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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.
We will be starting construction in the adjacent space soon. In November 2019 we started negotiations to expand into Unit 301 next door to our office. We knew one of our biggest service problems was that we couldn't schedule patients for cleanings in a timely manner. If someone had to reschedule, we weren't able to secure an appointment for them for up to 6 months. If someone called and they were overdue for 6 months, it would be months before we could accommodate them. This is no way to treat patients. We had already expanded hours to two evenings and we didn't want to strain more time away from our families. We felt more space was the only way to allow us more flexibility and freedom to provide the care our patients deserved, as well as provide work hours and a work environment that was in the best interest of our team members. We had reached out to our neighbors in 2016 regarding their space and have been looking for commercial property since then. Over 3 years later the opportunity presented and we took it.
We signed our architect's contract in mid-January and the final lease amendments in February 1, then COVID hit us in March. Since we had already signed the lease and arrangements in November 2019 were completed contingent upon us securing unit 301, we had to proceed with our project. As of the first week of June, a third party expeditor still has our plans and a Board of Water supply backflow valve for our building’s main water line is holding us up from proceeding to final permitting. Then, we don't know how long the permit will take once plans are submitted to the City and County. We would appreciate any help! Our contractor is ready to start and through courtesy inspection we hope to initiate construction in early-mid June.
It would have been ideal for construction to start during the first 8 weeks of COVID. Unfortunately that was not the case so this means at some point over the next 1-4 months we will have to close our office and reschedule appointments again. We sincerely apologize for 2020! However, we are excited for a new setting to offer a better service experience for our patients and team members.
We were in the middle of our health challenge when COVID hit the islands. An important part of our challenge was the number of steps we complete each day. To keep up a healthy lifestyle, many of us have been getting our steps out in the sun rather than inside at work. While it is refreshing to be outdoors getting some vitamin D, protecting ourselves from the sun's radiation is important. It's also key to place lip balm with UV protection as cancer can affect our lips as well. Stay safe everyone!
Meet some of our furry friends! We have been able to spend more time with them during our time away from work. Check out our Veterinary Oral Hygiene page for basic info on caring for their teeth and gums and for links to information from veterinary dentistry professionals. Also, a quick reminder to keep xylitol away from your dogs!
Xylitol is a sugar substitute, similar to sorbitol. These ingredients are much healthier options than the usual sugar additives table sugar, high-fructose corn syrup, or fruit juice concentrates, just to name a few. Xylitol is derived from plants and tastes similar to regular sugar, but it has 40% less calories and a low glycemic index (7 vs 85-100 for regular sugar).
With most sugar additives, the bacteria on our teeth convert them to acid. This acid causes tooth decay. More sugar = more food for the bacteria = more bacteria = more acid = more tooth decay = infection causing tooth sensitivity or pain, more time spent at the dental office, and more money spent on dental care. Xylitol can break this pattern. The bacteria can't convert xylitol to acid. They can't digest it period. It's like they get food poisoning and this discomfort causes them to detach from our teeth. Bottom line: Xylitol helps protect our teeth by reducing the amount of bacteria living on it.
We recommend 5-10 grams (g) of xylitol total per day, eaten 3-4x per day to properly reduce the bacteria. Most mints including the Epic brand we have available in our office have 0.5g per piece. The Spry gum available on Amazon has 0.7g per piece, while the Epic gum we offer has 1.06g per piece. Many other gum brands now include xylitol but we don't know how much xylitol is in each piece. Most of the Dr. John's candies and chocolates have 1g per piece. If you use granular xylitol sweetener for cooking or baking, 1 tsp = 4g of xylitol.
Please limit to no more than 20g total per day to avoid stomach problems and diarrhea. Also, KEEP AWAY FROM DOGS as it is very poisonous for them.
Let's fight tooth decay by complimenting your dental care with xylitol!
We offer the Epic brand gums and mints in our office. It is an all natural product with a good dose of xylitol per piece. With Epic's help, we are able to price it below Epic or Spry brand products on Amazon even if you have Amazon Prime free shipping and the Amazon Prime 5% back credit card. Note: If you have Amazon Prime, the Amazon Prime 5% cash back card, and subscribe and save to 5 or more products on Amazon, then it may be better to purchase from Amazon. Please let us know if you would like us to order larger quantities for you (such as the 500 or 1000 piece bags).
Dr. John's offers amazingly tasty sweet snacks made with xylitol. No guilty feelings eating these!
Try adding Xylitol when cooking, such as in smoothies. Dr. Blake also adds cacao powder (antioxidants and taste) and chia seeds (calcium, proteins) to his smoothies.