The Rapid Development of an Urgent Dental Care Hub in an Oral Surgery Unit-Key Learning Points.

Sir,

We would like to bring to the attention of your readers working in Oral Surgery and Oral and Maxillofacial Surgery units some of the salient lessons we have learnt whilst establishing and developing an urgent dental care hub at King’s College Hospital in response to the COVID-19 crisis.

King’s College Dental Institute was in the fortunate position of having an established telephone triage and appointment booking service for its existing “Acute Dental Care” service. At the time that our outpatient and elective operating activities were cancelled, the unit became inundated with calls from patients from across Greater London, the home counties, and as far as the south coast seeking urgent dental treatment as their local dental services began to close down.

In order to prioritise clinically urgent cases and to ensure social distancing Consultant-led telephone triage was introduced. A strict triaging process was adopted so that only those with genuine dental emergencies such as acute orofacial infections, severe uncontrolled pain, dental trauma, and uncontrolled bleeding were given appointments; these were usually on the same or next day. “COVID-19 screening” was incorporated into the telephone triage call, this allowed patients to be categorised into one of three streams: “COVID-19 Asymptomatic”, “COVID-19 Symptomatic” or “Vulnerable”. The latter group included those with medical comorbidities, the over 70s, and pregnant patients, whom we wished to isolate from other patients, should they be booked an appointment.

The appointments for booked patients were spread throughout the day and we developed a new COVID-19 period standard operating procedure for use across the Dental Institute. The only treatment we currently provide are dental extraction, and pulpotomy. Both are carried out in closed surgeries using PPE recommended in BAOMS/BAOS guidance by FFP3 mask fit-tested staff. Members of our team are assigned appropriate roles including telephone advice and triage, patient assessment in Acute Dental Care, and operating within the Oral Surgery department.

Now into week 4 of our COVID-19 urgent dental care service, we have received calls from up to 290 patients a day, there are a number of repeat callers who contact us again having failed to secure dental care in their locality as we advised. Whilst many GDP’s are taking calls, providing advice and prescriptions where appropriate this is not universally the case. There is a clear need for more Urgent Dental Care Hubs to become operational with immediate effect.

Ethics statement/confirmation of patients’ permission

Not applicable.

Conflict of interest

We have no conflicts of interest.