From extracting teeth to certifying death: the dentists who were put to work on Covid wards

Meet the dentists who have been on the front line, looking after coronavirus patients during lockdown

Kirandeep Nandhra was redeployed onto a Covid ward
Kirandeep Nandhra was redeployed onto a Covid ward

News that dentists’ surgeries are reopening today will come as a huge relief to many, but it's a little late for Bill Taylor from Devon who was forced to yank out an infected tooth with pliers after days spent in excruciating pain in mid-April. 

It won’t help 71-year-old Dorothy Prowse from Thatcham either, who suffered weeks of torment as a dental abscess went untreated during lockdown, causing her to collapse from a fever and breathing difficulties. A private dentist eventually removed the infected tooth for her.

Horror stories like these have been commonplace during the nine weeks dentist surgeries were forced to close and emergency facilities were either hard to access or struggled to cope.

"During lockdown, people were afraid to come to hospital because of the virus and now it’s easing, we’re seeing the results," says Ruby Glaskie, 24, a Senior House Officer (SHO) in oral and maxillofacial surgery at Luton and Dunstable hospital, whose day job involves fixing broken jaws or stitching cuts and lacerations to faces after accidents. "We’re busy dealing with acute problems such as tooth infections and abscesses that have been left to fester during lockdown and didn’t get proper attention."

While most dentists spent lockdown unable to work, Ruby was one of a group of eight SHOs at the hospital’s A&E who were taken off their normal duties and redeployed onto Covid wards early on in the pandemic, when it was a case of "all hands on deck".

Ruby Glaskie was redeployed to a Covid ward

Having spent a year previously in a North London dental practice carrying out routine treatments such as fillings, root canals and tooth extractions before arriving at Luton and Dunstable last September, nothing could quite prepare Ruby for what she witnessed during that month on the Covid wards.

"I was posted onto a ward with elderly patients who had multiple issues and were DNR – do not resuscitate – if anything escalated," recalls Ruby. "I had to take bloods and vital signs, prescribe medications, certify deaths and phone and update family members every day because they couldn’t see their loved one. My ‘breaking bad news’ training at dental school simply involved telling patients, ‘I’m so sorry, I couldn’t save your tooth’ and yet here I was, having to tell distraught family members over the phone, ‘I’m so sorry, but we can’t save your father.’ 

"It was a huge learning curve and I just felt completely helpless and wished I could have given them the detail that the other medical registrars were able to. But I had no medical training for this – I was just a dentist."

Many of the 35 patients on Ruby’s ward had advanced dementia and were in and out of consciousness because of the virus. 

"There was probably about one death a day," recalls Ruby. "Every morning I’d start at 7am and would come in and see who had made it through the night before preparing detailed notes to present to the consultant at 8.30am for the ward round that took up most of the day."

She was asked to certify death, an experience that will stick in her memory forever.

"I had never even seen a dead body before and I can still see his face clearly even now," recalls Ruby. "We had to be quick because you couldn’t spend too much time with a Covid-positive patient but I just looked at his face and body – now an empty vessel – and couldn’t stop wondering what life he had lived, what job had he done, what family did he have. It made me realise the importance of the job we were doing and how each life was significant; so much more than a number."

While trying her best to remain professional, Ruby came home after a nine-hour shift one day and broke down. 

"It all just felt so overwhelming," she says. "As a dentist in general practice and working as SHO in maxillofacial surgery, my job was always to fix things. A patient comes in with a problem and I can fix it and see the results. But I didn’t fix anything on the Covid wards – so much was out of our hands and we had to accept deterioration and simply follow people’s end of life journey. I really struggled with that."

At least Ruby had the luxury of being able to go home to her flat every night. Her SHO colleague Kirandeep Nandhra, 25, had to move out of the family home and into a Travelodge near the hospital as soon as she was redeployed onto a Covid ward as her father was in the 12-week shielding category. 

"I had very mixed feelings at the start," says Kirandeep. "On the one hand, I was keen to help out in the crisis but I was also scared."

Many of the patients on Kirandeep’s ward were on end of life care, going downhill rapidly, with few of them even on oxygen. 

"On my first week, we lost seven patients," recalls Kirandeep. "They often died overnight and I’d come in to find them no longer there or their bodies being wheeled out. The nature of the virus meant that patients deteriorated very quickly and when I phoned relatives to give them updates, they’d often be shocked and would get very upset as they couldn’t see their loved ones for themselves. It was tough."

Kirandeep Nandhra had to move into a Travelodge to work on a nearby Covid ward

Every day Kirandeep went for a walk with a colleague after work, then returned to her simple Travelodge room, eating a pot pasta or microwaved meal before having Zoom chats with her friends, watching light-hearted TV shows or filling in one of her adult colouring books. "These were the coping strategies I needed to keep me mentally sane," she says. "But I did feel very low and angry after the first week – it just felt like it was going to be a never-ending cycle and I was never going to get home."

What also kept her sane were the doctors on the wards who were a great support.

"They knew we were dentists and had limitations," she explains. "After all, we were doing work on the same level as people that had been medically trained for 5 years and had practised for a further four years. But there was great camaraderie between us and a feeling we were all fighting this thing together."

Kirandeep returned to maxillofacial a few weeks ago and is relieved to be back. 

"It’s definitely getting busier with more drunken injuries to fix – no doubt due to lockdown fatigue – and people feeling more confident to come back in," she says. 

Having made their contribution to coronavirus care, Kirandeep and Ruby are now busy with the fallout from over two months of dental neglect.

And with the huge backlog of urgent cases and strict infection guidelines to follow, dentists’ surgeries may slowly start to open, but the days of visiting your dentist for a routine check-up or simple clean are still a long way off.

Q&A: The new rules for dentists

Can we get routine dental appointments from June 8?  

In theory, yes, but in reality traditional dental appointments as you know them are set to change as dental surgeries will have to change the way they operate in order to comply with the government's PPE and Infection Prevention Control requirements. 

How will surgeries change to comply with the requirements?

Sara Hurley, the Chief Dentistry Officer (CDO) for England, released ‘return to work’ guidance for dentists in the UK. Waiting rooms may need to be partitioned with perspex glass, magazines and children's toys could be removed, and chairs will need to be set in line with the two-metre rule. As well as hand sanitising stations, new floor markings will advise on how to navigate the practice at a safe distance from others.  

Will every patient be seen?

Sara Hurley said patients will be accepted depending on the severity of the condition with emergency treatments prioritised and some appointments done on the phone or online only. Fewer patients will be able to be  seen too – capacity could reduce by up to two thirds – as there will have to be deep contamination cleaning in-between appointments that could take up to 30 minutes: the main risk in dentistry is aerosol creation when using the vibrating water cleaners. These can spread viral particles across great distances. 

What about PPE?

Dentists have long been wearing gloves, masks and protective clothing. This will continue, with the addition of hair coverings, perspex visors, eye protection and shoe covers. As dentists can't carry out social distancing during routine check-ups or treatments, they'll have to wear full medical-grade PPE and the British Dental Association (BDA) said that the availability of this PPE may limit the speed that dental care is restored, with different practices likely to vary and some finding it difficult to source. 

Patients will also need PPE too – at a cost of £5 per gown and £25 in total per patient, this may be an unpleasant cost added to the patient’s bill.  Shoe covers will be given out and all coats and personal accessories will have to be put in a sterilised box for collection on your way out.