Share this Post
On March 16, the American Dental Association (ADA) issued the following statement:
“The American Dental Association recognizes the unprecedented and extraordinary circumstances dentists and all health care professionals face related to growing concern about COVID-19. The ADA is deeply concerned for the health and well-being of the public and the dental team. In order for dentistry to do its part to mitigate the spread of COVID-19, the ADA recommends dentists nationwide postpone elective procedures for the next three weeks. Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments. As health care professionals, it is up to dentists to make well-informed decisions about their patients and practices."
Various local dental societies have issued statements echoing these recommendations. It is unlikely these limitations will be lifted any time soon.
Coronavirus has a global reach. It is in more than 200 countries and all 50 states, causing unprecedented havoc in every phase of our lives. Aggressive steps at containment changed to mitigation, but escalating deaths are grim recognition of the pandemic. Researchers and clinicians are racing to come up with a solution, with more than 50 drugs being investigated clinically.
COVID-19, the disease caused by SARS-CoV-2, is highly contagious with a rapid velocity of transmission. The disease appears to have a fatality rate that is lower than its predecessors, SARS-CoV-1 and MERS-CoV-2, and the majority of fatalities are in elderly patients and patients with pre-existing underlying chronic diseases such as cardiovascular disease, diabetes mellitus, hypertension and chronic obstructive pulmonary disease. However, there are innumerable young and healthy patients succumbing to the disease, heightening fear.
In 80% of cases, COVID-19, particularly in young, healthy patients, is mild and those affected have symptoms similar to the cold or flu. In 15% of cases, development of progressive respiratory symptoms may necessitate hospitalization. In 5% of cases, patients become critically ill and require intensive care unit support. The overall fatality is estimated to be about 2%.
The modes of transmission include droplets, surface contact, fecal-oral route and aerosolization during procedures. Increasing prevalence of asymptomatic carriers and transmission by asymptomatic carriers have been reported.
Although vaccines have been developed at a warp-speed pace in the United States, Israel, Queensland and China, it is expected to take too long for the vaccines to be deployed during this epidemic because of the need for safety testing and clinical trials. Clinical trials with antiviral agents such as remdesivir, chloroquine, hydroxychloroquine, hyperimmune globulin, convalescent blood, stem cell therapy and others are in place and will hopefully help the development of effective therapeutic agents.
As of now, the best protection for dental professionals is a heightened sense of awareness, avoiding unnecessary contact with patients who may have coronavirus, use of appropriate personal protective equipment, and increased attention to personal hygiene.
Recommendations continue to be predicated upon information that arises daily. You should be mindful of the situation in your local community and the continuing evolution of the disease globally.
We are aware of the risk to health care workers from the data coming out of Wuhan, China. Of the initial 44,672 cases, 3,019 (6.75%) were health workers and seven have died as of February 11. With increasing awareness and the uniform adoption of personal protective equipment, the risk has decreased progressively in Hubei.
Dental professionals are particularly at risk if working on an infected patient or an asymptomatic carrier because of the close contact with the patient and the risk of blood, saliva and droplet exposure. In Italy, seven dental professionals died of COVID-19 during the pandemic.
Currently, a fair number of dental offices have closed, but there are offices that continue to address dental emergencies. It is critical for those offices to take extra precautions during this period.
The CDC Recommendations are designed for all health workers. Because of the unique situation dental professionals are in, I have made modifications to tailor the recommendations.
The most important difference between medical and dental professionals is a great deal of dentistry can be deferred to a later time, whereas medical professionals are obligated to see patients when they are sick. The modifications to the recommendations have been made to minimize the likelihood of contact with an infected patient and to minimize disease transmission.
The CDC, the ADA, the Occupational Safety and Health Administration (OSHA) and the Academy of General Dentistry (AGD) have all made recommendations for dental professionals. The following is a culmination of these recommendations with the eye toward addressing important practical issues including:
We have made modifications to reflect the circumstances unique to dentistry.
This is an airborne infection that can be borne by asymptomatic or pre-symptomatic carriers. Respiratory precautions are of paramount importance.
While there are several parts to the recommendations, it is critical to go out of your way to ensure patient safety and the safety of yourself and your staff. Your attention to detail will reflect well on the practice. Lapses can result in unwarranted infection with a virus that can be deadly.
The Overarching Question
Prior to Patient Arrival
When Patients Arrive
It is important to stress that even with all these precautions, an infected patient might still slip through, particularly with the increasing awareness of asymptomatic or pre-symptomatic patients. It is therefore important to take every precaution possible to protect the office and staff.
The hope is to optimize ventilation in the operatory. Ideally, air exchange of the operatory six times an hour during operating hours minimize issues with undue exposure.
There are offices considering HEPA (high-efficiency particulate air) systems with ultraviolet light units. This is an expensive proposition but is probably of help.
Air purifiers with UV-C lamps will help with aerosolized pathogens and are visible cues in the operatory reminding patients you are indeed attentive to air quality.
