Caroline Holland describes how the UK's dental nurses have stepped up to the mark in the fight against COVID-19, and how they are learning to smile with their eyes.

Consider these situations: an intensive care unit where patients on ventilators must be turned every few hours, a medical centre where sick patients need their vital signs taken, an end-of-life ward with a family liaison role.

Four months ago a dental nurse would not have been familiar with any of these settings. But such roles are now part of the evolving story of the dental profession's response to the Covid-19 pandemic, giving new meaning to the phrase 'transferable skills'.

When the virus began to take hold in March, dental nurses stepped up to the mark. Among those to be redeployed was Jo Wrigley who works in the orthodontic and paediatric departments at University Dental Hospital of Manchester. She was asked to work in family liaison at the Manchester Royal Infirmary. Equipped with a tablet and asked to work on the end-of-life ward, she set up phone calls with patients' loved ones. Sometimes she would be making a call in which the family and the sick patient were given the chance to say their farewells.

'It's been difficult but rewarding too. I did not know what to expect at the outset. You are seeing things which are hard to describe. These patients are really sick and we are not trained to deal with death.'

One experience which stands out for Jo was the bond she formed with the family of a man who was on the end-of-life ward. Albert (name changed) had COVID-19 and also an underlying condition. When she was at his bedside, he told Jo all about his wife of many years, how they had met and how they had seldom been apart.

Then his wife contracted the virus and she was brought into the infirmary but into a different ward. Jo set up a call between the couple and they talked about their memories. Twenty minutes after the end of the phone call, the wife died.

'I then had to set up a call so the family could tell Albert his wife had passed. It was a heart-wrenching moment. Just a few days later he died too; the family believed it was of a broken heart.'

A few days later, one of the family rang to thank Jo and her colleagues for giving the family peace. 'It's lovely to think that you have given the patient peace. I do feel we have given them some kind of comfort and the family as well.'

Jo says she and other healthcare professionals in Manchester undertaking similar roles have formed a WhatsApp group so they can share stories and support each other. 'We have become very close because we have had to. We lean on each other. You are seeing the vulnerability of patients and it's hard not to take those experiences home.'

Jokingly, she promises herself: "I will never take my job for granted or complain about assisting for a root canal treatment ever again!"

She misses her team at the dental hospital and stays in touch with them too. Jokingly, she promises herself: 'I will never take my job for granted or complain about assisting for a root canal treatment ever again!'

Amanda Hunter [pictured in this article, before the lockdown] is another dental nurse who has found herself at the frontline but in South London at King's College Hospital. She was quick to volunteer in March. Initially she was thrown in the deep end as one of her roles was testing patients for the virus. She was not wearing a mask having been told these were only essential when a patient had tested positive! As a result of repeatedly being so close to patients with the virus she believes she has immunity and this gave her the confidence to carry on working.

With friend and colleague Paige Holdaway she has moved fulltime from the dental department to the Intensive Care Unit where assisting medical nurses with turning seriously sick patients on ventilators is one of the many roles they have. She says she has profound respect for the doctors and nurses who are now her colleagues.

There is one patient who came onto the ward around the same time that she started working there. Amanda recounts how he had a tracheotomy to help him breathe and once the tracheotomy was completed, he gave her the thumbs up sign. She said that as she urged him to keep fighting she herself was fighting back tears. Working on that ward is emotional but she would not want to be anywhere else.

Amanda lives with her young son and parents with whom she has agreed an isolation procedure in case she does get the virus. Her family is fully supportive, she says, and proud that she is helping.

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©Nick Wright for BSPD

Amanda Hunter, pictured here before lockdown, is a dental nurse who has found herself at the frontline at King's College Hospital in South London

Cherie Walker's working life today may on one level seem similar to how it was pre-pandemic. She is in the same building and with the same colleagues. In most other ways, it's been turned completely upside down. A dental nurse in the Community Dental Service in Bridgend, she has helped transform the clinic into an Emergency Dental Care Centre where patients who need urgent intervention can get help.

For several weeks she was very busy getting the centre ready, and then, as the clinic opened, found there was a lot of waiting around. This is because the surgery must be left for an hour after each patient and before she can go in and clean; her days now are completely unlike the busy routine she is used to.

She is very aware of how strange the experience of visiting the centre is for patients from the way they look at her in her full protective gear. 'Patients find this scary. They can't see the people who are looking after them and we are not their normal dental team. We usually smile to reassure patients and put them at their ease but we can't do that anymore.'

They have created named pictures of themselves with text underneath saying: 'Hello I am…' and as patients arrive, they are shown the picture of their clinicians.

Cherie would usually be treating special care patients. 'I miss the contact with our special needs patients. I miss our regulars. I cannot see us being back to normal for a while.' Meanwhile, she says, she is learning to reassure patients as best she can, smiling with her eyes.

Dental nurses Nicola Vale and Lesley Allan are employed by NHS Lothian and usually work at the Edinburgh Dental Institute. They were redeployed to work at St John's Hospital in Livingston which opened a COVID Assessment Centre. Like Amanda, Cherie and Jo, they must communicate with anxious patients who cannot see their faces.

They too have had to adjust to being less busy during the day. Lesley says she is glad to be helping and to have the additional qualifications such as the sedation certificate which enables her to monitor patients' blood pressure and use the pulse oximeter. Under normal circumstances, Lesley also works at the Royal Hospital for Sick Children in Edinburgh, supporting general anaesthetics for dental treatments.

'Working with adult patients who have symptoms of the virus is daunting. They are nervous but we are extremely used to working with patients who are anxious.'

In addition to scrubs, she wears a medical mask, face visor, gloves and an apron. She is probably better protected in the assessment centre than she would be in the supermarket, she says.

'I love my job and I love my profession. I love that I have got so much experience under my belt in the last few weeks but I am looking forward to getting back to my dental work.'

Nicola agrees. A mother to a 4-year-old and a 9-year-old, she says she was initially worried about the redeployment but her role took over and she knew it was her job to put patients first.

Sarah Haslam, Mouthcare Matters lead at Darent Valley Hospital in Kent, failed the fit-testing for the FPP3 masks so can no longer go up onto the wards to see patients who have oral issues. She is working around this by doing phone consultations, talking through concerns with doctors. She is also going to be trained to carry out fit-testing for others. As a dental nurse she is used to cross infection control procedures and has been empowered by the skills she can share.

Debra Worthington, President of the Orthodontic National Group and manager at the Maxillofacial unit Salford Royal Hospital has seen several of her team redeployed. They have been recruited to work weekend shifts with the PPE procurement team, ensuring all wards are fully stocked with essential PPE. She said: 'The feedback I got was that they worked really well, which didn't surprise me as dental nurses are organised and know how to work to schedule. I am proud of them.'

Looking after anxious or even phobic patients is a routine responsibility for dental nurses, as is basic life support, cross infection control and stock-ordering. These are skills that have been of great value during the pandemic and resulted in dental nurse redeployment being highly effective. Teamworking has also worked well as dental nurses adapted readily to having doctors, nurses and physiotherapists as colleagues.

All of my interviewees have been praised by their supervising clinicians for the way they rallied to help with patient care during the pandemic. All believe that the future of dentistry is going to be very different. Having very publicly demonstrated their dedication, one important outcome must surely be a greater appreciation of dental nurses and their transferable skills.