Changes Ahead in Safety Protocol for Dentistry
Face-to-face communication along with exposure to body fluids, saliva and bioaerosols produced during routine procedures put dental clinics in one of the highest risk categories for transmission and contraction of infectious diseases. COVID-19 has given rise to both a necessity and desire for changes to safety protocol in your dental clinic in order to ensure safety for your patients, your staff and yourself. From setting the appointment to checking out, what changes will your patients notice that when they walk in the door that show them you are working hard to keep them safe? Concerned dentists across the country have been awaiting for guidance from the CDC and the ADA for protocol on COVID-19 as they prepare to reopen their practices. Here we've compiled recommendations from the CDC, the ADA, and suggestions to consider from organizations across the globe that can help you return to work prepared with improved protocol to keep your clinic as safe as possible during these unprecedented times.
Proactively Communicate to Your Patients
While you are at home wondering about what you need to do to improve safety protocols around your clinic, your patients are at home wondering about their own safety as well, and contemplating postponing that appointment they had scheduled for June. It's important to be proactive and share with your patients how much you value their safety and how hard you are working to prevent the spread of infection. Reach out to them soon with a list of your efforts and improved safety protocols that will be in place the next time they come to your practice. For a free PDF letter explaining the increased efforts for patient safety in your dental clinic, click the link below:
Setting the Appointment
When you begin setting appointments again, a questionnaire should be used to screen patients before they arrive for their appointment. These questions should include, at a minimum:
Do you have a fever or have you had a fever in the last 14 days?
Have you experienced an onset of respiratory problems, such as a cough or difficulty in breathing within the past 14 days?
In the last 14 days have you visited an area with a high amount of documented COVID-19 cases?
Have you come into contact with people with fever or respiratory problems in the past 14 days?
Have you recently participated in any gathering, meetings, or had close contact with many unaquainted people?
If you patient answered yes to any of these questions, defer the appointment for 14 days.
Office Staff Procedures
It is recommended that all dental staff be able to identify a suspected case of COVID-19. Evaluation of symptoms of COVID-19 include, but are not limited to: fever, cough or other symptoms of respiratory illness. That being said, we know that patients infected with COVID-19 can easily be asymptomatic. Therefore, outside of training your staff to ask about and look for symptoms, many other precautions and protocols should be implemented by your office staff. Examples of these changes for the office staff include:
Patients and office staff maintain a six-foot distance between one another. A barrier, sign and/or markings on the floor will help inform and remind patients of this protocol.
Face masks and gloves worn properly by the office staff personnel. Training in wearing and removing gloves is necessary for effectiveness.
Wearing a hands-free headset to answer the phone or otherwise not touching office phones to faces during calls.
Using disinfecting wipes to wipe down credit card machines and any touch screens patients come in contact with after each use.
Regularly disinfecting the rest of the office area, including keyboards, phones and all surfaces.
The Waiting Room Experience
From the moment they walk in, your patient should immediately notice your efforts to improve their safety. Consider how to make the following changes work for your clinic:
Patients wait in their car and check in via phone or text message. Alert by phone call or text message when you are ready to see them.
Only allow patients with scheduled appointments in the clinic, no friends or relatives.
Patients wear disposable shoe covers and sanitize hands upon entering your clinic.
If your patients do wait in the waiting room, remove all magazines and toys.
Increase your disinfecting procedures, especially doors and door handles and bathrooms.
Using a contact-free forehead thermometer, check the body temperature of your patient before they are led to the dental chair. If the patient has a fever or is otherwise suspected to have COVID-19, take the following actions:
defer dental treatment
give the patient a mask
refer the patient to a medical facility
Have patients perform a 1-minute swish with a chlorhexidine oral rinse upon arrival.
Increased Protocol for the Exam Room
Outside of the protocol you are already following to disinfect your exam room, increased efforts to prevent the spread of infection include:
Using a disposable plastic wrap for all chairs, tables or any other surface that may be contaminated by blood or saliva and that are difficult to disinfect. These coverings should be removed, discarded and replaced between patients.
Check your ventilation system. Contaminated air may be withheld or recycled in areas with inefficient ventilation systems.
Disinfect all surfaces with chemical germicides between each patient, as contaminated bioaerosols can settle everywhere, especially within 6 feet of the patient.
Consider using an air ionizer at night.
PPE for Dental Staff
For yourself and all of your staff involved in patient care, appropriate personal protective equipment (PPE) is recommended beyond the standard measures. If available, the highest level of PPE should be worn. This includes but is not limited to:
Gloves (wash hands before and after use, do not remove until all other PPE has been removed)
Gown (launder if reusable or dispose of after each patient)
Eye protection (preferably a face shield that covers the front and sides of the face, disinfect if reusable or dispose of after each patient)
N95 or higher-level respirator
remove and dispose of after each patient.
If the minimally acceptable amount of PPE is not available, defer dental care.
The oral cavity is a reservoir for microorganisms that can pose a risk for contamination. Increased concern over COVID-19 has brought attention to an area of dentistry that is often overlooked: routine procedures performed many times a day in your dental office produce bioaerosols that have been shown to contain up to 100,000 bacteria per cubic foot of air.
Many diseases such as tuberculosis, influenza, severe acute respiratory syndrome and COVID-19 can be transmitted during routine dental procedures via aerosolization of body fluids. There is nothing a dental office can do to prevent the creation of aerosols. Most aerosols containing infectious agents originating from the patient remain 36” around your patient's face. Further, COVID-19 remains viable in aerosols for 3 hours or more around your dental chair.
However, there are measures a dental office can take to drastically reduce harmful aerosols. Proper High Volume suction during procedures eliminates over 90% of aerosols. Several researchers have found that using High Volume Evacuation (HVE) greatly reduces aerosols and spatter generated during routine dental procedures. HVE has been proven to significantly decrease transmission of communicable diseases from patient to dental professionals through reduction of contaminated aerosolized fluids.
Using continuous suction is one way you can protect yourself, your staff and your patients from infectious particles with the VacuLUX HVE adapter from Ascentcare Dental Products. High volume isolation mouthpieces like the VacuLUX have been found to properly reduce aerosols, more so than using HVE alone. The VacuLUX connects to your existing HVE valve and Dryshield or Zyris Isolite mouthpieces to simply remove aerosols during routine procedures. It is a cost-effective solution to reducing infections aerosols around your patient.
Resources and Further Reading
This blog was originally published on April 11, 2020. Their is still much about COVID-19 we don't know and the protocols listed here are not all inclusive and while advantageous, are not guaranteed to protect you, your staff or your patients from COVID-19. For more information on COVID-19, aerosols in dentistry and how to protect your clinic, check out the following resources: