A longer, more detailed version from Dr. Lisa Musgrave to her patients:
To my valued patients,
I started to write an update about our office several times this weekend. I deleted each attempt because the information coming in changes so rapidly and is completely different depending on the source.
As of Friday, March 13, 2020, the American Dental Association (ADA) recommended that we only make a few changes in our dental offices, including giving patients 1% hydrogen peroxide to rinse with, taking every patient’s temperature, screening patients for COVID-19 symptoms and asking patients about their travel history. As of March 16, 2020, the ADA is now urging dentists to postpone elective procedures and only treat emergencies for the next three weeks.
While the ADA, the CDC (Centers for Disease Control and Prevention) and the MDA (Michigan Dental Association) are all important sources of information for guidelines and recommendations, I have found they are typically a week behind in putting measures into place to support the latest research emerging from sources like The Journal of Dental Research and the actions put into place by the state dental schools. In slowing the spread of this virus, a week is critical time.
The Governor also issued an executive order as of Saturday, March 14, 2020, that stated:
“Beginning on March 14, 2020 at 9 am, and continuing through April 5, 2020 at 5 pm, all health care facilities, residential care facilities, congregate care facilities, and juvenile justice facilities must prohibit from entering their facilities any visitors that are not necessary for the provision of medical care or the support of activities of daily living, or that are not visiting under exigent circumstances, such as grave illness or imminent death of a family member under care in the facility.”
There has been a lot of controversy amongst dental professionals as to whether “health care facilities” includes dental offices and the Governor has not yet responded to my inquiry.
I have been relying on many evidence-based resources for the latest information to keep my patients, my team and our community safe. The Journal of Dental Research stated, on Thursday, March 12, 2020, that, “Due to the unique characteristics of dental procedures where a large number of droplets and aerosols could be generated, the standard protective measures in daily clinical work are not effective enough to prevent the spread of COVID-19, especially when patients are in the incubation period, are unaware they are infected, or choose to conceal their infection.”
“The use of personal protective equipment, including masks, gloves, gowns, and goggles or face shields, is recommended to protect skin and mucosa from (potentially) infected blood or secretion. As respiratory droplets are the main route of transmission, particulate respirators (e.g., N95 masks authenticated by the National Institute for Occupational Safety and Health or FFP2-standard masks set by the European Union) are recommended for routine dental practice.” N95 masks and gowns are all backordered and unavailable at this time.
So, for now, some of you may think I am being overreactive, but based on the science and current evidence that our historical universal precautions are not a safe guarantee against COVID-19, I am choosing to close our office until Monday, April 6, 2020. As of today, Sunday March 15, 2020, the MDA and the regional district dental society and other dental offices have not yet made the same decision.
I am always available by telephone or email if you have questions or concerns or are seeking dental advice that I can give remotely. I have networked with other dentists in our state to try to make a list of offices that may have more protective measures in place (N95 masks, etc.) for true dental emergencies.
As a patient, you have the right to a safe environment, and I would much rather be safe and proactive than reactive. Politics aside, it is evident that social distancing is the number one preventative method for slowing the spread of this virus so we do not overwhelm our hospitals. Dentistry has ALWAYS been at the forefront of preventative measures. I’d like it to stay that way.
Dr. Lisa Musgrave and Team