Two Air Force dentists give us an insight into the impact of COVID-19 on military dentistry in the UK.
The COVID-19 pandemic has impacted the lives of everyone in the UK and military dentists are no exception. I recently spoke to Wing Commander Penny Hartley-Green, Senior Dental Officer Royal Air Force, and Dr Brent Weller, Civilian Dental Practitioner in Defence Primary Healthcare, to find out about how the service has been affected.
Setting up urgent care hubs for the Armed Forces
Wg Cdr Penny Hartley-Green: Usually my role is Senior Dental Officer at Royal Air Force Marham and Robertson Barracks, where I am responsible for nine staff and around 2000 patients from the Army, Royal Navy and Royal Air Force. Our goal is to ensure patients can conduct their military duties and are dentally fit so that dental problems, whilst deployed, don't impact on the individual and their operational capability.
Defence Primary Healthcare, Dental (DPHC) closed its dental practices and established regional urgent care hubs very quickly to provide centralised emergency clinics for our patients. The hub at RAF Marham became the point of contact for patients from across three military units and we also gained some dental staff from those closed units which helped staffing resilience.
I became the local Clinical Lead and have since been surgically attached to a laptop and headset to advise, plan and manage the teams who were triaging patients calling with dental emergencies.
Dr Brent Weller: To begin with no patients could be seen and the AAA approach was adopted for all but the direst cases until protocols and PPE could be arranged. There are no longer several well-placed military hospitals across the country, so referral to local ones was required for serious infections and dangerous cases. Now we were able to see patients for both AGP and non-AGP procedures, and have strict social distancing and infection control measures in place.
Troops preparing for deployment
Dr Brent Weller: Military personnel are still being deployed to various parts of the world and to do this they need to be dentally fit or of minimal risk of dental problems. However, when the pandemic made routine dental inspections impossible, it became necessary to assess future morbidity risk via their computer records, radiographs and history. Where appropriate we also had to delay check up dates by several months to cover the period away from home.
This significant increase in digital dentistry has been a challenge and has involved long hours in front of a computer screen, with much risk of head, neck and back aches!
Keeping staff and patients safe
Wg Cdr Penny Hartley-Green: To keep staff as safe as possible, we split into two teams of four. Each team comprises a dentist, two dental nurses and a practice manager who can work from home but still support their team. This has allowed us a certain amount of flexibility and reduces risk. We have devised protocols for the hub to facilitate social distancing, patient flow and IPC to help minimise risk of cross infection.
We also station a clean nurse outside the surgery who not only escorts and reassures the patient, but also collects any items required during an AGP. Because no matter how much we plan for a procedure every dental nurse can support the fact there is usually something extra the dentist will ask for! It also means the AGP clinical team are ready in their enhanced PPE and FFP3 mask when the patient enters the surgery so contact time is reduced and we can be more efficient with our time utilisation.
Dr Brent Weller: Two main types of FFP3 masks were eventually supplied, as well as two models of gowns, coverall, aprons and visors, allowing us to provide non-AGP and AGP procedures. The FFP3 type masks needed to be test fitted before considered safe to use. This was arranged through the RAF Fire Section who use smoke resistant masks regularly. The testing was rigorous and alarmingly revealing of substantial leaks around the masks until correctly fitted and adjusted.
Dr Weller and a colleague wearing PPE
Managing military aid to civilian authorities
Wg Cdr Penny Hartley-Green: In my role as Liaison Officer for DPHC, I’ve been working on a team of people from all areas of Defence to help manage some aspects of military aid to civilian authorities. This has been very demanding, but also extremely rewarding.
The job involves significant communication across groups so that we, as Defence, can best plan such things as support to the Nightingale Hospitals, Testing Facilities and support to our personnel who are still deploying all over the world. We have also been heavily involved in PPE planning, accounting and provision which will be key to returning to the 'new normal' for the dental profession.
Putting the national interest first
Dr Brent Weller: Before March, I was in semi-retirement, only working 2.5 days a week. But when asked to come back and work full-time again, I agreed. Having served in the first Gulf War, I understood when there was a need to put national priorities ahead of personal ones. I’m happy to be able to help with clinical care during the pandemic and for a period afterwards to help clear the inevitable backlog of treatment.
Wg Cdr Penny Hartley-Green: Working within DPHC is very rewarding. It provides a fantastic opportunity for professional and personal development across a spectrum of disciplines. It will allow you to work alongside like-minded individuals, who want to deliver an excellent service for patients.
DPHC is still actively recruiting, so if you’re interested, check out the NHS Jobs website to see what possibilities may exist for you.