Collaborative response enables urgent dental care

News
28 Apr 2020
Dr Lester Settle, chair of the South Island Alliance's Hospital Oral Health Workstream.

Measures taken to prevent the spread of Covid-19 have dramatically changed how emergency dental care is being delivered across the South Island, with dentists and DHBs working collaboratively to provide the essential service.

There has been some uncertainty around dental care as it was initially not considered an essential service, says Dr Lester Settle, chair of the South Island Alliance’s Hospital Oral Health Workstream. “Dentistry is particularly difficult as it often sits outside of mainstream health, yet unresolved dental infection can still be life threatening, so it’s really important to seek help if you have any dental concerns.”

To ensure safety for both the patient and dentist, procedures have been put in place, so dental care is available for those who need it. Dentistry is one of the highest risk professions for transmitting viruses such as COVID-19, due to its close range and most dental procedures generating aerosols – tiny droplets that stay suspended in the air for up to an hour, harbouring the virus. For this reason, options for safe dentistry are limited to urgent care. “Toothache, for example, doesn’t necessarily meet guidelines for acute/urgent care, as it is not considered life threatening. But it’s incredibly hard to control with just pain relief at home, so we would encourage people with toothache – or any other dental issues – to contact us.”

The New Zealand Dental Council (NZDC) set regulatory standards for dentists to comply with during level 4, and level 3, including a higher level of personal protective equipment (PPE). However, PPE proved difficult to source by general dentists working in the community.

To deal with the challenges of providing a safe service, DHBs worked together to find local solutions. In Canterbury, the local New Zealand Dental Association (NZDA) branch, Community Dental Service (CDS) and Hospital Dental Service (HDS), joined forces to set up a coordinated call centre response for patients with acute dental needs.

After basic data is collected, this is then directed to CDS or a general dentist for a free telehealth consultation. If the problem is not deferable, then the patient is directed to a community-based dental practice or the DHB, says Dr Settle. “DHBs have been able to provide emergency practices with small amounts of vital PPE to enable care for those patients presenting through the DHB pathways.”

To enable wider access, Canterbury DHB also redirected funding to increase its subsidy to Community Services Card holders. The call centre currently receives about 80 calls a day during the week, with approximately 160 calls on the first day of the week. Dr Settle says the level of co-ordination and speed to enable the service was unprecedented. “The coordinated response between what are traditionally disparate groups has been inspiring.”