Reasonable Adjustments in Dentistry during COVID-19

The world of Dentistry has changed a lot over the past year as a result of the COVID-19 pandemic, but how has this affected how people with impairments or disability access dentistry...?

Routine dental care in England was suspended for 75 days this year because of the SARS-CoV-2 (COVID-19) pandemic. ​To address any urgent dental needs of the population during this time, Urgent Dental Care Hubs (UDCHs) were established. ​

Many patients with additional needs fell into the vulnerable or shielding category advised by the UK government, who are at high risk of serious illness should they catch COVID-19. ​This includes patients with medical complexities, learning disabilities, physical disabilities as well as other groups such as people who experience homelessness. 

Ensuring these patients had safe access to care with as low a risk as possible of being exposed to the COVID-19 infection was and continues to be critical, especially since there is evidence patients with additional needs not only have higher incidences of oral disease, but they also face barriers to accessing care; even before a global pandemic. ​

As a Special Care dental service, we have made adjustments to ensure our patients can still access care. All of dentistry have a responsibility to make reasonable adjustments (as per the Equality Act 2010) in order not to discriminate against certain patient groups. I encourage all services to think about making adjustments for some of their patients in order to ensure that everyone can access the dental care they need. 

We had an instance during the first lock down where a patient who had severe toothache and needed an extraction had their urgent referrals rejected from a local UDCH because they were unable to supply a photo of the culprit tooth - this patient did not own a Smartphone and lived by themselves. As a result, we ended up seeing them after they were admitted via A&E because of analgesia overdose... they had taken so many pills to try to manage their pain they were slurring their words! 

Depending on the setting and patient, the adjustments required will vary. Some examples our service has provided are:

  • Virtual sedation assessments (telephone or video)​
  • Domiciliary visits on appropriate risk assessment​
  • Photographs of staff in Level 3 PPE shared to construct social stories for those with learning disabilities as an alternative to acclimatisation visits
  • Accepting patients from a larger geographical area to support services who could not offer sedation or general anaesthesia​
  • Virtual best interests meetings for those who lacked capacity​
  • Adjustments to patient flow and prioritisation​ e.g. more vulnerable patients waiting in a separate waiting area, seeing them at the beginning/end of the list to minimise patient mixing
  • Using clear face masks when needed to aid in communication (non-clinical) 

To read more about what reasonable adjustments we made during the pandemic, read my poster which I presented at the International Association for Disability and Oral Health's Research Conference here

During the pandemic, adults with additional needs required some adjustments to allow safe and timely access to urgent dental care. Access to sedation especially has been a vital asset to accommodate the difficulties in initially accessing theatre lists during the peak of the pandemic and continues to be as access to theatres is still a challenge for many dental services.​

It is important to continue with these adjustments as the COVID-19 risk continues how we deliver dentistry in the UK, especially as we are working at a reduced capacity, so that the needs of these vulnerable groups are not forgotten. ​​This is the responsibility of the entire dental profession - not just Special Care dentists. 

What reasonable adjustments have you had to make in dentistry over the past year? Please leave them in the comments below

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