Life back in practice – how lockdown is changing the way dentistry is practised

dentist after lockdownWe speak to Nik Sethi about what his practice has done and what he thinks other practices can do to ease the transition back into practice.

Are you back in practice now? How has it been?

We are indeed. It’s been great. We started back on the 22 June.

Initially we were a bit apprehensive. But my brother Sanjay and I, we work at the same practice. We made the call to go above and beyond the guidelines.

We spent thousands of pounds on building work, put in a brand new negative pressure mechanical air ventilation system that changes the air very regularly. The surgeries got air purifiers as standard. We have screens everywhere, stickers everywhere. We’ve completely changed our protocols for patient journeys.

We didn’t want to just jump into opening on the 8 June. We wanted to sound out how everyone was finding it first and make sure when we came back, we came back with a bang.

It really helped. When we started, patients felt that we were really slick straight away.

Yes, it’s a big change, but we got our team on board. This is the new normal now and we’ve got to adapt. The team has been fantastic.

You didn’t have to go above and beyond the protocol, so why did you do that? Do you think you’ll get the pay back from your investment?

I think so. The motto in our practice is: ‘Excellence is just our standard’. We’ve always spent time with and given patients the best.

We’re not the best business people in the world, we never really care about that side of things. We always believed that if we do the right thing, it will come back around and pay us in the long run.

With patient examinations, we spend an hour. Everyone gets a digital scan. We spend a lot of time with patients going through what’s going on in their mouths to educate them. They almost come to a diagnosis themselves rather than us telling them what they need. My minimum treatment appointment is an hour and a half.

It means we’re never working in a rushed way, each patient gets that care. For them, to see we’re taking these extra steps, a lot of patients actually pointed out they weren’t surprised. I loved that response.

Where we are in our building, we don’t have windows in our surgeries. So we wanted to keep it as fresh and future-proof as possible. If the lockdown ever happens again, we’re prepared for it and wouldn’t have to close.

What have been the difficulties and positives since going back?

At the moment we’re just running one dentist and one nurse per day. Just to get patients and the team used to the flow. We’re going to open up our second room next week or the week after.

Financially, we’re still possibly breaking even, if not making a slight loss. So financially it’s not great.

Time away from the practice gives me an opportunity to galvanise my team and spend more time training. Before, myself and my brother, we had such a big list. We didn’t spend enough time training or individual time with each member of staff. This has allowed me to spend hours with them.

It’s given me time to step outside of the surgery and spend a bit of time walking in the shoes of every member of staff in the practice.

I’ve sat on reception for the last week. Sitting there I’ve realised how manic it can become. Particularly with new COVID protocols. So for me to live a week in their shoes really made me realise how much support I need to give them, so they can do an efficient job and enjoy what they do.

I’m just trying every role in the practice to see where we can improve for the patients. It’s really interesting, I always thought we had it perfect, like I’m sure everybody does. There’s actually so much more we can do to improve our patient flow. Just in terms of little soft touches, interaction with patients, emails, how we design treatment plans. All the little things I’ve never looked at before made me think, despite how good we might be in the surgery, there are so many other improvements we can make around the practice.

Is there any equipment that you’d recommend other dental practices install?

There are quite a few things to consider.

We’ve always used rubber dam, and now more so than ever. Use rubber dam as much as possible. It makes me very grateful we’ve trained all our dentists to be proficient with rubber dam from the minute they start.

What I’d say to a lot of younger dentists is don’t be afraid to tell people you’re not confident with rubber dam. Don’t be afraid to go on a course and get tips. It is tricky to use. Go on courses, practice on models. Once you get to grips with that, you’re protecting your team and offering clinical work at a much higher standard.

The other stuff that we’ve invested in like the mechanical air ventilation, I wouldn’t suggest that is a necessity. It depends on your building, because it’s a massive investment. We just felt that it was right in our practice because we don’t have any windows. There isn’t a lot of evidence to support the use of air purifiers, but we did it. I don’t think practices have to go too much above the current guidelines and wearing the correct PPE.

In terms of growing your practice, you need to make sure you’ve got a clear poster of the patient journey, and you make a sing and dance about what you’re doing to make patients feel safe. Patients are apprehensive about leaving the house let alone going to a dental practice.

We send patients a pre appointment pack, with a poster of the patient journey, showing them we’ve taken all the measures necessary to protect patients. I don’t know of any patient complaint as yet. They’re totally understanding because we’ve told them in advance.

Do you think in the future you’ll continue the new patient journey?

I think the only thing that will relax is the need to wear the FFP3 masks, possibly the gowns and the fallow time in between. That’s going to be difficult for NHS practices.

The rest of it, well it’s not been that much of a change. These things are not rocket science; they don’t take a lot of time if your team is slick.

In the UK we offer such a high standard of care. I do believe that we will have to keep some of these changes for the foreseeable future.

You mentioned FFP3 masks, do you see the demand for these dropping?

Interestingly, a mentor of mine recently told me he had been using FFP3 masks for years when removing amalgam. He learnt this from Switzerland where studies have shown levels of mercury in dental care professionals to be far higher than a control of general public. Some are close to toxic levels

I find this really interesting and reading these studies does indeed show that there is potential benefit in wearing these FFP3 masks in the long term in the attempt to reduce the particulate we breathe in of potential hazardous substances.

We use a lot of air abrasion in our practice also. Compounds like aluminium oxide are not dissolvable. So once in the lungs, they could cause an issue down the road.

Despite the FFP3 masks not stopping vapour, this combined with the use of rubber dam and high volume suction, to me makes total sense in safeguarding the health of our team in the long run.

I wish I had invested in a PPE company. I reckon I could do a good sales pitch for them!

So to finish, how are you feeling about the profession and how we move forward?

I feel this is time for our dental community to come together and continue to share the information we have.

There has never been a time I can remember where everyone was on the same mission. Creating the same protocols within practice, and being so transparent in the process. I have learnt so much during this time about clinical and business management. I am excited to step back slightly from clinical and see how much I can improve our practice as a brand.

Personally, I think young dentists should feel inspired by the free education on offer throughout lockdown. It really does show the incredible passion amongst the community to share knowledge and push our standards higher.

It is time to drop egos and forget about competing with others. As a good friend, Dhru Shah, told me, instead it is time to be inspired by others and learn together. This is a new game, with new rules, but we are certainly no first time players!

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