Dentists need help. Doing this alone has never been harder. Before the pandemic, running a dental practice was already a challenging endeavor due to increasing hourly rates, rising healthcare costs, and falling reimbursement rates. With new PPE protocols and staffing challenges, there is less profit in practice ownership. To top it off, practice owners must also make substantial investments to upgrade IT hardware, replace imaging equipment, and refurbish chairs/carpet/paint/furniture in order to stay competitive.

These challenges became back-breaking during the pandemic when government shutdowns left many practices without revenue, forcing dentists to terminate staff and take on even more responsibility, or in some cases, to retire earlier than anticipated. The current labor shortage is driving a shortage of hygienists and assistants, complicating the hiring process and compounding the pre-existing human resources issues such as employee turnover and toxic office culture.

The pandemic exposed just how hard it can be to keep a good practice up and running. While many dentists continue holding the pieces together on their own, many have failed. To ease the burden of ownership, it may be worth considering a dental support partner with the right approach to alleviate these difficult HR issues and help drive growth in the practice again.

COVID-induced talent shortage in the dental industry

During the pandemic, many dentists, hygienists, and assistants were terminated due to the government ban on elective dental procedures. Many dentists and hygienists chose to retire early due to the health risks posed by COVID-19 (especially considering 40% of US-based dentists are currently over the age of 55). A large number of dentists and hygienists were laid off while others left the profession for personal reasons. The American Dental Association (ADA) estimated a 38% reduction in overall dental industry for 2020 and up to a 19% reduction for 2021, suggesting the bleak prospect that the dental industry contracted in the post-pandemic economy. These reductions are not due to a lack of patient demand, but come from understaffed dental offices that are unable to meet patient needs.

According to a May 2021 ADA Health Policy Institute poll, 35.8% of owner dentists are recruiting dental assistants, 28.8% are seeking dental hygienists, 26.5% are looking to hire administrative staff and 13.1% are in search of associate dentists — all confirming increased competition for talent since October 2020. However, given the smaller pool of applicants and increased competition, 80% of dentists report that hiring dental hygienists and assistants is extremely challenging; more than 70% report that hiring administrative staff is very challenging and more than 50% reported the same struggles for recruiting associate dentists.

Hiring hygienists and assistants prior to the pandemic was already difficult, but health and safety concerns regarding the virus made it even worse. The American Dental Hygienists’ Association surveyed hygienists who voluntarily left their positions during the pandemic and found that 42.9% reported that “I do not want to work as a dental hygienist until after the COVID-19 pandemic is under control,” and 38.1% of respondents stated, “I have concerns about my employer’s adherence to workplace/safety standards.”

The pandemic and resulting labor shortage are creating a chain reaction that is exacerbating pre-existing HR challenges that leave owner dentists fighting an uphill battle to keep their practice afloat.

Ongoing HR issues in the dental industry

Implementing a PPE and infection control protocol that meets the shifting standards of the CDC and the ADA present a whole new challenge for practice owners. These protocols are driving substantial increases in dental supplies expenses for practice owners. Dentists are also grappling with employee demands for pay raises, prospective employees asking for higher hourly rates, while simultaneously keeping the office afloat with a very understaffed dental team.

According to the HPI data mentioned above, among dentists who are actively searching to fill open positions, 73.1% increased pay for dental assistants, 70.7% for hygienists and 67.1% for administrative staff. High turnover was always an issue in the dental industry, but in the face of the emerging labor shortage, practices cannot afford to lose their current employees. Practice owners are being pressured to offer raises to team members or face the prospect of turning away existing dental patients. 

Many practices are still recovering from lower patient volumes and higher supply costs, as a result of the pandemic. Operating with an understaffed team creates more pressure and stress as the team takes on an unsustainable workload to keep patients happy and the business running. The compounding effect of these forces is squeezing practice owners financially and crushing morale for understaffed dental teams.

In an attempt to solve this problem, many practices will be tempted to fill open roles with inexperienced candidates. Professional job training for new hires is basically non-existent in most dental practices. Most candidates do a working interview and then jump right into the job after they are hired with little to no training and instruction. As practices hire more inexperienced candidates, the lack of training will drive even high employee turnover as new employees feel they are failing with no resources to fill the gap in their skills. These new hires will feel unsupported in their role and will likely leave in a matter of weeks.

This toxic cocktail leaves owner dentists struggling to meet the demands of providing quality clinical care, a great patient experience, properly filing insurance claims, collecting patient payments, managing the patient schedule, paying all the bills, and turning a profit. Dentists were never trained to deal with so many business issues simultaneously. The pandemic has created an uncertain future for practice owners, and many are facing the difficult prospect of selling their practice in this challenging environment.

Thoughtful DSOs are positioned to help practices succeed

Most dentists are reluctant to consider joining a DSO because of the preconceived notion that it means relinquishing all the control over your practice. While that may be true with some DSOs, there are more attractive alternatives that operate with the best interest of owner dentists in mind and are dedicated to preserving the heart and soul of private practice.

Partnering with the right DSO will relieve dentists of the management burden and allow them to maintain complete ownership and autonomy over the clinical side of the practice. This means dentists can delegate the recruiting, training, compensation, benefits, and employee relations to a management partner, allowing dentists to focus on providing high quality clinical outcomes and providing the best patient experience possible.

A thoughtful DSO lets dentists focus on what they do best, while providing robust business services that help fill the gaps for their dental teams. Partnering with the right DSO will dramatically improve a dentist’s work/life balance and remove the need to burn the midnight oil managing the business. Since 2018, there are now officially more women graduating from dental schools in the US than men.  Many female dentists are joining DSOs at a higher rate than men because of the support and flexibility a DSO can provide to a practitioner.

A strong DSO partner will help with recruitment, training and retention. DSOs with strong financial backing will recruit top talent, provide comprehensive training and drive engagement with periodic employee surveys to measure sentiment regarding workload, compensation, benefits, and receive feedback to better meet their needs. DSOs drive retention for dental teams with regularly scheduled performance reviews, a structured process for employee raises, creating opportunities for professional growth, improving benefits, and adequate vacation time. With the increasing student loan debt for young dentists, joining a dental office supported by a strong DSO removes the financial risk and the management burden traditionally associated with practicing dentistry as a solo practitioner. 

According to Fortune, 18% to 20% of dental practices are affiliated with DSOs today. DSO market share is projected to increase to 30% to 35% in the next five to ten years.  However, given the business pressures created by the pandemic, DSO market share will likely increase at a faster pace.  Most dentists are skeptical of DSOs, but there are DSOs dedicated to preserving the legacy of private practices that focus on helping dentists reach their personal, professional, and financial goals. Over time, when a high quality dentist partners with a high quality DSO, they can improve the patient experience, the employee experience, and ultimately the dentist’s professional experience.

ABOUT THE AUTHOR

Justin Jory is the Founder and CEO of Lightwave, the largest and fastest growing dental group in the Mid-Atlantic providing business services top tier dental offices. Lightwave is the first Dental Leadership Organization (DLO) that believes dentists are the natural leaders of the dental practice and the company’s purpose is to help dentists reach their personal, professional, and financial goals. After spending a decade investing in high-growth companies on behalf of investment firms (Mercato Partners, Leucadia, and Bank of America), Justin founded Lightwave to solve the problems surfacing in the dental industry in a way that will improve the industry for patients, dental teams, and dentists. Justin considers himself blessed to be working with some of the most successful dentists and dental offices in the Mid-Atlantic. Justin obtained a JD/MBA and BA in Philosophy from Brigham Young University where he also played tight end for the football team.

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The US Food and Drug Administration (FDA) is revoking the emergency use authorizations (EUAs) of all disposable respirators that have not been approved by the National Institute of Occupational Safety and Health (NIOSH), which include imported disposable respirators such as KN95s, along with EUAs for decontamination and bioburden reduction systems.

The FDA said that its actions are consistent with updated recommendations from the Centers for Disease Control and Prevention (CDC) that healthcare facilities not use crisis capacity strategies and should promptly return to conventional practices.

