Although I am a dental professional by trade, I hardly find the urge to wax poetic about teeth on this, here, blog. I would much rather write incessantly about improving the world via consumer choices, lifestyle habit-shifts, creating personal awareness and harboring mental space. However, once in a while, I do feel compelled to share a bit of news in the dental sphere, and the safety of patients and dental professionals vis-a-vis the COVID-19 epidemic seems a worthy pause from my usual ramblings regarding simple living.
As a dentist working the front-lines and seeing emergency cases, it has come to my attention that a few pointers and tips could be of use to the general public regarding dental visits at this time.
It has been highly recommended by the United States government that dental professionals halt the treatment of their patients with the exception of emergency treatment. Soon thereafter, as a result of the coaxings of dental professionals across the nation, it was clarified that the referred emergencies were to be “life-threatening“. The American Dental Association (ADA) posted this clarification of terms, separating what is considered life-threatening emergency from urgent dental care. Dental non-emergency procedures are to be put on hold until further notice.
Risk of Exposure
The dental profession has the highest risk of exposure to COVID-19 due to our close proximity with patients and our dealings with the respiratory tract. The coronavirus is an airborne disease and the human airway is essentially our work office. This popularly circulating image portrays just how risky the COVID-19 epidemic is for dental professionals.
Therefore, it behooves the general public to limit dental visits to only the direst of emergencies, firstly, to preserve personal protective equipment in order to supply hospitals first, and secondly, to reduce potential exposure to staff and patients alike.
Safety Tips for Patients
For the general public, I am sure there are a lot of questions regarding going to the dentist. During this time, I know that safety is your main concern. Therefore, here are a few tips for you and your loved ones.
- Do not go to the dental office unless you have a life-threatening emergency or an urgent need (see ADA recommendations above). Initially, I was on board with the recommendation of life-threatening emergencies only, but with predicted return-to-normal dates as late as June (for example, in Oregon), I cannot say with confidence that urgent dental cases will not turn into a life-threatening emergency in the near future. With that in mind, I would prefer you see a dental professional for urgent dental needs (such as severe pain due to a rotting tooth) and let them determine whether it is best to nip the infection in the bud early on or whether it is worth risking a life-threatening emergency in the near future. Together, you guys can make a decision that is best for you.
- Do not go to the dental office if you have had any of the following within the last two weeks: Recent travel, a cough, a cold, or a fever. Please. For the safety of those in your community, do NOT go to the dental office if you can manage. Most likely, they will turn you away if any of these apply to you.
- Practice social distancing by staying six feet away from the front-desk ladies when checking in and sitting in a chair at least six feet away from another patient in the waiting room. If possible, opt to wait in your car until they are ready for you. Let the front desk know you would prefer to be alerted via text or phone call when your appointment is ready.
- Limit the number of family members who go into the dental office. Like I said before, we want to flatten the curve. Do not take the entire family with you if only one member has to be seen. In most cases, a maximum of two people should suffice (if a child needs to be accompanied by an adult). The less people we expose, the better. Your family is safer at home.
- Carry around a hand sanitizer with you. Sanitize your hands frequently and after any time you touch something (such as a doorknob to open a door).
- Ask to rinse with an anti-microbial rinse such as Listerine before and after your appointment.
- Ask the dentist if the infection can be managed with medication. Opt for the most minimally invasive treatment that will control or fix the problem for a decent amount of time. With stay-at-home mandates extended all the way to June in some states, the short-term solution or continual prescription of antibiotics may not be the best solution. I urge you to have a lengthy discussion with your dentist about the pros and cons of waiting on treatment.
- Fill out new patient forms online. With most dental offices closed, you may need to go to a new office to seek emergency care. Fill out forms online to decrease the number of paperwork and pens you have to touch while in the office. Also, this will reduce your time in the waiting room significantly.
