“We always used surface disinfectants, but we have to be particularly meticulous about it now. We are recommending that when aerosols are being created that dentists use higher suction and filtration devices.”
PRESIDENT OF THE NEW MEXICO DENTAL ASSOCIATION
It’s way more complicated than scraping, cleaning, drilling, filling and pulling.
Dentistry in a COVID-19 world has to give considerable attention to the use of high-tech suction devices, face shields, protective gowns, room fogging, air filters, intensive surface sanitizing, laser thermometer readings, social distancing and plastic partitions.
“And it’s probably going to be this way for the foreseeable future,” said Albuquerque dentist Tom Schripsema, president of the New Mexico Dental Association.
Because the coronavirus is a respiratory illness, dentists have to take special precautions because of the amount of aerosols released from tooth drilling and high-pressure water sprays, he said.
The Centers for Disease Control and Prevention has come out with a list of safety precautions that dentists can follow.
“I don’t think their expectation was that every office would do every one of those things, but that some combination of those things would create a safe situation,” Schripsema said.
“We’ve been operating without a lot of research, and most of the recommendations have been based on other viruses and protocols we’ve used for other diseases.”
The assumption for the moment is that aerosols can remain in the air for anywhere from 10 minutes to two hours, and that the COVID-19 virus can easily be riding in that aerosol mist, and will eventually settle on surfaces along with the mist, he said.
“We always used surface disinfectants, but we have to be particularly meticulous about it now. We are recommending that when aerosols are being created that dentists use higher suction and filtration devices,” Schripsema said.
He expects to see dentists, dental assistants and dental hygienists using face shields for nearly every procedure, in addition to face masks.
The situation with COVID-19 is not totally new.
“We went through it in the 1980s with HIV,” Schripsema said. “We went from not using gloves and masks at all to using them routinely.”
Aerosols were always a concern, but the current pandemic has amplified that, said dentist Michael Armijo of Northtowne Dental, 5900 Cubero NE.
During Armijo’s career, dentists have had to deal with the possibility of exposure to HIV, various types of hepatitis, ebola, hantavirus, SARS, MERS, swine flu and bird flu.
“I live in the virus world every day,” he said.
To help contain aerosols and eliminate as much as possible the spread of any viruses, Armijo is using a high-tech suction device or intra-oral negative vacuum called the Isolite. It contains a soft and flexible mouthpiece and a light to illuminate the mouth from the inside and to suction aerosols before they leave the mouth. The mouthpiece is designed to keep the tongue and cheeks out of the way while providing ample room for Armijo to work on the teeth.
He also uses an external vacuum unit that draws in air exhaled by a patient via a snorkel placed close to the patient’s face. The air is then processed through a high energy particulate absorbing, or HEPA, filter, a plasma arc lamp and an ultraviolet light before the air exits the vacuum.
All these high-tech devices are expensive, particularly if a dentist has one in each treatment room. And then there is the cost of personal protection equipment.
“We’ve seen the cost of disposable face masks go from 90 cents to up to $5 or $6 per mask,” Armijo said.
Some dental offices are now adding a fee to cover the cost of PPE, although depending on how insurance policies are written the cost can not always be passed on to the patient.
Rio Rancho dentist Kirk Wondra uses many of the high-tech machines to curb aerosols and to sterilize his treatment rooms.
Like most dental practices, he has seen a decline in patient visits because of COVID-19 at Wondra Dental, 701 Broadmoor in Rio Rancho. Wondra estimates his business is down about 30%.
And like most dentists, he has adopted strict protocols to maintain social distancing and safety for his staff and his patients.
“Before patients even come in to the office, we screen ourselves, take temperatures of all the employees and make sure no one is showing any signs of having COVID-19. If they are, then they’re sent home,” he said.
Patients are screened at home via telephone prior to their visit, and are rescheduled until they are symptom free or test negative. When they do come for their appointment, they must wear a mask and are again asked screening questions and have their temperatures taken. They are then ushered into a side door of the practice and taken directly to a treatment room, bypassing the waiting area.
Wondra’s office is big enough so that he is able to keep adjacent treatment rooms vacant. When patients’ visits are over, they leave through the front door, an additional measure to prevent those who are arriving and those who are departing from coming in contact with one another.
In addition to face masks, Wondra, his dental assistants and hygienists wear washable gowns that go past their knees and tie in the back. These are changed after treating each patient where aerosols are generated, he said.
They also wear a surgical cap, an N95 respirator mask covered by a disposable mask to protect the N95 from blood splatter, and a plastic face shield.
Strict protocols are then followed for sanitizing all dental tools and treatment rooms, which include the use of a sanitizing room fogger.
“We’re seeing fewer patients, but we’re doing more dentistry while each patient is in the chair, which takes longer to treat each patient but also means we can eliminate some future visits,” Wondra said.
Even if a vaccine against COVID-19 is developed, or as more populations develop herd immunity against the virus, Wondra said the pandemic has changed the way dentistry will be practiced.
“This is definitely the way things will be done into the future,” he said, “at least for quite a while.”