Also, the FDA said, its actions are consistent with the recently published emergency temporary standard from Occupational Safety and Health Administration (OSHA) to protect healthcare workers requiring healthcare employers to provide NIOSH-approved or FDA-authorized respirators for workers potentially exposed to COVID-19.

“Throughout the pandemic, the FDA has worked closely with our federal partners at the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health, the Occupational Safety and Health Administration, and with manufacturers to protect our frontline workers by facilitating access to the medical supplies they require,” said Suzanne Schwartz, MD, MBA, director of the Office of Strategic Partnerships and Technology Innovation in the FDA’s Center for Devices and Radiological Health.

“As a result of these efforts, our country is now better positioned to provide healthcare workers with access to NIOSH-approved N95s rather than using non-NIOSH-approved respirators or reusing decontaminated disposable respirators,” Schwartz said.

All manufacturers of decontamination and bioburden reduction systems have requested, and the FDA has proceeded with, the revocation of their EUAs, effective June 30, 2021.

“Early in the public health emergency, there was a need to issue emergency use authorizations for non-NIOSH-approved respirators as well as decontamination and bioburden reduction systems to disinfect disposable respirators,” Schwartz said. “Today, those conditions no longer exist. Our national supply of NIOSH-approved N95s is more accessible to our healthcare workers every day.”

Since the beginning of the pandemic, the FDA said, NIOSH has approved more than 875 respirator models or configurations, with some of these manufactured by approximately 20 new, domestic NIOSH-approval holders. Also, there are now more than 6,400 total respirator models or configurations on the NIOSH-certified equipment list that have met NIOSH-approved EUA criteria and thus are FDA authorized. These include

• More than 600 filtering facepiece respirator (FFR) models, of which there are more than 530 N95 FFR models
• More than 5,500 elastomeric respirator configurations, including new elastomeric respirators without an exhalation valve
• More than 360 powered air purifying respirator configurations

The FDA’s EUA revocation of all non-NIOSH-approved disposable FFRs follows earlier actions to limit authorization of imports of non-NIOSH-approved FFR respirators, imports of non-NIOSH-approved FFRs manufactured in China, and decontamination and bioburden reduction systems for disposable respirators, the FDA said.

The FDA said it also has withdrawn two related decontamination and bioburden reduction guidance documents:

• Recommendations for Sponsors Requesting EUAs for Decontamination and Bioburden Reduction Systems for Face Masks and Respirators During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency: Guidance for Industry and Food and Drug Administration Staff
• Enforcement Policy for Bioburden Reduction Systems Using Dry Heat to Support Single-User Reuse of Certain Filtering Facepiece Respirators During the Coronavirus Disease (2019) Public Health Emergency

The FDA recommends that healthcare personnel transition from extended use of disposable respirators to single-use for single-patient interactions as appropriate.

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Ninety-five percent of the 3,400 respondents in a recent DentaVox survey said they have become significantly more demanding of hygiene at the dentist’s office due to the COVID-19 pandemic.

Also, 50% said that the disinfection of dental equipment was the most important hygienic measure that dental offices need to ensure, followed by 22% who said that often-touched surfaces need to be disinfected to maintain proper hygiene in dental practices.

However, DentaVox said, only 61% of respondents said they have actually seen the dental staff disinfecting dental equipment, and 46% have seen staff disinfect often-touched surfaces.

According to the poll, 9% said the use of personal protection equipment (PPE) and 5% said that handwashing and sanitizing were the most important hygiene protocols. On a related note, 67% of respondents have seen dental staff wash their hands, and 50% have seen staff change their PPE.

Meanwhile, 4.2% of respondents said that keeping the office organized was most important, prompting DentaVox to note how tidiness may be confused with hygiene, which the World Health Organization says “refers to conditions and practices that help to maintain health and prevent the spread of diseases.”

