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Moving on from AAA: the 3Ps and 3Rs protocol for remote management of dental patients Samy Darwish Kariem El-Boghdadly Maysoon Abdelmajeed Wala Belhaj Tarik Shembesh Dental Update 2025 47:11, 707-709.
With the coronavirus disease 2019 (COVID-19) pandemic limiting movement, and dental services being somewhat reduced, there is a need for remotely managing patients through teledentistry. The ‘advice, analgesics, antibiotics’ (AAA) protocol has become common practice but concerns have become apparent on its application, as some patients' needs are not met, sometimes with potentially serious consequences. Throughout different phases of the pandemic, there may, at times, continue to be a need to minimize direct clinical contact with a patient, while safely managing their care. We suggest an alternative protocol for the remote management of the dental patient: the 3Ps and 3Rs, namely phone, photo, prescription and record, refer, review. This modified protocol has the potential to improve safe patient care throughout the current crisis and beyond, by providing an enhanced structure to the remote management of the dental patient.
CPD/Clinical Relevance: The current widely practised ‘AAA’ clinical protocol may be appropriate for some patients, but also has scope for much improvement. An alternative acronym is suggested, presenting an improved structure for how a dental patient could be managed remotely.
Article
As the crisis caused by the coronavirus disease 2019 (COVID-19) pandemic dramatically took effect on society in early 2020, the Chief Dental Officer of England announced on the 25th March 2020, that all face-to-face management of dental patients should cease with immediate effect.1 The aims of this intervention were to respect lockdown and prevent people from leaving their homes, as well as to protect patients and staff from potentially hazardous clinical environments.
The announcement led to an immediate scurry of re-writing of standard operating procedures, as dental professionals improvised to manage their patients as best as they could. Remote management was initially considered, simply to deflect patients who contacted the non-operational practices from seeking face-to-face attention. Dentists were instructed to give relevant advice over the phone, manage patients with analgesics and prescribe them antibiotics. The guidance was in line with that produced by the Scottish Dental Clinical Effectiveness Programme on Emergency Dental Care,2 and the acronym AAA was born. Since dental services started to re-open on 8th June 2020, the profession has become accustomed to a new way of practising. Working from home is a concept that could not previously have been fathomed by most in clinical dentistry, but it is likely that a place will remain for the remote management of dental patients in some instances for a number of possible reasons:
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