Winter is coming | British Dental Journal

Sir, we provide an update of the report of the enhanced Acute Dental Care (ADC) service provided by Guy's and St Thomas' NHS Foundation Trust.1 Between the peak (22 April 2020) and

1 August 2020, the ADC service has clinically assessed a further 4,849 patients with urgent and emergency dental care needs despite the widespread establishment of Urgent Dental Care (UDC)

hubs. Approximately 1,200 aerosol-generating procedures (AGPs) have been carried out, the majority being pulpal extirpations, followed by surgical extractions. The availability of re-usable

FFP3 respirators and the ability to fit test clinicians has allowed an increased provision of AGPs, with fallow times for each surgery being adhered too. The gradual resumption of elective

local anaesthetic, intravenous sedation and general anaesthetic (GA) operating lists as well as face-to-face clinic appointments from 1 June 2020 has enabled the department to also assess

and treat referred patients with routine dental needs. Pre-operative isolation protocols and COVID-19 testing for patients on GA lists have ensured that patient and staff safety is

prioritised. This increased workload has been facilitated by the return of staff who were redeployed to other services within the Trust. We now face a growing pressure for the directorate to

resume pre-COVID-19 levels of service provision whilst maintaining urgent care. This poses a challenge considering the newfound constraints to dentistry such as fallow time, isolation of

surgeries and social distancing. This dilemma is compounded by concerns over what winter may bring with regards to a second wave and further strains placed on the healthcare system. Coupled

with the recent spike and mounting number of confirmed COVID-19 cases nationwide, almost doubling from 7,995 in the last week of August to 12,217 in the first week of September 2020,2 this

challenges the practicality and sustainability of providing regular routine and elective care alongside an acute dental service. Despite these anticipated challenges our experience of this

service thus far highlights the capability of a department to effectively adapt in response to rapidly developing circumstances and can act as a framework for the provision of acute dental

care in the coming months. REFERENCES * Grossman S, Sandhu P, Sproat C, Patel V. Provision of dental services at a single institution in the UK's epicentre during the COVID-19 pandemic.

_Br Dent J_ 2020; 228: 964-970. * Public Health England, 2020. National COVID-19 Surveillance Report: 11 September 2020 (Week 37). [ebook] Available at:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/916993/Weekly_COVID19_Surveillance_Report_week_37_FINAL.pdf (accessed 17 September 2020).

Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * By email, London, UK P. Sandhu, S. Grossman, C. Sproat & V. Patel Authors * P. Sandhu View author publications You can

also search for this author inPubMed Google Scholar * S. Grossman View author publications You can also search for this author inPubMed Google Scholar * C. Sproat View author publications

You can also search for this author inPubMed Google Scholar * V. Patel View author publications You can also search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints

and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Sandhu, P., Grossman, S., Sproat, C. _et al._ Winter is coming. _Br Dent J_ 229, 500 (2020). https://doi.org/10.1038/s41415-020-2296-x

Download citation * Published: 23 October 2020 * Issue Date: October 2020 * DOI: https://doi.org/10.1038/s41415-020-2296-x SHARE THIS ARTICLE Anyone you share the following link with will be

able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing

initiative