Cleanliness is often considered hygienic too, DentaVox said, though that is a misconception as well. Cleaning is the removal of visible dirt, while hygienic cleaning also eliminates invisible dirt, germs, and other pathogens. And while tidiness may mean neat and organized, it does not guarantee cleanliness or good hygiene, DentaVox said.

Also, only 0.76% called open windows and 4.1% called air purification and disinfection priorities, even though 23% said they have seen dental staff opening windows during their last dental visit and 25% said they spotted some sort of air purification system.

Disposable shoe covers are mandatory in many dental clinics, but only 1.3% of respondents said that washing floors was necessary to hygiene, and 18% have seen staff washing floors during their last dental visit.

First impressions matter too, with 55% of respondents forming a first impression simply by looking around the dental office, and 19% of them noting how it smells. Other respondents checked the cleaning protocols or asked or were informed by the staff about the last cleaning session.

The largest proportion of respondents, 41%, judge the hygiene in the office by the state of the tools and equipment used during an appointment. Next came the condition of the entire treatment room at 29%, the condition of the waiting room at 12%, and the condition of the surgical room at 9%.

Only 4% said that the way the dental staff was dressed mattered, while 3.76% said the state of the bathroom was the best indicator for hygienic cleanliness in the dental office. As for PPE, respondents would like to see dental staff wear:

• Protective gloves: 93%
• Face masks: 88%
• Goggles: 61%
• Disposable coats: 46%
• Shoe covers: 39%
• Caps: 16%
• Shields: 15%

During their last dental visit, more than 90% of respondents said their dentist wore gloves and masks; 62% said their dentist wore goggles; 46% said their dentist wore a disposable coat; 35% said their dentist wore shoe covers. Caps and shields were part of their outfit less frequently, which DentaVox called a serious lapse on the dentists’ part.

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It has been a year since face-to-face dental care has resumed in England, prompting the British Dental Association (BDA) to ask the four chief dental officers (CDOs) to commission the Scottish Dental Clinical Effectiveness Programme (SDCEP) to develop a roadmap for the safe relaxation of current restrictions currently limiting access to dentistry across the United Kingdom.

UK practices are continuing to operate at a fraction of their pre-pandemic capacity to meet infection prevention and control (IPC) guidance, with an estimated 30 million appointments lost since March 2020 in England alone, the BDA said.

In a message to the CDOs of England, Wales, Scotland, and Northern Ireland, the BDA said that SDCEP is now best placed to review any new scientific literature, assess the wider prevailing conditions, and produce recommendations for IPC de-escalation founded on the best available evidence while accounting for expert views of a safe yet pragmatic way to move forward.

The BDA said this review should include but not be limited to community infection, transmission, and vaccination rates, as well as the threat posed by emerging variants of SARS-CoV-2.

Also, this review should include the relevance of aerosol-generating procedures to COVID-19 transmission. Evidence is accumulating that infective aerosols arise principally from coughing by COVID-19 patients, the BDA said, with medical interventions posting a relatively low risk. This suggests that high-level personal protective equipment might not be necessary in dentistry except for the treatment of patients known or considered likely to be infected with SARS-CoV-2.

The review additionally should consider the range and impact of international dental standard operating procedures (SOPs), the BDA said. Cochrane compared dental guidance from around the world in May 202, but the pandemic has progressed since this publication, and IPC practices will have evolved. More information should now be available on any transmission of COVID-19 linked to dental settings, the BDA said.

The impact on poor oral health and inequalities should be reviewed as well, the BDA said, including the impact of limited access to care, the suspension of dental public health programs, poor lockdown diets, and altered oral hygiene habits. The BDA expects the demand for dental services and the number of high-needs patients to be greater than before March 2020.

Further, the BDA said the review should note missed or delayed diagnoses of oral cancers across all of the nations in the United Kingdom as a result of reduced access to dental services.

Dental antibiotic prescribing also remains elevated relative to 2019 levels, the BDA said. Timely access to urgent dental care, which currently is impeded by IPC requirements, is essential for dentistry to play its part in averting a further global health disaster due to antimicrobial resistance, the BDA said.

