COVID-19 and Dentistry
What a challenging first half of 2020. Thank you to all of the individuals and organizations who have extended a helping hand to others as we navigate through these uncertain times. Dental procedures have stirred concerns due to aerosols created by high-speed handpieces (mostly used for fillings and crowns) and ultrasonics (also know as cavitrons, which may be used during dental cleanings). We’d like to share how we are addressing our delivery of care. Please visit our COVID-19 Page for additional information:
Prior to COVID-19, the CDC and ADA had established infection control guidelines for dental offices due to the risk of exposure to infectious diseases such as Hepatitis, HIV, MRSA, Influenza, TB, Legionella, Herpes, E. coli, Measles, Coxsackievirus, and others. These guidelines included sterilization monitoring and testing, waterline treatment, written policies and procedures with annual third party training and review, sharps handling and disposal, PPE use, and many other guidelines (The CDC Summary is a 17 page checklist). Studies show the transmission of infectious diseases such as HIV, TB and Hepatitis in a dental office is extremely rare (zero to very minimal documented cases worldwide), especially in the post-PPE era of dentistry (yes, there was a time dentists didn’t use gloves!). Despite exposure to pathogens a daily basis, dentists and hygienists do not get sick more often that other workers. According to the US Bureau of Labor Statistics, the dental industry rate of illness or injury is ranked #981 out of 1046 occupations. The respiratory illness rate is ranked #287 our of 1122 occupations, and the median days of work missed per year by dental hygienists is tied for #580 out of 1126 occupations (https://www.bls.gov/iif/soii-data.htm). It is likely that the pre-COVID infection control guidelines set by the CDC and ADA have been effective in helping to protect patients and dental providers from existing infectious diseases.
What about COVID-19?
While dentists already had strategies in place to protect against aerosolized diseases such as TB, measles, and influenza, COVID-19 is a new disease with no vaccine and appears to be highly contagious. Its R0 or basic reproductive number (measure of how contagious a pathogen is, a higher number means more contagious) is thought to be between 1.5-3.5 but has been reported as high as 5.7 (SARS was 3, H1N1 at 1.5, seasonal influenza at 1.28, measles at 12-15).
To defend against the spread of COVID-19, the CDC and ADA have established additional guidelines such as: We screen patients and dental workers with questionnaires and temperature checks daily. We also practice physical distancing, require facemasks to be worn in the office, use a hydrogen peroxide based pre-rinse, and increased the frequency of disinfection of non-clinical surfaces such as light switches, doorknobs and counters. We installed acrylic splash guards and HEPA air purifiers, use additional PPE including respirators with custom fit 3-D printed frames, as well as use pre-cautions like rubber dams, intraoral and extraoral suction devices. Please visit our website for additional information.
Our team prepared for one week with virtual and live training and rehearsals with our new precautions. Combined with the continued decline of active COVID cases in Hawaii, we felt comfortable and confident to phase our reopening beginning on May 11th to provide dental services in accordance with Governor Ige’s and the Hawaii Dental Association’s recommendations to do our part to help maintain the health of our community. Although we do not know much about COVID-19 at this time, the virus does seem to more adversely affect those with underlying health conditions. Inflammatory mediators and pathogens can spread from our mouth to the rest of our body which is why it is especially important to defend against bleeding gums through proper dental care. Dentists also look for signs of sleep apnea in kids and adults which can have significant affects on our overall health.
We sincerely apologize to our patients we had to reschedule. Our hygienists have reviewed our COVID Reschedule list and we have prioritized rescheduling patients most at risk for periodontal (gum) disease. As COVID permits, we will continue to increase our availability to help accommodate other patients on our list. Hygienists will continue to work extra hours including Saturdays and our dentists will continue to be providing cleanings to help our patients. Thank you so much for your understanding. Our community of patients, team members, and vendors have been so supportive and it has been a joy to see everyone in person again.
New PPE Procedures
As part of our efforts to defend against COVID-19, our entire team will be wearing facemasks in the office. Team members involved with clinical care including dentists, hygienists, and clinical assistants will be greeting patients already in our gowns, respirators and facemask frames. Eye glasses, dental loupes and face shields may be placed after our initial greeting. However, we still recognize that not seeing our faces may provide an impersonal experience. We truly apologize and we hope this doesn’t become the new normal.