Dentists in Spain call for collaboration with health authorities
MADRID, Spain: In Spain, dental clinics are considered an essential service. This means that approximately 40,000 dentists are obliged to keep their practices open even though they are only allowed to provide emergency care. Just recently, dental practices have experienced a drastic decrease in the number of patients, and dentists are still lacking personal protective equipment (PPE). Additionally, they have limited access to testing for SARS-CoV-2. For these reasons, dentists in Spain are insisting that the government decrees the temporary closure of dental clinics and that dentists are allowed to take advantage of the economic measures offered by the government, such as temporary redundancy, the lay-off of workers and tax exemptions.
Dr Juan Carlos Llodra Calvo, executive director of the Consejo General de Dentistas de España (general dental council of Spain), told Dental Tribune International that the council has created a specific site on its website to promptly inform dentists about the current SARS-CoV-2 situation and offer specific guidelines for dentistry. Additionally, it has produced two technical reports based on available national and international information and has sent dentists an updated guide on how to apply for government grants for the self-employed. To help reduce cross-infection, the council has closed all its offices, and staff are currently working from home.
Like in other countries, dentists in Spain were urged to exclusively attend to dental emergencies. However, most dental practices lack PPE and are ill-equipped to protect their staff and patients. In a recent statement, representatives from the general councils of dentists, nurses, pharmacists, physicians and veterinarians urged that all necessary health protection measures be put in place to guarantee the safety of those who are on permanent duty in the fight against the pandemic. This includes those working in hospitals, health centres, doctors’ offices, dental clinics, pharmacies and veterinary practices.
As an estimated 14% of those infected in Spain are health professionals, all dental practices have agreed to donate all PPE to those health sectors that need it the most to show solidarity and ensure the continuity of clinical activity. “In this difficult situation, we are in permanent contact with health authorities and the minister of health,” Calvo stated. “I can only tell you that right now, the dental industry in Spain is almost totally paralysed. Fundamentally, that is due to the significant lack of PPE and the recommendations to dentists to exclusively attend to emergencies.”
“We have received briefs from several supplier companies informing that the situation of the lack of PPE will last at least a couple of months because, by order of the Spanish Ministry of Health, priority must be given to the medical and hospital health system,” Calvo added.
The financial recovery from COVID-19 and the fear of bankruptcy
According to Dr Óscar Castro Reino, the president of the general dental council, owing to the present confinement measures, dental clinics have experienced a drastic decrease in the number of patients. Since most of the dentists are self-employed and have salaried staff, they now have no income to pay their salaries, social security or taxes, which might lead to the closure of a significant number of dental practices, especially those owned by young dentists.
On 18 March, the Spanish government introduced new legislation by royal decree. The law established that companies that carry out a temporary employment regulation file (ERTE) owing to a loss of activity prompted by COVID-19 will be exempt from paying social security contributions and will be entitled to unemployment benefits. The law applies to both workers with suspension of their contracts and those whose hours have been reduced. However, up until now, the law has only regulated recoverable paid leave for employees who do not provide essential services, which means that dentists are exempted from it and are being forced into bankruptcy, Castro Reino stated.
For this reason, the general dental council demanded that the government decree the temporary closure of dental clinics and only allow a small number of practices to remain open for emergency care. Additionally, it requested that the appropriate economic measures be taken to help dentists qualify for ERTE and tax exemptions and alleviate their economic burden.
Recommended actions for dental professionals
In a recent statement, the Sociedad Española de Cirugía Bocal (Spanish society of oral surgery) noted that dentistry is going to undergo some crucial changes in the coming months and emphasised the need for more evidence-based information on the topic, such as reliable scientific articles, and consensus on the risk of infection and treatment protocols. According to the organisation, adequate scientific knowledge on the subject may help mitigate any fears that dentists and oral surgeons might have upon returning to routine dental care.
Additionally, the organisation believes that, to minimise the generation of aerosols in dental practices, dental clinics will need to develop new working systems, such as more powerful suction systems. Some of these systems are already on the market, the organisation said, but they are likely to increase in use and improve in design and performance.
Finally, to overcome the challenges that dentists will inevitably face once dental activity resumes, dentists must get organised and not engage in abusive panic-buying of dental equipment. Since they are at high risk of nosocomial infection and may become potential carriers of the disease, dental professionals should study the actions of their Chinese colleagues to learn from their intervention protocols and avoid possible errors that could favour the transmission of this virus.
By 9 April, there had been 140,510 reported cases of COVID-19 in Spain and 13,798 associated deaths, according to the World Health Organization.