DENTAL leaders have questioned why routine NHS treatment is being restarted amid a spike in coronavirus, as they warned that patients should not expect a return to normality.

Dentists told the Herald on Sunday that NHS waiting times are "going to shoot through the roof" amid a cap on patient numbers, and that six-monthly check ups are unlikely to ever return.

There are also fears that 'two-tier' access to dental care will continue as some dental practices invest in powerful ventilation systems that will enable them to see far more private patients per day, driving many more people who can afford it to pay for quicker treatment.

From tomorrow, all routine dental services such as fillings, scaling and root canal can be performed on the NHS in Scotland for the first time since lockdown in March.

READ MORE: Now is the right time to rethink what we want from a care service 

For months aerosol-generating procedures (AGPs) have been banned on the health service amid fears over viral transmission, with patients requiring emergency care referred to community hubs.

Professor Phil Taylor, Dean of the Royal College of Surgeons Edinburgh's Faculty of Dental Surgery, said it "doesn't add up" that practices are now being told it is safe to restart.

He said: “Why all of a sudden can you do AGPs when we’re in the middle of a second wave that almost seems to be worse than the first in some areas?

“If we accept the Scottish Government logic that we can’t do AGPs on the NHS because of Covid, when prevalence was much lower, then it makes no sense to say we can start up again now in the middle of a spike.

"I don’t see why they couldn’t have been done from the beginning, with the right precautions.”

Dentists will be limited to seeing 10 patients and performing a maximum of five AGPs per day on the NHS.

They must wear full PPE, including respirator masks when drilling, and allow a one hour 'fallow period' from the time the drill stops so the particles released into the air can settle.

Only then can the treatment room be cleaned, a process which adds another 42 minutes to the turnaround time according to David McColl, chair of the British Dental Association's (BDA) Scottish Dental Practice Committee.

He said: "It's going to take a full morning to do two patients, plus we need to tie up another surgery for donning and doffing PPE and then there's the requirements for social distancing in the waiting area.

"If you think about the backlog of that's built up since March, you can see that the return to routine dentistry is still a long way off."

Mr McColl, who is based at a practice in Govanhill, Glasgow - one Scotland's most deprived communities - said he expects the pressures brought about by Covid to usher in the end of routine check-ups, something which the profession had already been debating pre-pandemic.

"If someone hasn't had a filling in three years, they're looking after their mouth, and everything's okay, you probably don't need to see them every six months," said Mr McColl.

"Maybe more affluent patients could be seen once a year so that you can spend more time on the deprived - but it all comes down to risk assessments.

"We're not going to go back to everyone getting a check up every six months, but some people might need a check up every three months."

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Mr McColl added that it was "foolish" that a full dental service was rebooting when virus levels are higher than they were in summer, but said he believes the Scottish Government is pushing it forward amid widespread criticism of a 'two-tier' dental system.

Since July, private dentistry has been able to carry out the full range of dental treatments, including AGPs, because the the Scottish Government has no power to stipulate what services are provided in the independent sector.

However, one East Renfrewshire dentist, who spoke to the Herald on Sunday on condition of anonymity, warned that two-tier dentistry "will rocket" despite the ban on AGPs in the NHS being lifted.

The dentist, who works in a mixed practice providing both NHS and private care, said that while NHS and private practitioners were subject to the same guidelines on PPE, fallow time, and cleaning, some practices are investing in expensive ventilation systems which deliver at least 10 air changes per hour.

Under guidance recently updated by the Faculty of General Dental Practice (FGDP) and Scottish Dental Clinical Effectiveness Programme (SDCEP), surgeries using this technology can cut their fallow time to as little as 10 minutes.

As private dental practices have no cap on the number of patients they treat in a day - as long as hygiene requirements are met - those with high-spec ventilation installed will be able to significantly boost their patient turnover, opening the door to much faster dental treatment for those who can afford it.

The dentist, whose practice is among those to have upgraded its ventilation, said some larger mixed practices could end up treating more private than NHS patients each day.

He said: “In a practice where you might have four or five treatment rooms, you’re only going to be allowed to have one treatment room operating – in some circumstances two – providing NHS treatment.

"But these other treatment rooms can be used to provide private treatment.

"Without a shadow of a doubt, it will continue to be faster and easier to get treatment privately, but NHS waiting lists are going to go through the roof."

READ MORE: Dentists' anger amid 'ludicrous' funding row 

One patient in Edinburgh, who requires root canal surgery, told the Herald on Sunday he had already been advised to pay for the treatment privately - which can cost up to £970 - rather than wait for an NHS appointment.

The man, who did not want to be named, developed severe toothache three weeks ago and was sent to his local dental hub.

They dressed the tooth and advised him to register with a dentist for further treatment.

"I thought they'd just pull it out there and then," he said. "It's impossible to get registered with a dentist right now.

"No dentists are taking on new patients because they're not going to be able to see as many as it is.

"Over the weekend my toothache came back with a vengeance - I've got a massive abscess.

"I phoned 111 and they gave me a phone appointment with a dentist at Chalmers Dental Hospital, who prescribed antibiotics and told me I'd need to get registered with a dentist for follow-up treatment.

"Then she said to me 'but you'll probably have to go private'. She said even when NHS work resumes they'll hardly be seeing anyone."

During lockdown many practices incurred major losses in income.

While they were funded through Covid support grants equivalent to 80% of their previous average monthly NHS income, they received no compensation for loss of private income - which can account for the bulk of a some mixed practices' revenue.

From tomorrow, the value of Covid support grants will increase to 85%, before checks kick in from March.

At that point, dentists will be required to show that they are meeting 20% of their average pre-pandemic NHS activity in order to receive 85% of the funding.

That could mean a practice which previously saw around 30 NHS patients a day treating six, depending on the treatments.

Those doing less than 10% of the NHS activity they averaged pre-Covid will get payments from Government equivalent to 40% of their previous NHS income.

The BDA opposes these targets.

David McColl said it was unclear how the Scottish Government would measure them, stressing that it was potentially unsafe to "start prescribing NHS activity within practices when throughput is going to be so constricted".

However, other dentists told the Herald on Sunday that practitioners have been "astonished by the generosity".

One said: "These relatively low levels of activity are meant to curtail the spread of Covid in the community, however, an unintended consequence will be increased waiting times for NHS treatment.

"Practitioners have been working on a treadmill for years. Now they can take their foot off that treadmill and get 85% of the income for 20% of the activity.

"With the best will in the world, how many will be trying to exceed 20%?"

A spokeswoman for the Scottish Government said the re-mobilisation of NHS dentistry has been "informed by clinical evidence".

She said: “We understand this is not business as usual and our public-facing exercise in the coming weeks will help inform patients of the latest measures in place. We have also issued guidance to dentists. 

"The use of an aerosol needs to be done under strict guidelines for the safety of patients and staff, which means fewer patients can be seen. With appointment times limited, dental practices will need to prioritise people according to their oral health needs."

She added that the Scottish Government will be supporting NHS dentistry through payments worth a total of £14.75 million per month, alongside free supplies of PPE sufficient to cover NHS workloads.

She said:“NHS financial support will in the future be linked to ensuring patients can access similar levels of NHS care and treatment regardless of where they live, and for all NHS dental teams to provide appropriate levels of care.”