Post-COVID-19 return to work policy

This policy has been created based on multiple updated sources from within the dental and medical professions and direct feedback from all members of the practice. It outlines modifications to our normal procedures that we intend to employ once dental practices can be reopened after the COVID-19 pandemic peak of infection has subsided. It is not known at this time whether these procedures are temporary or whether they will become a permanent feature of the way dental practices must be run to ensure patient and staff safety in the future.

The worldwide COVID-19 pandemic is still being evaluated and studied and policies and recommendations are likely to change in line with new scientific evidence over time. We would like to thank all of our patients for their patience and forbearance doing this long period of practice closure and for their understanding and cooperation whilst we implement new measures at the practice.

Provisional timetable It is our intention for all staff members to return to work on Monday 1st of June 2020 unless an extension to the current lockdown recommended by the government or professional bodies. The team will spend four days preparing the practice for reopening and practising updated procedures before patients return to the practice. It is envisaged that

the practice will reopen to normal patient treatments commencing Monday 1st June, current government and professional advice permitting.

Patient communication before reopening We would of course like to continue providing necessary dental care to all of our patients in the safest possible environment. We therefore respectfully request your full cooperation with any new or modified procedures at the practice

We will request that all patients who are returning for treatment update their standard Medical and Dental Questionnaire (MDQ) (or Medical and Facial Aesthetics Questionnaire via the links below.

This includes a new, more detailed, section regarding your recent activity which will allow us to assess your level of risk for coronavirus infection before you attend the surgery. New measures at LCIAD to reduce risk of COVID-19 transmission Our normal cross-infection control protocols at the practice against all previously known pathogens are already woven into all clinical activity carried out at the practice.

It should be remembered that the dental practice is already a very clean environment compared to public areas and it is not possible for us to control sources of infection outside the dental practice. There have been multiple suggestions from many sources as to how the risk of transmission of COVID-19 can be reduced in a dental clinical environment. Some of these are straightforward and some of these are patently impractical when carrying out fine and detailed dental procedures. We have collectively evaluated all of these and feel that the

following measures will reduce risk to an acceptable level at the practice. Please be assured that all of our clinical staff will also be complying with these procedures to reduce the risk of cross infection in both directions.

Before attending the practice

• We will carry out a pre-attendance assessment via your completed Medical and Dental Questionnaire (MDQ). Our staff will contact you to remind you of this if we have not received your completed questionnaire. If we feel that you are a medium to high risk of having possibly been infected, even if you are asymptomatic, we will respectfully request for you to delay bookings. However we will endeavour to make provision for even higher risk patients to have emergency treatment when required.

• We would recommend that patients in high-risk and extremely high-risk groups delay non-essential dental treatment for as long as possible until the trend of the pandemic becomes clear. To find out whether you are in a higher or very high-risk group please see the link below:

• In view of the potential seriousness of this disease, please note that we respectfully insist that this Medical and Dental Questionnaire (MDQ) is completed at least three days before your appointment. If we do not receive the completed questionnaire in time and we are unable to contact you for assessment of your current condition, we will cancel your appointment and inform you by email. You may be charged for the appointment if we are unable to fill it at short notice as per our normal terms and conditions

• Twyford Dental normally operates a payment-in-advance policy for treatment phases and we would request that payment is made online by BACS for your appointment prior to you attending. We would extend this policy to regular examination and hygienist visits (which are normally made on the day of your visit) during this period. Advance payment will be requested when your appointment is booked and should be completed before attendance. This reduces the requirement for unnecessary contact or use of card terminals at reception.

• When travelling to the practice, we would recommend that you limit your close contact with other members of the public as far as possible. If you are able to drive or be driven and picked up by somebody with whom you live, this would be ideal. Alternatively, we would recommend coming to the practice in a taxi. Please book cabs in advance as there may be a shortage due to this reason when businesses reopen.

• Please carry hand sanitiser with you at all times, use regularly and avoid touching your face. Please wash your hands thoroughly for at least 30 seconds at every opportunity.

Arriving at the practice

• We would like to eliminate waiting times in reception as much as possible so that you are not in close proximity to other patients. Accordingly, appointments will be The London Centre for Implant and 4 staggered so that patients do not arrive or leave at the same time as other patients as far as we are able to manage.

• When you attend the practice, we will welcome you, ask for you to hang your coat or jacket at the entrance to the practice and digitally take your temperature. If your temperature is above a certain level, you would not be permitted to enter the practice and will be asked to return home and self-isolate as per current government guidelines.

