How Covid-19 Has Affected Dentistry

With restrictions lifting and the UK seemingly over the worst of Covid, many in the dental industry will be beginning to look more optimistically towards the future.

Likewise, many will be reflecting on what has undoubtedly been one of the industry’s most challenging periods ever.

As the pandemic fast approaches its two-year anniversary, here is a look at some of the ways Covid-19 has and continues to affect dentistry.

Drastic reduction in dental treatment

Over the course of the pandemic, the number of dental procedures carried out has declined significantly.

Several factors have caused this, from the lockdowns and social distancing to staff shortages and the introduction of fallow time (downtime in surgery following an aerosol generating procedure).

As recently highlighted in our UK Dental Market Statistics 2021 Report, the total courses of treatment for 2020-21 were down over 67% versus the previous period. This was a drop from 27 million procedures to around 8.8 million, according to the BDIA.

Even more recently, the BDA has claimed that in total, around 38 million appointments have so far been lost as a direct consequence of the pandemic since March 2020.

NHS data shows practices operating at around a third of pre-covid capacity and the situation within the NHS is regularly described as at crisis point.

Damaging effect on oral health

The lack of access to dental services available to people over the past two years has had a significant effect on the nation’s oral health. Some patients have reported waiting two years for a routine check-up.

Many patients have struggled to find urgent dental treatment. Others have resorted to DIY dentistry, horror stories of which have not been uncommon.

In October 2021, a Care Quality Commission report highlighted problems that children and young people have had in accessing routine dental care during the pandemic.

An Association of Dental Groups (ADG) survey from last year found that half of parents in the UK said their children had missed a check-up since March 2021 and described dentists as having a “tsunami of tooth decay to tackle.”

Also worrying, GDC findings have revealed that Covid’s impact has been felt more severely by those who were already more likely to have poorer health outcomes, including people from ethnic minority backgrounds, patients with disabilities, and those living in more deprived areas.

Though the long-term effects on oral health cannot yet be known for sure, there are worries over a rise in oral cancer over the coming months and years with the NHS backlog set to take some time to clear.

The UK Government has recently announced £50 million of funds to NHS dentistry in a bid to clear the backlog.

The rise of private dentistry

The lack of NHS dental care has caused a shift in people turning to private dental care. At the same time many practices are scrapping their NHS contracts to go fully private.

Data in our UK Dental Market report showed that the number of private practices now stands at 3,320. This is over 46% more than in 2009/10 when private practice figures were first recorded.

By comparison, the number of NHS high street practices (8,732) is 20% down on the number operating in 2005/06.

Martin Woodrow, BDA Chief Executive, described private dentistry as having “really flourished” since the 2020 summer lockdown.

He said: “Whilst private practice capacity is impacted by infection prevention and control (IPC) measures, that has been not nearly to the same extent as NHS dentistry, where the intensity offers little room to accommodate those IPC constraints.

“Some traditionally NHS-dependent practices are seeing the conditions now right to diversify their income streams and move away from the NHS treadmill. We may see that trend continue in 2022.”

Loss of revenue

The severe shortage of NHS treatment over the pandemic is reflected in the financials. The BDIA puts real net profit for NHS owners in England in 2021/2 down 3% on previous period.

Average profitability levels of NHS high street dental practices throughout the UK was down 0.4% on the previous year to £112,600 and down a huge 42.7% on 2006/07 in real terms in England.

GDC research found that 80% of dental business owners reported a decrease in current income in 2020 when compared to the same period in 2019, and 65% expected income to decrease further over 2021.

These adverse financial effects of Covid-19 on dental businesses and dental professionals are expected to continue in the future.

Day to day work changes

Covid has brought with it some big changes for the way the dental team goes about its day-to-day work at the practice.

Changes have included new social distancing rules, new room ventilation, a higher-level of infection control protocols, stricter hand hygiene, face mask wearing, fallow time, limitations on treatments and a rise in teledentistry.

Dentists have been required to change the grade and amount of personal protective equipment (PPE) they wear. FFP2/FFP3 masks, hats, gloves, aprons, visors, surgical masks and AGP-specific gowns have all been introduced.

FFP2/FFP3 masks requirements have now gone (unless the patient is "respiratory" positive) but the often-maligned fallow period remains, though the rules have changed since introduction

Fallow time was recently mentioned in a parliamentary address by a Yorkshire MP as still being a factor in limiting dentists’ ability to see more patients. Several other ongoing issues were also raised.

MP Peter Aldous said: "The lack of access to NHS dentistry has a fivefold impact on patients. First, millions are missing appointments. Secondly, there has been a significant increase in DIY tooth extraction. Thirdly, the poor are hit hardest. Fourthly, mouth cancers are going undiagnosed. Finally, children are suffering."

Conclusion

Despite the unprecedented backlog the dental industry looks set to face over the next few years, the immediate future of dentistry after covid is beginning to look brighter as patient numbers start to bounce back, PPE normalises and NHS contract restrictions reduce.

In addition to this, the political spotlight the pandemic has put on dentistry and some of its challenges has the potential to put some "momentum behind NHS contractual reform", according to BDA chief Martin Woodrow.