"We try our best to smile with our eyes."
23 June 2020

"We try our best to smile with our eyes."

Dr Rob Emanuel describes how he and his team have changed the way they work to continue to provide emergency care for shielding and vulnerable patients across Sussex throughout COVID-19.

Sussex Community NHS Foundation Trust (SCFT) provides special care dental services for patients with special needs or for those patients who have difficulty accessing general dental services. The Trust's Special Care Dental Service is for patients with specific health and social care issues including alcohol and drug misuse, along with vulnerable children and young people, travellers, people with dental phobias, and people with learning disabilities, mental health illnesses, or physical disabilities.

The Trust also provides an out of hours Emergency Dental Service.

Dr Rob Emanuel, Consultant in Special Care Dentistry at SCFT, has been a dentist for 27 years and is based at Haywards Heath Health Centre.

Here, he describes how the team responded to the challenges of COVID-19 when the country went in to lockdown, and established an urgent dental care hub where they continue to provide emergency dental care.

How has COVID-19 changed your way of working?

At Haywards Heath Health Centre we normally provide specialist Special Care Dental (SCD) services to the local population - that is, dentistry for adults and children with a wide range of disabilities who are unable to attend a high street dentist.

SCFT also run an out of hours Emergency Dental Service (EDS) where routine patients can attend for out of hours urgent dental treatment in the evening, during the week, or during the mornings on weekends and Bank Holidays.

However, since the lockdown on 23 March, we have needed to adapt to the new role specified by the NHS to act as an Urgent Dental Hub. This means that in the day we are providing urgent dental care to both shielding and vulnerable patients as well as being ready to offer urgent care to any patients who have COVID-19 symptoms and who cannot wait until their symptoms clear.

We are also working more closely with the EDS in the evenings which means patients now have access to urgent dental care from our staff, which includes both telephone advice and face to face appointments if needed from 9am in the morning through to 9pm at night. The day team focus on shielding and vulnerable patients whilst the EDS staff have been offering out of hours care for routine patients. In addition to Haywards Heath we are also running Urgent Dental Hubs in Chichester at the Jubilee Dental Centre and at Morley Street Clinic in Brighton. 

What is it like being a dentist working during a pandemic?

The main thing I have noticed is how grateful patients are to receive both advice but more particularly face to face dental treatment. It has been reported widely in the media that dental services have been drastically reduced over worries about spreading/contracting the virus via the risky aerosol generating procedures we carry out as part of our day to day work, and as a consequence of this patients are entirely unable to obtain routine care, whilst urgent care has also been reduced. This puts a great pressure on being one of only nine hubs providing dental care to the population of West and East Sussex. For example, in Haywards Heath, we take referrals from dental practices in Haywards Heath, Burgess Hill and East Grinstead, but also Crawley, Horsham and Billingshurst and as far afield as Crowborough and Uckfield in East Sussex too. That is a huge challenge, but thanks to working with such a great team within Special Care Dentistry and being well supported by the Trust and its wider teams, I believe, at least at this moment in time, we are fully rising to the challenge!

The best example of this hard work within our team and the wider Trust was when, at the beginning of the crisis, parts of the NHS had huge problems with obtaining Personal Protective Equipment (PPE), but due to the efforts of our HQ staff (especially Sue Francis, our Nurse Manager for PPE, and Parul Patel, our Clinical Director) and the relevant managers/teams at the Trust, we were able to not only obtain the PPE we needed, but also get fit tested (the process by which PPE is properly fitted to the person who will be wearing it) in a very short time. Also, we were very quick to produce and agree a new Standard Operating Procedure and, as such, were ready to see patients straight away with little delay after the lockdown was announced. From 24 March to 20 May inclusive, at Haywards Heath we provided 276 telephone consultations and 119 face to face visits in the daytime alone. These numbers are greatly increased if you consider the EDS figures and the activity at the other clinics/EDS sites in Chichester and Brighton.

What does a normal day look like for you now?

We start the day with a socially distanced briefing in the training room for all the clinical staff. As infection control is such a key factor, the nurses split into teams which are made up of clinical nurses and buddy nurses. The clinical nurse role is to provide the traditional chairside assistance, where the buddy nurse sets up the PPE and ensures appropriate equipment and materials are supplied for the treatment of individual patients. The dentists split their time between telephone consultations and face to face contacts. If it is decided that a root canal dressing is needed then full level 3 PPE is worn ready for using the water spraying dental drill. We try our best to smile with our eyes as most other forms of non-verbal communication and reassurance are limited when you look like a spaceman!

As a consultant for the service and clinical lead for Haywards Heath I have some additional duties including supporting the administrative team to make sure all referrals are triaged to an appropriate clinic and meet the criteria of patients who are vulnerable or shielding. At the end of the week we try really hard to get as many patients in and treated before the weekend, so they are not left in pain for too long. So far, we are managing to get most patients in either on the same day or the day after, which is very much appreciated, but one of my worries is that if the crisis continues for too much longer without opening up of more capacity in dentistry, either with additional hubs or practices partially opening, then this will become harder to do.

One of my other roles as consultant is to provide education and training for the staff and the wider dental population. During the COVID-19 period, I have presented a webinar on geriatric dentistry to our staff and to a group of 90 dentists via an educational session organised by the local postgraduate deanery. In the surgery, I have been supporting the team learning on an X-ray technique called lateral oblique, an old fashioned but extremely efficient way of getting a decent picture of back teeth prior to extraction. 

How have your patients found the new way of working?

We have been seeing a slightly different cohort of patients during the crisis period and I believe these patients, as mentioned earlier, have been extremely grateful in accessing dental care in a time of scarcity. My big worry is for many of my patients who may have been unable to come to the clinic, or for those whose dental health may be slowly declining as they are not receiving the normal level of routine care and maintenance under lockdown rules and regulations. Once we are back to routine care, we are going to have to work extremely hard to get things back to where they were prior to the crisis.