The End of Dentistry?

Dr Vernon Coleman MB ChB DSc FRSA

I doubt if anyone really looks forward to going to the dentist. Most of us find it a slightly unnerving experience at the best of times.

But when dentists open their doors after many weeks of shutdown the experience will be considerably more unnerving than it ever was before.

The Government and the dental governing bodies in the UK have together created a nightmare scenario which will scare the living daylights out of even the most robust of patients and put most dentists out of business well before Christmas. Dentists will have to spend a fortune obeying the new laws and they will be forced to see around a third of the patients they saw before. More expenditure and less income donít sound like much of a business plan to me Ė especially when dentists have been shut for months. There will not, I suspect, be any time for preserving teeth or for the dental and gum care we have, for so long, been warned is essential. Long-term dental care in Britain is about to hit a bad few decades. If international travel ever becomes possible again everyone will be able to spot the Brits by their rotten teeth.

Most of us donít spend much time feeling sorry for dentists. But itís time to start.

Hereís the plan; these are rules that dentists have been told they must follow if they plan to reopen their practices on the 15th June.

And if the barking mad quartet from that wonderful movie the Dream Team had sat down with the Marx Brothers they could not possibly have dreamt up a dafter, more absurdly chaotic scheme than the one which dentists say will be their new normal.

I hate that phrase. New normal. It may be new but there is nothing normal about it. Nothing at the moment is normal and it never will be.

Apparently dentists are going to have to follow official government advice from the Chief Dental Officer. I honestly didnít know we had one but Iím told there are individual Chief Dental Officers for all the UKís regions and I have no doubt they are all well equipped with Deputies, Assistants and the usual platoons of administrative staff. The formal advice hasnít been issued yet or hadnít when I recorded this, though there is only a week to go before opening day, but the guidance available, predictably entitled Standard Operating Procedures for Return to Dental Practice will give dentists enough information on policies and procedures for them to start planning.

So, here is what I am assured will be the new normal as far as dentistry is concerned.

Could the administrators whoíve thought up all this crap be unaware that dentists have for years been accustomed to using procedures which protect them and other patients from infectious diseases such as AIDS and hepatitis? Of course not. But then this is the new flu.

Back in May I reported that Iíd heard a rumour that the Government was going to force dentists to see no more than one patient an hour. And now it appears that the rumour was true. Dentists working in the NHS have to see a huge number of patients to make a living and I honestly cannot see any NHS dentists managing to survive these rules and regulations. I suspect that getting rid of NHS dentistry was part of the deliberate, planned reset of our society.

And unless they quadruple their fees, I canít see many private dentists surviving either. Those who obey all the new rules simply wonít be able to see enough patients to earn a living. Those who donít obey the laws will doubtless be defrocked de-smocked or whatever they do to naughty dentists these days.

To start with, of course, dentists will give priority treatment to patients who have had untreated dental emergencies during the last three months. Unfortunately, dentists have been told that they cannot use procedures which generate aerosols so they canít use the drill. This means they canít do fillings or use ultrasonic scalers to clean teeth. One assumes, therefore, that teeth with enough decay to be painful will have to be removed. The tooth fairy is going to have a busy future and the denture making industry is set to boom.

Patients who are in the high risk groups are advised to delay routine dental treatment for as long as possible. Iím not sure what the high risk groups are today but they have, at various times, included transplant patients, anyone over the age of 70, anyone living with someone over the age of 70. Male, black, diabetics who are bald and overweight should be top of the at risk groups but no one likes to say that in case it sounds racist, fattist or some ist.

So hereís the protocol, as they love to say these days.

First, you ring and make an appointment. This wonít be easy and you will see why in a few minutes.

Three days before your appointment date the dentist will email you a medical history questionnaire, a COVID 19 screening questionnaire and a consent form which you have to fill out and return via email so that all your private information goes online and is readily available for hackers to steal.

If you donít have access to email youíre stuffed but no one ever said life was fair. No one seems to understand that several million people in Britain donít have a computer, a mobile phone or any idea what an email is.

Pigeon keeping and pigeon racing is, however, one of the most popular sports and pastimes in Britain so it did occur to me that maybe dentists could be persuaded to allow patients without computers to use pigeon post. It would make as much sense as anything else. But then I realised that no one is allowed bits of paper anymore so the pigeons are out.