Because the coronavirus can live on surfaces for 24 hours+, it is important to keep all surfaces clean and sanitized. While this pertains to the waiting room, the bathroom, all common areas and the front desk, it is particularly important to disinfect the operatory as frequently as is feasible.
Common cleaners such as 0.1% sodium hypochlorite, 0.5% hydrogen peroxide or 62-71% ethanol have all shown to be effective.
Hypochlorous acid is a popular cleaning agent for the operatory because it evaporates from the surface without wiping.
Good hand hygiene is the most important protection for dentists and their staff:
Dental Professional and Staff
During this period of heightened concern, all members of the office and patients should wear surgical masks.
Dental professionals are used to working with a mask, gown and gloves on. Because the coronavirus can be aerosolized with procedures, conventional surgical masks are not adequate. Depending on potential exposure, the dental professionals and staff should use:
Front Desk Staff
Full contact and respiratory precautions should be in place including deployment of:
The recommendations outlined are subject to change as the clinical scenario evolves. However, they are certainly reasonable cornerstones to help dental professionals navigate these troubled times.
Leslie S.T. Fang received his PhD degree in Physiology and Biophysics from the University of Illinois, Champaign-Urbana. He did his medical training at Harvard Medical School and completed his residency training at the Massachusetts General Hospital. He maintains an active practice in Internal Medicine and Nephrology and is a teacher at Harvard Medical School. He is the co-author of the textbook Principle and Practice of Oral Medicine and Oral Medicine Secrets and of an interactive DVD on Antibiotics in Dentistry in the EndoMagic Interactive Teaching Series. His chairside resource, “The Ultimate Cheat Sheets,” was voted the Best Product of 2008-2015 by Clinicians Report and is now designated a Classic in Educational Product.
With four locations in the United States and Canada, Open Health® is providing medical-grade PPE and COVID-19 testing swabs to healthcare professionals....
There are a variety of ways to manage high-priced PPE without impacting your bottom line....
Social media can be a powerful tool, and you don’t have to be an “influencer” to benefit....
SSC gives dentists the opportunity to gather in small groups to collaborate with and learn from each other—and Dr. Cohen has found ways to keep members connected even during the coronavirus pandemic....
By providing emergency dental treatment, we have the power to keep patients away from our overcrowded emergency rooms. But if we choose to offer this service, we have to be smart....
Selling your practice to a DSO isn’t the answer. Instead, it’s time to work with other small practices to scale and ultimately survive this crisis....
Practical recommendations for the dental professional...
Virtual consults should be used to offer transparency and to build connections with patients, especially now....
Two dentists share letters they’ve sent to patients about the crisis and the need to shut their practices down....
Learn how to win at the game of dentistry. Your professional life can be likened to playing a game. In fact, many professionals intentionally use the game analogy in their approach to their businesses....
Why it’s so important to find root fractures before endodontic treatment, and how to do it....
Use cognitive, conative and affective traits to find the perfect candidate for your practice....
On March 16, the American Dental Association (ADA) issued the following statement:
“The American Dental Association recognizes the unprecedented and extraordinary circumstances dentists and all health care professionals face related to growing concern about COVID-19. The ADA is deeply concerned for the health and well-being of the public and the dental team. In order for dentistry to do its part to mitigate the spread of COVID-19, the ADA recommends dentists nationwide postpone elective procedures for the next three weeks. Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments. As health care professionals, it is up to dentists to make well-informed decisions about their patients and practices."
Various local dental societies have issued statements echoing these recommendations. It is unlikely these limitations will be lifted any time soon.
Coronavirus has a global reach. It is in more than 200 countries and all 50 states, causing unprecedented havoc in every phase of our lives. Aggressive steps at containment changed to mitigation, but escalating deaths are grim recognition of the pandemic. Researchers and clinicians are racing to come up with a solution, with more than 50 drugs being investigated clinically.
COVID-19, the disease caused by SARS-CoV-2, is highly contagious with a rapid velocity of transmission. The disease appears to have a fatality rate that is lower than its predecessors, SARS-CoV-1 and MERS-CoV-2, and the majority of fatalities are in elderly patients and patients with pre-existing underlying chronic diseases such as cardiovascular disease, diabetes mellitus, hypertension and chronic obstructive pulmonary disease. However, there are innumerable young and healthy patients succumbing to the disease, heightening fear.
In 80% of cases, COVID-19, particularly in young, healthy patients, is mild and those affected have symptoms similar to the cold or flu. In 15% of cases, development of progressive respiratory symptoms may necessitate hospitalization. In 5% of cases, patients become critically ill and require intensive care unit support. The overall fatality is estimated to be about 2%.
The modes of transmission include droplets, surface contact, fecal-oral route and aerosolization during procedures. Increasing prevalence of asymptomatic carriers and transmission by asymptomatic carriers have been reported.
Although vaccines have been developed at a warp-speed pace in the United States, Israel, Queensland and China, it is expected to take too long for the vaccines to be deployed during this epidemic because of the need for safety testing and clinical trials. Clinical trials with antiviral agents such as remdesivir, chloroquine, hydroxychloroquine, hyperimmune globulin, convalescent blood, stem cell therapy and others are in place and will hopefully help the development of effective therapeutic agents.