Noting the impact of the current IPC requirements on the dental workforce, the BDA noted that 47% of dentists in England are likely to leave the profession in the next year if existing SOPs remain in place, with a similar proportion intending to reduce their National Health Service commitment. Such an exodus would have a devastating and long-lasting impact on already inadequate levels of access, the BDA said.

Finally, the BDA said, the review should consider patient triaging and waiting arrangements, which affect patient flow and capacity.

The BDA said it has underlined the need for clear and consistent guidelines and public communications alongside practical support to underpin a safe de-escalation of IPC requirements across dentistry.

“It’s a year since face-to-face care resumed in England, but the restrictions we work to remain largely unchanged. So today we have asked all four UK chief dental officers to begin work on a roadmap to ease restrictions,” said BDA chair Eddie Crouch.

“The risk we face today from the virus needs to be balanced against the millions unable to access care, and threats to the very sustainability of this service,” said Crouch. “It is time to let the experts weigh up the risk of COVID transmission with the dangers of prolonging the status quo. We know this issue is already high on the official agenda, but patients and the profession deserve clarity on the way ahead.”

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During the height of the COVID-19 pandemic, there was a manufacturing shortage of a small part used in fittings for N95 masks and other personal protective equipment (PPE). Rutgers School of Dental Medicine (RSDM) student Michael Masino then got to work.

“It’s super necessary for the fitting because it takes this foul-smelling liquid and aerosolizes it so you can tell if the mask is airtight,” said Masino.

The staff at Rutgers’ University Hospital asked RSDM if it could try using its 3D printers to make the part, but the dental school could not figure how to make the small perorations it required.

Masino, who began a career as a biomedical engineer before enrolling in dental school, then joined the project and figured it out. Since then, their work has resulted in 45 devices being used for fit tests to help protect faculty, staff, and students from infection.

The project reminded Masino that craft and technological innovations are a large part of dentistry, just as they are in engineering, especially when they’re in the service of helping others.

“Being able to transform someone’s smile, it takes a little bit of artistry, a little bit of engineering, and a doctor’s skill,” Masino said. “Being able to do something for someone and making them happy makes a world of difference to me.”

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The ADA told the White House Office of Management and Budget that there doesn’t appear to be any grave danger of COVID-19 exposure in dental settings, especially as the pandemic is slowing down, during a June 1 meeting.

Seven ADA representatives attended the teleconference, which was held to discuss the potential impact of the Occupational Safety and Health Administration’s (OSHA) draft COVID-19 Emergency Temporary Standard.

President Biden has issued an executive order directing OSHA to enact emergency rules to protect workers from COVID-19. OSHA submitted its draft standard to the Office of Management and Budget for review in April.

These rules, if approved, would be in effect for six months and impact dental practices among other businesses.

During the meeting, the ADA noted that dentists have experienced “exceptionally low monthly incidences of COVID-19” even though there have been several regional and national spikes during OSHA’s study periods.

Following the meeting, ADA president Daniel J. Klemmedson, DDS, MD, and executive director DMD, MPH, sent a letter to the Office of Management and Budget further outlining how dentistry has minimized risks of infection in their offices.

For example, the letter cited ADA studies finding that dentists saw a 2.6% infection rate in November 2020, while dental hygienists experienced a 3.9% infection rate in October 2020, reflecting data collected before vaccines were available.

The letter also said that 87.5% of dentists have been fully vaccinated since then, and another 5.3% have received at least one dose. Additionally, 70% of dental hygienists have been fully vaccinated, and another 7% have received at least one dose.

