COVID Inspired Infection Control

The dental industry has always been a risk for exposure to infectious diseases due to the close proximity of people to each other and the sharp instruments used during procedures. Diseases such as Hepatitis B, HIV, MRSA, TB, Herpes, influenza and Legionnaires are just some of the infectious diseases that dental offices have been protecting against with existing infection control procedures recommended by the CDC and OSHA.

COVID has recently highlighted airborne transmissible diseases such as influenza, TB and measles within dentistry.  There are very little studies or documented cases of transmission in a dental setting of airborne or even bloodborne diseases (even pre-PPE days). There is also very limited information detailing transmission protocols in other highly confined areas with close proximity to others such as airplanes, movie theaters, or screaming fans in sports or music venues. This lack of knowledge suggests we still have a lot to learn about airborne transmissible diseases and how to properly protect against them without living in fear or severely hindering our innate human need for social interactions. There is no denying the reality of COVID and that certain dental procedures create a lot of aerosols, so we wanted to share some strategies we have put in place to help protect the well-being of our patients and ourselves:

According to the CDC's hierarchy of controls for infectious diseases (1), the most effective control is to keep the disease out of the office. This is done by screening patients and making the necessary medical referrals if needed. As dental professionals, we are not licensed to practice medicine so testing, diagnosis and treatments must be done by a medical professional.

Engineering controls are actual strategies put in place to remove a hazard at the source, as compared to intangible administrative policies. Regarding pre-existing infectious diseases, some examples include properly disposing of sharps and needles, ultrasonic cleaning with enzymatic solutions prior to autoclave sterilization, or treating water and suction lines.

COVID requires treatment beyond surfaces and instruments. Our aerosol controlling strategies for a patient that has passed screening include: Pre-rinse with 1.5% hydrogen peroxide rinse, rubber dam or Isodry isolation devices, intraoral suction devices, extraoral HEPA suction equipment, HEPA air purifiers, HEPA HVAC filters, ionizers in the HVAC units, UV air purifiers, and proper technique by dental assistants with HVE suction.

PPE protection is the least effective defense against transmission according the hierarchy of controls. We request all patients to wear their facemasks while in the office, and to wear eye protection during procedures. Our team members are equipped with KN95 respirators as N95 respirators are on back-order and we don't expect our shipment to arrive for months. We scanned their faces and custom 3D printed frames that fit so well it makes it tough to breath even through our Level 3 surgical masks, and seal is the most important aspect of a facemask. Faceshields, gowns, donning and doffing training are other strategies in place.

Please note, your dentists and hygienists will enter with their PPE already on. Your dentist may not wear a faceshield or might remove it if we are performing a fine detailed procedure as we cannot see as well through the faceshield. Please bear with us as we are not used to working in this type of PPE that makes it hard to breathe and traps our body heat.

(1) https://www.cdc.gov/niosh/topics/hierarchy/default.html