The first six weeks - setting up a UK urgent dental care centre during the COVID-19 pandemic

Abstract

Introduction The COVID-19 pandemic has posed many challenges, including provision of urgent dental care. This paper presents a prospective service evaluation during establishment of urgent dental care in the North East of England over a six-week period.Aim To monitor patient volumes, demographics and outcomes at the North East urgent dental care centre and confirm appropriate care pathways.Main outcome methods Data were collected on key characteristics of patients accessing urgent care from 23 March to 3 May 2020. Analysis was with descriptive statistics.Results There were 1,746 patient triages (1,595 telephone and 151 face-to-face), resulting in 1,322 clinical consultations. The most common diagnoses were symptomatic irreversible pulpitis or apical periodontitis. Sixty-five percent of clinical consultations resulted in extractions and 0.8% in an aerosol generating procedure. Patients travelled 25 km on average to access care; however, this reduced as more urgent care centres were established. The majority of patients were asymptomatic of COVID-19 and, to our knowledge, no staff acquired infection due to occupational exposure.Conclusion The urgent dental care centre effectively managed urgent and emergency dental care, with appropriate patient pathways established over the six-week period. Dental preparedness for future pandemic crises could be improved and informed by this data.

Fig. 1

Timeline of international (red), national (yellow) and local (blue) events in the COVID-19 pandemic (CMO = Chief Medical Officer, CDO = Chief Dental Officer, BAOS = British Assoication of Oral Surgeons, BAOMS = British Association of Oral and Maxillofacial Surgeons, WHO = World Health Organisation)

Fig. 2

Number of triage and clinical consultations by the NDH UDCC by week of service during the COVID-19 pandemic. Number of UDCCs open in the region shown for reference (yellow line). OOH triage consultations (provided by NHS 111) are not included as the data are unavailable. Week one starts on 23 March 2020 and week six ends on 3 May 2020

Fig. 3

Geographical area served by the NDH UDCC. Heat map indicates home address of those attending clinical visits in-hours (OOH data excluded as this service normally covers a wide region). Green = highest signal. Black 'H' illustrates the NDH UDCC location. a) Weeks one to two. b) Weeks three to four. c) Weeks five to six. Other UDCC locations shown in this panel by crosses, with blue indicating 'cold' sites, orange indicating 'warm' sites and 'red' indicating hot sites

Fig. 4

Diagnoses of a) triage and b) clinical consultations in the NDH UDCC during the COVID-19 pandemic. OOH triage consultations (provided by NHS 111) are not included as the data are unavailable. 'Other' notable diagnoses included: post-extraction pain (triage, n = 29; clinical, n = 11), removable prosthesis problems (triage, n = 3; clinical, n = 1) and extraoral non-odontogenic swelling (triage, n = 2; clinical, n = 1)

Fig. 5

Outcomes of a) triage and b) clinical consultations in the NDH UDCC during the COVID-19 pandemic. For triage outcomes, those who were asked to call/attend other providers included 89% (n = 93) to GDPs, 9% (n = 9) to NHS 111 and 2% (n = 2) to A&E. Telephone advice constituted 85% (n = 213) receiving analgesia advice, 8% (n = 19) receiving trauma advice and 7% (n = 18) advised temporary filling kit. For clinical outcomes, 3% (n = 22) of the extraction outcomes had antimicrobials also prescribed, while 2% (n = 17) were incomplete extractions, ie root or apex fracture, with follow-up arranged