• If you are well, we would direct you straight to the surgery and request that you do the following before commencing your appointment: Thoroughly wash your hands for 30 seconds with the antiseptic hand wash provided Carry out a dilute (0.5%) aqueous povidone-iodine nasal spray and 30 second mouthwash and gargle. We will provide this in disposable bottles for you to be able to take with you or discard. This has been shown to rapidly kill the virus and reduce any viral load even if you are asymptomatically infected. Our clinical staff will be carrying out the same process at each session. (If you have any concerns regarding use of iodine, please see the link below). Don a disposable water repellent gown, hood and gloves to limit any aerosol absorption by your normal street clothes.

• We regret that during this interim period, we will not be providing our normal tea and coffee services in the interests of reducing all opportunities for cross infection to a minimum.

• When using the restrooms, please do your best to ensure that you leave the facilities as you would expect to find them. The restrooms will be regularly disinfected between patients and we would respectfully ask that make our team’s task easier by being considerate.

Practice procedures

• Our team will have spent time critically looking at every aspect of the practice with a view to removing all non-essential items in the open to reduce the number of objects that may act as fomites (surfaces on which microorganisms may reside and can potentially be the cause of cross infection). You will find that the practice may appear quite bare when you attend.

• All clinical and common areas including door handles and surfaces will be regularly disinfected at set times using hypochlorous acid solution (electrically activated water) which is potently viricidal against COVID-19 and other microorganisms and can be used safely on all work surfaces and indeed within dental water lines and for operative procedures.

Hypochlorous acid solution (Sterilox) for many years in its dental chairs and will increase production for additional use as a surface disinfectant in addition to our normal surface cleaning protocols between patients.

• We will be providing an additional 30-minute buffer period between patients to allow additional time for decontamination procedures, allow for any treatment overruns and allow preparation time for the next patient so that they do not need to wait in the reception area. • All future appointments will be made and confirmed by email or telephone to limit your time spent at reception. Dental procedures

• All dental staff will be upgrading their personal protective equipment in line with current recommendations and evidence including FFP2 and ‘s FFP3 masks, or N95, visors and protective clothing as appropriate.

We apologise in advance for the necessary reduction in social interaction that this will necessitate. Whilst our garb may make us appear impersonal and distant, please be assured we are still the same friendly team underneath it all!

• We are especially mindful that most dental treatments are aerosol-generating procedures (AGP’s). It is almost impossible for us to carry out meaningful dental procedures without generation of some level of aerosol. Aerosol suspended in the air is a potential source of infection which we wish to keep to a minimum. Currently the dental literature suggests:

– Our use of our normal high-volume suction reduces aerosol production by over 90%.

– The use of dental rubber dam which is also routine in the practice further reduces bio aerosols by a further 30 to 90%

– Our regular facemasks filter approximately 60% of remaining airborne particles.

– FFP2/N95 and FFP3 masks filter 94% and 99% respectively of airborne particles in both directions (patient to clinician and clinician to patient). We therefore feel that our normal dental procedures can be carried out with minimal risk with use of high-volume suction, dental dam and FFP2/N95 and, in high aerosol generating procedures such as hygienist visit for periodontal treatment, FFP3/N95 masks as appropriate.

• At the end of your appointment, we will collect all of your protective equipment for disposal by incineration and you will be able to leave directly after your appointment.

• We are also looking into the procurement of viricidal air filtration and purification systems for the surgeries and the reception area to further reduce aerosol risk.

• There has the financial impact of the coronavirus for us. Time taken to carry out treatment sessions may need to be extended by approximately 30 minutes which will be included into the fees for your procedure. We will endeavour to simply adjust fees to cover costs of PPE and additional time needed. Unfortunately due to the nature of how the timing structure of

the business is run we will find it hard to accommodate minor issues due to the period of time it takes to clean down after each patient. Thus we will inform patients of any new policies arise due to this and how It can be made functional so we are a viable business in the long term. As a family run dental practice we have had little to no government help during this time and thus would ask all patients to be understanding and patient with us whilst we triage bookings and will get to potential issues and problems in time.

The vast majority of our patients are otherwise healthy without coronavirus infection and we would like to be able to provide normal dental care for these patients in as normal an environment as possible while bearing in mind our responsibilities to mitigate risks of infection spread as far as is practically possible.

This policy will be constantly reviewed and updated as necessitated by circumstances over time. If you have any questions regarding this policy or about your dental care please do not hesitate to contact us on .

Yours sincerely

Dr Avik Jonathan Dandapat BDS(Birm), MFGDP(UK) RCS Eng, Dip.Imp.Dent RCS (Eng),Adv.Cert RCS(Eng),

MSc (Implant Dentistry)

The University of Leeds Principal Dentist

Practice Limited to Implant Dentistry ADI Mentor & Lecturer Director Implant Academy, UK

PA 07760 766807

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