The ADA further touted its own efforts in providing guidance and materials for dental practices during the pandemic, including:

• A dental office hazard assessment checklist modeled after OSHA’s Hazard Identification and Assessment
• Fact sheets and frequently asked questions about OSHA and Centers for Disease Control and Prevention Guidelines
• 4.5 million KN95 face masks from the national stockpile
• Guidance on providing point-of-care testing at dental offices
• Guidance to minimize the risk of exposure when the recommended personal protective equipment has been in shortage
• Guidance for high- and low-exposure staff to take when patients report a positive COVID-19 test after their appointment
• A flowchart, risk assessment, and strategies for self-quarantine and returning to work if a staff member of someone in their household tests positive for COVID-19
• A guide for handling patients who refuse to wear a face mask, whether because of disability or a personal choice
• State-by-state updates on procedure requirements and/or restrictions for dentists
• Informational webinars on vaccine efficacy, targeted toward addressing vaccine hesitancy concerns among patients and staff

“As you continue deliberating over the impact an emergency temporary standard will have on so many industries, we urge you to keep in mind the remarkably low incidence of COVID-19 in dental offices,” the letter said.

“The data suggest that requiring substantial new infection controls—such as rerouting ventilation systems and making other capital improvements—will have little (if any) notable impact on dental office workers or the patients they serve,” it said.

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Henry Schein has received a $53.4 million contract from the US Department of Health and Human Services (HHS) to store and distribute 80,000 pallets of personal protective equipment (PPE) and products related to COVID-19 to support the Strategic National Stockpile (SNS), which is part of the Office of Assistant Secretary for Preparedness and Response (ASPR) at HHS.

This agreement will further ASPR’s efforts to leverage the collective strengths of the public and private sectors to maximize the breadth of coverage and capabilities, minimize vulnerabilities, and facilitate an expedited response to public health crises and other emergencies, Henry Schein said.

“We are honored to have been selected to serve HHS in such a critical capacity, and we look forward to supporting the efforts of ASPR, along with state and local agencies, to provide additional resources and infrastructure needed to get healthcare products where they are needed most,” said Stanley M. Bergman, chairman of the board and CEO of Henry Schein.

“This pandemic is a painful reminder that it is vital for healthcare workers to have the protection they need for their safety and to care for their patients,” said Bergman.

“As a solutions provider to the federal government, we strongly support ASPR’s strategy to expand and enhance the SNS and its capabilities to supplement state and local medical supplies in response to the COVID-19 pandemic and for future public health emergencies,” Bergman said.

Henry Schein said that it has a long history of serving the United States government, including throughout the COVID-19 pandemic, to ensure the quick and efficient distribution of medical supplies to those most in need.

The company also said that it has supported the HHS COVID-19 Supply Chain Task Force since its inception in 2020, which was originally managed by the White House and then the Federal Emergency Management Agency.

Further, Henry Schein said, it worked with the SNS to deliver essential products to COVID-19 testing sites and collaborated with the United States government to source and accelerate the availability of PPE to safeguard and support frontline healthcare workers.

“Adequate stock of emergency medical supplies at the point of care is essential to combat public health crises,” said Brad Connett, president of the US Medical Group at Henry Schein Medical.

“We recognize that effective inventory management requires extensive logistical and administrative capabilities to maintain, coordinate, and distribute inventory when the entire spectrum of the US healthcare system is activated,” Connett said.

“In collaboration with SNS, we are well positioned to engage our innovative logistics capabilities to deploy essential PPE and COVID-19 related products to health professionals who are vital in our nation’s frontline response,” he said.

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The British Dental Association (BDA) has urged the government to set out a clear roadmap for reform and relaxation of COVID-19 restrictions as new survey data points to an exodus from the service as the access crisis continues with nearly 30 million appointments lost since the first lockdown.

According to a new survey of dentists in England, 47% of dentists indicate they are now likely to change career or seek early retirement in the next 12 months should current restrictions remain in place. The same proportion says they are likely to reduce their National Health Service (NHS) commitment as well.

Also, working in high-level personal protection equipment (PPE) mandated under current infection control procedures is having a devastating effect, the BDA said, with 88% indicating it is having a high impact on their morale.

Additionally, 78% say financial uncertainty is having a high impact on their ability to provide pre-pandemic levels of care. Two-thirds cite hitting NHS targets imposed by the government on January 1, 2021. Since the new year, the BDA said, the workforce has reported the highest levels of stress compared to any point since the onset of the pandemic.

