Clarifications from the CDO: Sustainability and Aerosols

18 March 2020

There has been a new update from the CDO this evening (18th March 2020) that aims to give the clarifications around the sustainability uplift and the definition of aerosols. The letter is attached below.

  1. As feared, the 90% sustainability uplift is not adjusted to take into account the fact the patients are not actually in the building to pay their 80%. This is deeply disappointing as it discriminates against practices who have higher numbers of non-exempt patients. We will be expressing our concern and disappointment at every level. We suggest all dentists affected do the same.
  2. Clarification around AGPs (Aerosol Generating Procedures) is given. High-Speeds, Ultrasonics, and anything that requires use of 3-in-1 syringes are classed as AGPs. It appears we can only use AGPs to drain a tooth in an emergency (whether this means pus or to remove inflamed/necrotic pulp is again unclear).
  3. In a somewhat contradictory statement, use of the 3-in-1 may be possible. The CDO seems to suggest that minimising mixed air/water jets may limit aerosols.
  4. Non-AGP procedures that are mentioned (despite the lack of 3-in-1) are Examinations, Hand-Scales, Denture Stages and Simple Extractions. The assumption here is that the CDO expects us to continue with these procedures for patients who do not fit the high-risk categories (70+, immunocompromised, pregnant, COPD, Asthma, Diabetes etc), still refusing those who should be self-isolating. Based on all recent teaching the diagnosis of dental caries requires air-drying… perhaps using cotton wool as an alternative to dry surfaces may mitigate the risks posed by aerosols.
  5. We understand GG&C Oral Health Directorate are working to set up a referral service for those who are suspected to have contracted COVID-19 and need emergency treatment. NHS 24 is the first port of call until a referral pathway is set up.

PCA(D)(2020)6 – COVID-19 Guidance – 17 March 2020