- Do not read complimentary magazines or touch TV remotes. If there are magazines in the waiting room, do not read them. If there are TVs in the treatment rooms, ask the assistant to turn it on and turn to a channel that you prefer. Try to touch as few things as possible during your visit.
Safety Tips for Dentists
If you are a practicing dentist, it is highly likely that you do not need additional safety tips from me. I am sure you are aware of the situation and are practicing accordingly. However, for the general public, it may be helpful to see how dentists can practice in a safer environment. This list does not include the usual safety measures we take, such as sterilizing instruments and disposing of single-use items in the practice. These tips are specifically safety measures meant to combat COVID-19, which include but are not limited to the following:
- Have patients fill out and sign a questionnaire confirming that they have not traveled recently or have had any flu symptoms in the past two weeks. Additionally, confirm that the patient has not had contact with any COVID+ persons. Add a statement saying you have a right to dismiss any patient that show symptoms of a flu.
- Practice social distancing in the lobby.
- Remove magazines and kid’s toys from the waiting area.
- Ask patients to fill out forms online.
- Have patient sanitize their hands prior to entering the back office.
- Once the patient enters a treatment room, take their temperature first. Any patients with a fever must be dismissed.
- If the patient has no fever, have them rinse for 30 seconds with an anti-microbial rinse.
- All doctors, assistants, and treatment counselors should wear personal protective equipment, including N95 masks, protective eye wear, face shields, and full-length disposable gowns.
- All health professionals must wash their hands before and after seeing a patient.
- Opt for minimally invasive treatment that will give good results for a moderate period of time.
- Only focus on the chief complaint.
- Reduce the number of visits each patient must have. Opt for same-day treatment and treat multiple areas of concern instead of splitting the visits between multiple days. For example, avoid having separate appointments for the right side and one for the left side. Do both sides on the same day as the exam. The less exposure both patient and staff have, the safer everyone will be.
- Use high-vaccuum suctions during all treatment, and absolutely no ultra-sonic scalers!
- Have HEPA-filters in every room and in the waiting room.
- Check the temperatures of every staff member when clocking in for the day or returning from lunch.
- And of course, shower directly upon returning home and do not come in contact with many other friends and family members during this time, just in case you are a carrier of the virus.
The safety of the dental team is of utmost concern. A staff member testing positive for COVID would indicate the complete closure of the entire dental practice for two weeks. With most offices closed, those who are staying open must maintain their health. I work in Santa Ana and treat emergencies coming as far as Riverside. Very few offices have chosen to remain open at this time.
How Will This Affect Dentistry Moving Forward?
It’s still too early to tell but I would gander that this pandemic has, and will continue to, raise awareness as to the importance of protective measures for dentists against air-borne illnesses. Just as the AIDS movement in the early 1980s led to the use of gloves during dental treatment (I know of dentists who were of the glove-less generation…), this too would pave the future for N-95 masks and fever/flu triaging as the new norm. Tele-dentistry is also creeping into a few younger practices, and may become a new way to do examinations.
When the COVID restrictions are lifted, it is hard to say whether people will flock to the dental offices or if people will avoid the most easily-exposed professional work space.
One thing is for certain. The longer we avoid dental care, the more dental emergencies grow in number. During the first week of closure, we had one doctor working at our office to treat emergencies. In the following week, they added me as a second. The third week, there are three.
Dentistry relies heavily on preventative work. As we ignore treating dental caries that are asymptomatic, we start to see more and more cases that lead to facial swelling and severe pain. Options are slim these days, and I have never extracted more teeth in my life. Incision and drain is a continuous occurrence. We cannot continue in this way. A return to the old days of only seeing the dentist when pain arises will lead to many people losing their teeth. I think it would be catastrophic. I predict that emergency cases will exponentially rise the more we prolong regular dental care.
But for now, unfortunately, we must pick the lesser of two evils. Safety and flattening the curve is the main priority.
Following these tips can help. Make sure to call your dental provider prior to arriving at the office.