Nearly two-thirds of NHS dentists estimate they won’t meet imposed targets and will face penalties for not hitting 60% of their pre-pandemic activity levels. Those that have made progress say that they have done so unsustainably.

Meanwhile, 62% say their practice had to invest in new ventilation equipment without any government support, 41% say they were forced to refocus on routine over urgent appointments, and similar numbers say they have reduced private work or reduced or eliminated annual leave.

England remains the only nation in the United Kingdom where the government has not committed to or embarked on exploratory work to provide capital funding for ventilation systems to enable practices to increase patient numbers while meeting infection control restrictions, the BDA added.

While securing new equipment has been the number one strategy deployed by dentists to meet NHS activity targets, the BDA said, nearly 70% of practices say they now face financial barriers to further investment.

Finally, the BDA said, 47% of dentists lack confidence in terms of the business outlook for their practice should current standard operating procedures remain unchanged.

The BDA’s analysis of Freedom of Information data indicates that nearly 70% of appointments, or 28 million courses of treatment, that would have been delivered in NHS services in England in the year since March 2020 have been missed. The BDA estimates the figure to have grown to exceed 30 million.

While some ministers of Parliament had expressed concern in January that the current interim system of targets would prioritize volume over need, the BDA said, urgent treatment delivered has fallen since the start of 2021.

Dental leaders have welcomed recent government commitments to reform the widely discredited activity-based contract at the heart of NHS dentistry, the BDA said, but they also have warned that needed change could be fatally undermined by further reductions in capacity through colleagues leaving the service or reducing their NHS commitment.

The BDA believes that contractual and legislative change needs to be in place before April 1, 2022, which is the beginning of the next NHS financial year.

With the vaccination program making real headway, the BDA said, the organization added that it also has underlined the need for a clear timetable for revising high-intensity infection prevention and control procedures, including heavy-duty PPE and maintaining lengthy gaps between appointments, given the huge impact on both productivity and the workforce.

“The pandemic has wiped out access for millions and taken a hammer blow to the workforce, with many now looking for the exit. Practices have managed to hit punitive targets but at a terrible cost. Churning through appointments against the clock in heavy-duty PPE now risks an exodus from this service,” said Shawn Charlewood, chair of the BDA’s General Dental Practice Committee.

“Fixing NHS dentistry will be impossible if dentists are left unwilling to work in it. We need a clear roadmap that lifts restrictions, provides needed support to all practices, and makes a decisive break with a broken contract,” Charlewood said.

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Healthcare workers in Scotland overall were three times more likely to become infected during the COVID-19 pandemic compared to the general population, according to researchers at Ninewells Hospital and Medical School in Dundee. Yet dental professionals faced the highest rates of infection among these workers, with 26% of those in the study testing positive.

Approximately one in five healthcare workers who were infected were asymptomatic and unaware that they had COVID-19, the researchers said. It also wasn’t just the frontline staff who faced higher risks of infection, suggesting that there was transmission between staff and within the wider community, the researchers added.

However, according to the researchers, healthcare workers who had been infected were very unlikely to contract COVID-19 a second time in the following six months.

“We have always believed that frontline health workers face a high risk of contracting COVID-19, and that’s why we’ve tried to ensure they have the PPE needed to protect themselves,” said professor James Chalmers, a consultant respiratory physician at the University of Dundee.

“But many questions remain about the level of this risk and what other measures we can take to protect staff and reduce transmission of the disease,” Chalmers said.

The study included 2,063 staff including 50 dentists working in a wide variety of healthcare roles in the east of Scotland. Between May and September 2020, participants were given blood tests for antibodies against COVID-19, which researchers called a very accurate indication that someone has been infected with the virus.

The researchers also recorded whether any participants developed an infection in the following months. The results from these healthcare workers were compared with a randomly selected control group of blood samples taken by local general practitioners during the same period of time.

The blood tests showed that 300 (14.5%) of the healthcare workers had been infected, which is more than three times higher than the proportion of people infected in the local population. Dentistry saw the highest rates of infection at 26%, though the researchers caution that this rate should be interpreted with caution due to the lower number of dental staff enrolled.