Dentists may also carry out a video consultation prior to their appointment. If the dentist doesnít receive all the completed forms on time then they will almost certainly cancel the appointment and youíll have to go to the back of the queue.

The day before your appointment you will be contacted again to discuss the forms you have completed. If you or anyone in your household has any of the 3,937 symptoms so far thought to be associated with the plague, sorry the flu, sorry the coronavirus you will be asked to postpone your appointment but if you have a real, real emergency and you can convince someone that you will kill yourself if you arenít treated you will be referred to an Urgent dental Care hub which will probably be 600 miles away and shut but heyho no one ever said life was fair and this is, after, the new normal in the toothless land of Comrade Boris.

Youíll be asked to pay in advance for your treatment because you wonít be able to pay with cash because cash is dirty and kills people and the banks donít like it. If you donít have a suitable means of paying over the internet or by telephone then itís hard luck and youíll have to resort to the old piece of string and a door handle solution.

Things now start to get exciting.

Before you leave home for your appointment you are advised by the Government to ensure that you have cleaned your teeth, drunk plenty of fluids and been to the loo. This assumes, of course, that everyone lives next door to the dentist. Anyone unfortunate to have to travel for an hour to reach their dentist will probably find it impossible to be fully hydrated and not need the loo on arrival.

As you set off on this adventure, you should take only essential items with you and you should attend your appointment on your own unless you canít stand without support. You should make sure that you wear extra layers of clothing because the surgery will be colder than usual as air conditioning is used to replace the air in the room at regular intervals. The dentist and his nurse, who have to spend all day in cold air will presumably wear thick sweaters and overcoats under their protecting clothing but will, nevertheless, be for ever falling ill with colds and having to take two weeks off work. It is of course well known that air conditioning causes breathing problems, dry skin and constant tiredness. It also tends to exacerbate all existing illnesses.

The dentistís front door will be locked and when you arrive youíll have to telephone and let the receptionist know that youíve arrived. If you donít have a mobile phone or your battery is dead then youíre buggered but who said life was fair? You could I suppose just shout loudly and hope someone hears you.

But no, that wonít work because when the dentist is ready for you as you wait outside in your car, they will telephone you to say that there are no other patients in the reception area and so you can safely enter. If you are travelling by public transport then you have to let the dentist know in advance so that special arrangements can be made for you to wait inside the building safely.

I am not, I promise you, making this up.

Once you have been telephoned to confirm that Elvis has left and that you can safely enter the building, a receptionist or nurse will unlock the door and let you in. She or he will be wearing personal protective equipment including a mask and a visor. Donít jump out of the car and expect to be let in soon however because there will have to be a delay after the departure of one patient and the arrival of another because the staff will have to disinfect all common areas including door handles and all surfaces.

Once you get into the now sterile surgery premises, floor markings will enable you to make sure that you obey social distancing requirements.

You will be asked to put all your belongings including your coat and any bag you are carrying into a large box in the reception area and you will be asked to sanitise your hands. If you arenít already wearing one you will be offered a mask to wear.

You will then be taken into the surgery which will have been thoroughly disinfected and cleaned after the last patient Ė you are I suspect beginning to see why dentists arenít going to be able to see quite as many patients as before and why, if this farce continues much beyond the summer, most of them will be planning to emigrate or looking for some other form of employment.

In the surgery, the dentist and the dental nurse will both be smothered in protective equipment. There will be no shaking of hands. You will be asked to keep your mask in place until the dentist is ready to start sticking his gloved fingers into your mouth.

As soon as the treatment is completed you must sanitise your hands again and replace your mask. There wonít be any jolly little chats afterwards. If you need to discuss anything the dentist will telephone you later when you are safely separated by some distance.

All things considered I wonder how many will bother going to the dentist in the future?

And I wonder how many will choose to resort to the old trick of tying one end of a piece of string to the painful tooth and the other end to a door handle. Slamming the door half a dozen times to yank out the tooth will seem to some to be a darned site easier than this crazy charade.

Finally, as we trudge reluctantly into the Governmentís carefully designed new normal where the entire nation becomes slowly edentulous we can perhaps take some small comfort from the knowledge that when we have lost all our teeth we will be able to hide our empty mouths behind a mask.

Perhaps that, after all, is what mask wearing is all about.

Copyright Vernon Coleman June 2020

Vernon Colemanís international bestselling book How to Stop Your Doctor Killing You is available as a paperback and an eBook.