As of now, the best protection for dental professionals is a heightened sense of awareness, avoiding unnecessary contact with patients who may have coronavirus, use of appropriate personal protective equipment, and increased attention to personal hygiene.
Recommendations continue to be predicated upon information that arises daily. You should be mindful of the situation in your local community and the continuing evolution of the disease globally.
We are aware of the risk to health care workers from the data coming out of Wuhan, China. Of the initial 44,672 cases, 3,019 (6.75%) were health workers and seven have died as of February 11. With increasing awareness and the uniform adoption of personal protective equipment, the risk has decreased progressively in Hubei.
Dental professionals are particularly at risk if working on an infected patient or an asymptomatic carrier because of the close contact with the patient and the risk of blood, saliva and droplet exposure. In Italy, seven dental professionals died of COVID-19 during the pandemic.
Currently, a fair number of dental offices have closed, but there are offices that continue to address dental emergencies. It is critical for those offices to take extra precautions during this period.
The CDC Recommendations are designed for all health workers. Because of the unique situation dental professionals are in, I have made modifications to tailor the recommendations.
The most important difference between medical and dental professionals is a great deal of dentistry can be deferred to a later time, whereas medical professionals are obligated to see patients when they are sick. The modifications to the recommendations have been made to minimize the likelihood of contact with an infected patient and to minimize disease transmission.
The CDC, the ADA, the Occupational Safety and Health Administration (OSHA) and the Academy of General Dentistry (AGD) have all made recommendations for dental professionals. The following is a culmination of these recommendations with the eye toward addressing important practical issues including:
We have made modifications to reflect the circumstances unique to dentistry.
This is an airborne infection that can be borne by asymptomatic or pre-symptomatic carriers. Respiratory precautions are of paramount importance.
While there are several parts to the recommendations, it is critical to go out of your way to ensure patient safety and the safety of yourself and your staff. Your attention to detail will reflect well on the practice. Lapses can result in unwarranted infection with a virus that can be deadly.
The Overarching Question
Prior to Patient Arrival
When Patients Arrive
It is important to stress that even with all these precautions, an infected patient might still slip through, particularly with the increasing awareness of asymptomatic or pre-symptomatic patients. It is therefore important to take every precaution possible to protect the office and staff.
The hope is to optimize ventilation in the operatory. Ideally, air exchange of the operatory six times an hour during operating hours minimize issues with undue exposure.
There are offices considering HEPA (high-efficiency particulate air) systems with ultraviolet light units. This is an expensive proposition but is probably of help.
Air purifiers with UV-C lamps will help with aerosolized pathogens and are visible cues in the operatory reminding patients you are indeed attentive to air quality.
Because the coronavirus can live on surfaces for 24 hours+, it is important to keep all surfaces clean and sanitized. While this pertains to the waiting room, the bathroom, all common areas and the front desk, it is particularly important to disinfect the operatory as frequently as is feasible.
Common cleaners such as 0.1% sodium hypochlorite, 0.5% hydrogen peroxide or 62-71% ethanol have all shown to be effective.
Hypochlorous acid is a popular cleaning agent for the operatory because it evaporates from the surface without wiping.
Good hand hygiene is the most important protection for dentists and their staff:
Dental Professional and Staff
During this period of heightened concern, all members of the office and patients should wear surgical masks.
Dental professionals are used to working with a mask, gown and gloves on. Because the coronavirus can be aerosolized with procedures, conventional surgical masks are not adequate. Depending on potential exposure, the dental professionals and staff should use:
Front Desk Staff
Full contact and respiratory precautions should be in place including deployment of:
The recommendations outlined are subject to change as the clinical scenario evolves. However, they are certainly reasonable cornerstones to help dental professionals navigate these troubled times.
Leslie S.T. Fang received his PhD degree in Physiology and Biophysics from the University of Illinois, Champaign-Urbana. He did his medical training at Harvard Medical School and completed his residency training at the Massachusetts General Hospital. He maintains an active practice in Internal Medicine and Nephrology and is a teacher at Harvard Medical School. He is the co-author of the textbook Principle and Practice of Oral Medicine and Oral Medicine Secrets and of an interactive DVD on Antibiotics in Dentistry in the EndoMagic Interactive Teaching Series. His chairside resource, “The Ultimate Cheat Sheets,” was voted the Best Product of 2008-2015 by Clinicians Report and is now designated a Classic in Educational Product.
There are a variety of ways to manage high-priced PPE without impacting your bottom line....
With four locations in the United States and Canada, Open Health® is providing medical-grade PPE and COVID-19 testing swabs to healthcare professionals....
Social media can be a powerful tool, and you don’t have to be an “influencer” to benefit....
The CareCredit credit card can help patients accept recommended care. CareCredit is a Synchrony solution, the largest provider of private label credit cards in the U.S....
