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More dental procedures allowed as authorities move to resume some healthcare services from June 2

SINGAPORE — From June 2, dentists will be able to perform more services such as root canal treatments, fixing dental crowns and fitting retainers, as Singapore moves to ease some of the regulations that have been in place to stem the spread of Covid-19.

All dental clinics and registered dental practitioners were told by the Ministry of Health that general dentistry services can resume, but practitioners should minimise aerosol generation as much as possible.

All dental clinics and registered dental practitioners were told by the Ministry of Health that general dentistry services can resume, but practitioners should minimise aerosol generation as much as possible.

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SINGAPORE — From June 2, dentists will be able to perform more services such as root canal treatments, fixing dental crowns and fitting retainers, as Singapore moves to ease some of the regulations that have been in place to stem the spread of Covid-19.

All dental clinics and registered dental practitioners were told by the Ministry of Health (MOH) that general dentistry services can resume, but practitioners should minimise aerosol generation as much as possible.

This is because aerosol-generating procedures present a higher risk of transmission of the coronavirus, MOH said in a circular dated May 21 — a copy of which was seen by TODAY.

“(These procedures) should only be undertaken where no other option is available,” it added. 

An aerosol refers to fine solid or liquid particles that are suspended or floating in the air or gas. Typically, it also refers to liquids that are kept under pressure and forced out in a spray.

Dentists make use of instruments such as handpieces or scalers and these create a spray — dental aerosols — that is mostly water or, at times, disinfectants.

The concern over procedures that generate aerosol is chiefly because it is still unknown whether Covid-19 can be spread through aerosols and some studies have shown that the coronavirus can survive in fine particles suspended in the air, or aerosols, for hours.

With more dental services resuming, MOH said that dentists should schedule time in between patients to allow for the complete disinfection of the clinic, it added.

For aerosol-generating procedures, the interval between patients should be at least 45 minutes.

This is to allow for enough time to disinfect the area as well as to ensure that the room is rested for a sufficient amount of time to mitigate the risk of aerosol transmission.

For non-aerosol-generating procedures, there should be at least a 15 minute interval between patients. 

Dentists should see patients only by appointments, in order to ensure that crowds do not form in or outside the clinics, MOH added.

As for patients, they should adhere to safe distancing measures while at clinics by keeping 1m apart from one another in waiting areas and registration areas.

MOH also said that urgent and emergency dental care should continue to be prioritised, followed by ongoing dental care that was previously deferred as well as the management of time-sensitive cases that are likely to lead to higher clinical risk or potential complications if left untreated.

PROGRESSIVE STAGES FOR SERVICES TO RESUME

The gradual resumption of dental care services will take place in phases.

In the first phase, some examples of procedures that can be performed include the fixing of crowns and bridges, wisdom tooth extractions and the making of dentures.

However, all other surgical procedures that involve general anaesthesia, local anaesthesia or local anaesthesia with sedation should be referred to the National Dental Centre Singapore, the National University Centre for Oral Health, or public and private hospital dental clinics for management.

Procedures that will continue to be deferred include the initiation of new cases for fixing crowns and bridges and non-urgent dental implant placement, including the placement of an immediate implant after a tooth extraction.

MOH added that should the Covid-19 cases in the community remain low and stable in the coming weeks and the situation at foreign workers’ dormitories remains under control, more restrictions will be eased.

It is in this second phase that all dental procedures, with the exception of aesthetic facial procedures, can resume.

Dentists interviewed by TODAY agreed with the move to resume some of the services specified by MOH, because it would greatly benefit the patients whom they have had to turn away for the duration of the circuit breaker from April 7 to June 1, when people have to stay home and non-essential activities are halted.

Previously, TODAY reported that some patients have had to cope with pain for a prolonged period as the treatments that they needed were not considered essential.

Dr Raymond Ang, 51, chief operating officer of Q&M Dental Group, which runs more than 70 clinics in Singapore, said: “This is a significant improvement over the previous circular… Patients will be overjoyed (to know they can finally get treatment), especially those who are in pain.”

In the previous circular issued on Tuesday (May 19), MOH said that only dental procedures with minimal aerosol use can be done after the circuit breaker period ends.

As for the cautious stance towards aerosols, Dr Ang said that there are machines that extract them and they can be used to ensure that there is minimal transmission of aerosols. His dental chain is looking to install these machines at its clinics, he added. 

TAKING PRECAUTIONS TO MINIMISE RISKS

Dentists here told TODAY that they believe the risk that a patient could contract Covid-19 while visiting a dental clinic is minimal and dentists will take the necessary precautions to ensure that patients are safe when they are getting treatments.

For example, dentists are already used to wearing full personal protective equipment such as gowns and masks.

Dr Ronnie Yap, 51, a dentist in private practice, said that this has been the case even before the pandemic.

He added that aerosols have been used by dentists for a long time and they have been able to safely carry out procedures even during other viral outbreaks such as the severe acute respiratory syndrome (Sars) and H1N1. 

No Covid-19 clusters have emerged in dental clinics here and in other countries where the coronavirus has broken out, Dr Yap noted.

“Of course, in the middle of a pandemic, it is better to be safe and cautious. That is why we supported (the restrictions during the circuit breaker).

“But now that the community spread is low, it is important that more procedures can be allowed on patients who are experiencing pain,” he said.

Related topics

Covid-19 coronavirus healthcare circuit breaker doctor dental

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