Introduction {#sec0005}
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The National Health Services (NHS) faces huge financial pressures, which will likely worsen in the current Covid-19 climate. Current guidelines relating to Oral and Maxillofacial surgery recommend increased levels of personal protective equipment (PPE) to reduce viral transmission, helping to protect patients and staff.

The aim of this project is to highlight the additional cost of this PPE to NHS services during Covid-19. As a profession it is incumbent on us to regularly review evidence in order to assess what PPE is justified at different stages of viral prevalence.

Material and methods {#sec0010}
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Data was taken retrospectively from Aneurin Bevan Healthboard to assess how many clinical procedures were carried out over a one year period. This was then multiplied by the additional cost of PPE required due to Covid-19 to estimate an overall cost. Choice of PPE was made in accordance with the latest British Association of Oral and Maxillofacial Surgeons (BAOMS) guidelines [@bib0005], [@bib0010], which recommends FFP2 masks for non-aerosol generating procedures (AGP) and FFP3 masks for AGP.

The increased PPE cost was calculated per patient, where each clinician and assistant each wore an additional surgical sterile gown and FFP2 or FFP3 mask. Increased amounts of clinical waste were also calculated, with an average increase of one bag for every 3 patients. The added cost of this disposal was also included ([Fig. 1](#fig0005){ref-type="fig"}, [Fig. 2](#fig0010){ref-type="fig"} ).Fig. 1(Left) Example of clinician wearing full PPE prior to intraoral surgery. (Right) FFP3 mask sourced from 3 M.Fig. 1Fig. 2table showing itemised PPE cost per patient.\*PPE prices correct as of June 2019.Fig. 2

The total number of patients seen per annum was calculated by multiplying the average number of patients per list (3) by the total number of lists per week (18). This equates to 2808 patients seen per year for intra-oral surgery.

Results {#sec0015}
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The added cost of PPE due to current Covid-19 guidelines totaled £11.50 per patient. Multiplied by 2808 patients the total cost of a 1-year period was £32,292.

Discussion {#sec0020}
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Guidelines from governing bodies have a widespread impact on clinicians in both primary and secondary care settings. The aim is to provide treatment whilst maximizing safety for both patients and clinicians. Cost should not be a disproportionate driving factor when guidelines are written, however the likely long term effects of Covid-19 means that this financial burden will be significant. As such, all guidelines should be founded on a strong evidence base that should be regularly reviewed though the various stages of the pandemic. This will help reduce the likelihood of unnecessary use of PPE where there is no appreciable clinical benefit, whilst improving cost efficiencies.

Conclusions {#sec0025}
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A conservative estimate of increased PPE expenditure for the forthcoming year is £32,292 for Aneurin Bevan Maxillofacial unit. This is likely to increase significantly as wholesale PPE costs rise. The expenditure is needed to reduce Covid-19 transmission whilst continuing to provide surgical treatment. To reduce this ongoing cost all must be done to help reduce viral spread ensuring normal clinical standards can return as soon as possible.

Conflict of Interest {#sec0030}
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None.

Ethics statement/confirmation of patient permission {#sec0035}
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NA.

Uncited References {#sec0040}
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[@bib0015], [@bib0020], [@bib0025].
