Flattening the Coronavirus Curve - Dimensions Students

To combat spread of the coronavirus, we are told to stay home, practice social distancing, wash our hands, and avoid touching our faces. Those who can may work from home. But what about dental offices? Because it would be impossible to deliver dental care at a 6-foot distance, on March 16, the American Dental Association took the unprecedented step of calling on dentists across the nation to postpone all elective procedures, focusing only on emergency cases for the time being. This action is designed to help limit the spread of COVID-19, and alleviate the burden on hospital emergency departments.

EMERGENCIES ONLY

But let’s say you have a patient requiring emergency dental care. This might be a good time to use teledentistry. This kind of long-distance treatment may be adequate, at least temporarily, to address a patient’s concerns. But for office visits, the standard infection control practices should be deployed. This includes the use of appropriate personal protective equipment (PPE), and adherence to strict sterilization protocols for equipment, instruments, and cleaning and disinfection of all surfaces, using hospital-grade disinfectants. Use of single-use instruments would be prudent. Asking patients to use an antimicrobial oral health rinse before beginning treatment is also a good idea.

Additionally, patients should be asked about their recent travel history and screened for signs of infection, including fever. During treatment, rubber dams and high-speed evacuation for procedures that produce aerosols should be used. Handpieces should be autoclaved between patients.

Patients should be kept at least 6 feet apart and should rinse with 1.5% hydrogen peroxide prior to appointments to reduce the oral microbial load. Patients might also wait in their cars until the operatory is ready for them.¹

COVID-19 PROTECTION

But what if that patient needing urgent care has a suspected or confirmed case of COVID-19? In such an event, the ADA recommends that the patient be masked to minimize transmission of respiratory droplets and placed in a single room. Practitioners should wear masks, face shields, eye protection, and respirators when in the room with such patients. Oral healthcare and medical providers may work together to keep the disease spread potential to a minimum. This may require that treatment take place in a medical rather than dental facility.¹

The US Centers for Disease Control and Prevention (CDC) recommends the use of disposable N95 respirators for clinicians when treating infected patients. Capable of filtering 95% of airborne particles, they offer greater protection against smaller airborne particles than do masks—and the coronavirus is tiny. If dental team members elect to wear N-95 respirators, they must be properly fitted per CDC recommendations. But first they must be found.²

As of this writing, N95s are in short supply. Dentists are being asked to donate theirs to medical facilities. In fact, it’s gotten to the point that healthcare workers are resorting to reusing single-use masks and wearing homemade masks. The CDC has determined that the latter, though not considered PPE, may be used as a last resort. They can also help extend the life of N95 masks.³

On March 27, the ADA and other health organizations signed a public statement urging the federal government to accelerate its efforts to increase production and distribution of PPE during the pandemic. To help keep yourself and your staff safe, visit cdc.gov, ada.org , nih.gov, and osap.org for the latest updates on this rapidly changing situation.