Healthcare assistants (23.3%) and hospital porters (22.2%) had the second and third highest rates. The rates among administrative staff and doctors were the same at 21.1%. Students were next at 16.0%, and nurses, domestic staff, and pharmacy staff followed, all at 13.0%. Administrators saw a 12.0% rate. 

Rates among people working in areas of the hospital where COVID-19 patients were being treated were a little higher than those working in non-virus areas (17.4% versus 13.5%). But most infections were among staff who were not working directly with COVID-19 patients, suggesting transmission between staff or infections acquired in the community.

Among the 300 healthcare workers who tested positive, 56 (18.7%) did not think they ever had COVID-19 and were completely asymptomatic. The researchers said this is important since people without symptoms are likely to go to work and could potentially infect other people.

In the months following their blood tests, 39 workers developed a symptomatic COVID-19 infection, but only one of them was a worker who had previously tested positive. This equates to an 85% reduction in risk, which is similar to the protection provided by COVID-19 vaccines, the researchers said.

“A lot of attention during the pandemic has been around PPE for doctors and nurses, but we found that dentists, healthcare assistants, and porters were the staff most likely to test positive,” Chalmers said.

“We continued to monitor staff for up to seven months and found that having a positive antibody test gave 85% protection against a future infection. This is really good news for people who have already had COVID-19, as it means the chances of a second infection are very low,” said Chalmers.

The researchers hope to continue the research to see how long immunity lasts and how vaccination affects infections among healthcare workers.

“This research shows the high levels of COVID-19 infection among all healthcare workers, with the highest evidence of infection in dentists, healthcare assistants, and porters,” said professor Anita Simonds, president of the European Respiratory Society and consultant in respiratory and sleep medicine at Royal Brompton Hospital. She was not involved in the research.

“Staff working in critical care, who are likely to have been protected by using personal protective equipment at all times, were not disproportionately affected,” said Simonds.

“It should be noted that among administrative staff, 21.1% were found to have been infected with COVID-19, indicating that all those working directly with patients, and those working in other hospital roles, are at risk, and vaccination and risk assessment for appropriate levels of PPE in all these frontline groups are crucial,” said Simonds.

The study, “The Protective Effect of SARS-CoV-2 Antibodies in Scottish Healthcare Workers,” was published by ERJ Open Research.

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Henry Schein has partnered with CH Robinson and the CH Robinson Foundation to donate more than 2.5 million personal protective equipment (PPE) and infection control items through Henry Schein Cares, the company’s social responsibility program, to enhance the safety of frontline healthcare workers in Brazil and India as they combat the recent surge in COVID-19 cases.

The recipients in India currently include the Baptist Hospital in Bangalore, LNJP Hospital in New Delhi, the All India Institute of Medical Sciences in New Dehli, Deenanth Mangeshkar Hospital in Pune, Nair Hospital in Mumbai, and the State of Maharashtra. In Brazil, items will be distributed to healthcare workers in Rio de Janeiro and the State of Sergipe.

“It is critical that we help combat the rise in COVID-19 cases in Brazil and India, where the outbreak is particularly severe,” said Stanley M. Bergman, chairman of the board and CEO of Henry Schein. “Together with our NGO partners, we will continue the urgent task of enhancing the safety of the heroic healthcare professionals caring for patients battling the COVID-19 virus.”

Henry Schein’s NGO partners in this effort include:

• Direct Relief is a humanitarian aid organization active in all 50 states and more than 80 countries with a mission to improve the health and lives of people affected by poverty or emergencies without regard to politics, religion, or ability to pay.
• Heart to Heart International is a global humanitarian organization that improves access to health and responds to the needs of people affected by disasters worldwide.
• IsraAID is an Israel-based NGO that responds to emergencies all over the world with targeted humanitarian help.
• MAP International is a nonprofit humanitarian organization providing medicines and health supplies to millions of people worldwide so they might experience life to the fullest.
• Project HOPE is a global health and humanitarian relief organization committed to placing power in the hands of local healthcare workers to save lives across the globe.

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