exceptionally well with our own guidance and we feel it is important that current standard operating procedures are reviewed in light of SDCEP’s recommendations. Adoption of these measures will enable the increased delivery of patient care to tackle the backlog of unmet need, and avoid further deterioration in dental access and oral health inequality. A reduction in fallow time will also support the viability of practices, while the maintenance of universal precautions will continue to keep both patients and members of the dental team safe.

“We aim to update our guidance as soon as possible, and are currently working with partners to develop an online Fallow Time Calculation Tool to support its implementation.”

SDCEP’s Mitigation of Aerosol Generating Procedures in Dentistry – A Rapid Review is available at https://www.sdcep.org.uk/published-guidance/covid-19-practice-recovery/rapid-review-of-agps.

The current CGDent-FGDP guidance, Implications of COVID-19 for the safe management of general dental practice – a practical guide, is available at https://cgdent.uk/standards-guidance and https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide 

College of General Dentistry appoints new Ambassadors

The College of General Dentistry is delighted to announce the further development of its ‘College Ambassadors’ scheme with the appointment of two new Ambassadors: Professor Jason Leitch CBE and Professor Jacky Hayden CBE.

College Ambassadors are drawn from different backgrounds and walks of life. They support engagement of the College in society, and promote its influence in the interests of patients, building trust and confidence in the College and dental healthcare professionals. Ambassadors help the College ensure dentistry is properly recognised for its importance as an integral element of general healthcare and wellbeing. Ambassadors support the College’s mission to promote preventatively orientated, minimum interventive, patient-centred, longitudinal care. 

More Ambassadors will be appointed in the coming months as the College works towards its historic, formal launch, rescheduled for early 2021, COVID restrictions permitting.

Chair of the College Board of Trustees, Professor Nairn Wilson, said:

“The Board of Trustees of the College is delighted to further develop the College Ambassador scheme with the appointment of Professors Jason Leitch and Jacky Hayden, both of whom have a wealth of experience and expertise. The College greatly looks forward to working with its new Ambassadors in realising its immediate and longer-term goals, including reaching out to all stakeholders, including patients and other healthcare professions, to enhance the effectiveness, standing and status of dentistry.”

Commenting on his appointment Jason Leitch said: “It is a huge honour to be invited to be an Ambassador for the College of General Dentistry. As National Clinical Director of the Scottish Government, the advancement of quality in all areas of healthcare is close to my heart. It is an exciting time for dentistry, and I am delighted to contribute to the initiative to form the College.”

Jacky Hayden said: “I am honoured to accept the invitation to be an ambassador for the College of General Dentistry. General Dentistry has led the way in postgraduate dental education, and it is a tribute to all involved that the aspiration for an independent College is now being realised. Our health care system needs generalists and the special skills that they bring in promoting good health and preventing disease. Congratulations to all involved.”  

Professor Jason Leitch CBE

Jason has worked for the Scottish Government since 2007. In January 2015 he was appointed as The National Clinical Director in the Health and Social Care Directorate. He is a Scottish Government Director and a member of the Health and Social Care Management Board. He is one of the senior team responsible for the NHS in Scotland, an Honorary Professor at the University of Dundee, and the 2011 UK Clinician of the Year. 

He is a Senior Fellow at the Institute for Healthcare Improvement (IHI), and a 2005-06 Quality Improvement Fellow at IHI, in Boston, sponsored by the Health Foundation. 

Jason is also a trustee of the UK wing of the Indian Rural Evangelical Fellowship which runs orphanages in southeast India. He has a doctorate from the University of Glasgow, an MPH from Harvard and is a Fellow of the Royal College of Surgeons of England, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Surgeons of Edinburgh.  He is also a Fellow of the Higher Education Academy.

Jason was appointed to NHS England review group led by Don Berwick looking into the patient safety elements of the Francis Inquiry.

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Professor Jacky Hayden CBE

Jacky Hayden is President of the Academy of Medical Educators, a Non-Executive Director and Senior Independent Director at University Hospitals Plymouth, a member of the Medical Tribunal Service Committee and the Suitable Person for the MPTS. She is also an Associate for the General Medical Council and has led quality assurance visits to most parts of the United Kingdom.

Jacky’s clinical background is in general medical practice, she was a partner in Bury, Greater Manchester for thirty years and she was a long-standing member of the Council of the Royal College of General Practitioners. She has always been an advocate of high-quality medical education and after experience as a trainer and then course organiser she was appointed as Regional Adviser in General Practice (1991-1996).

In 1997, she was appointed Postgraduate Dean for the University of Manchester and the North Western Region, a position she held for almost 20 years. She was the first general practitioner to be appointed as a Regional Postgraduate Dean and she led the merger of the two former deaneries in the North West. She has chaired and served on many national committees and working groups including Chair of the Committee of English Deans. She was awarded Honorary Fellowship of the Academy of Medical Educators in 2011.

Following her retirement as Postgraduate Dean in 2016, she worked for the University of Nicosia Cyprus to establish a postgraduate clinical training programme in Cyprus. Jacky has also championed medical leadership throughout her career: she is a Council member of the Faculty of Medical Leadership and Management and was awarded foundation senior fellowship of FMLM in 2018. Jacky has been awarded three honorary doctorates: St Georges University of London, Lancaster University and Edge Hill University, and honorary fellowship of the Royal College of Psychiatrists. In 2013 she was awarded the CBE for service to medical education.

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Returning to Dentistry after COVID-19: Implementing Safe Practice

9 August 2020

11.00am -12.30pm (British Summer Time), Sunday 9 August 2020

The recent COVID-19 pandemic has caused dental practices across the world to close for several months. As practices now start to re-open, dentists, dental care professionals and governments are trying to work out the optimum way in which dental care can resume, while ensuring the safety of patients, staff and the community. The volume of information that is coming out can be challenging to navigate for the practising dentist and this webinar will provide practical and evidence based guidance for the safe return to practice. 

This webinar has been developed in particular for dentists and dental care professionals practising outside the UK, with the opportunity to address the most popular and relevant questions, and is being hosted in association with the Faculty of General Dental PracticeSri Lankan Dental AssociationKenya Dental AssociationProdental CPD and the Nepal Dental Association.

The Panel members are from the task group which developed the recent FGDP(UK)-CGDent guidelines, Implications of COVID-19 for the safe management of general dental practice, and several have experience of dental practice in South Asia.

Chair:

Panellists:

  • Dr Abhi Pal, GDP, Chair of the FGDP(UK) Professional Affairs Committee and Past Vice-Dean of FGDP(UK)
  • Dr Mick Horton, GDP, Trustee of the College of General Dentistry and Past Dean of FGDP(UK)
  • Dr Andy Edwards, Consultant in Oral and Maxillo-Facial Surgery and Vice President of the Royal College of Physicians and Surgeons of Glasgow
  • Prof Phil Taylor, Professor in Prosthodontics at the University of London and Dean Elect of the Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh
  • Dr Chet Trivedy, Consultant in Accident and Emergency Medicine

To register, follow this link.

Participants will be invited to submit two questions on registering, and the most popular questions will be selected for the panel to answer.

The College recruits for an Advisory Strategy Group to guide its development

The College of General Dentistry is recruiting an Advisory Strategy Group, seeking contributions from across the dental team. This is an important opportunity for people across the Registrant community to make an active contribution, guiding the future direction of the College. 

The Group will play a crucial role in advising the Board of Trustees as they make plans to launch the College. The Group’s 15 members, who will have first-hand experience working across the dental team, will provide much-needed insight into the ideas, perspectives and priorities of people working in dentistry. 

Chair of Trustees, Prof Nairn Wilson, said:  “This is an exciting moment for the College, a step closer to its formal launch, and a mark of our commitment to embrace the interests and contributions of the whole dental team. We believe that a lack of diversity in leadership and influence in dentistry is a barrier to effectiveness – and we want our Advisory Strategy Group to draw upon strengths across the many communities that have such an important role to play for the future.”

Applications close on August 21st, with interviews planned in early September. Details can be found at https://wp.me/P8ZZcL-tx