How Dentists are Cautiously Emerging from the COVID-19 Crisis

In March 2020, the American Dental Association (ADA) recommended that dentistry practices close to all procedures except emergencies. This quickly was extended through April and into May. Of course, these closures greatly impacted dental practices and the business of caring for their patients. The challenge was made more difficult by the fact that most jurisdictions did not consider dentists to be front-line personnel. According to a statement by the ADA, only as recently as May 21 did the Federal Emergency Management Agency (FEMA) raise dentists to fourth on their PPE priority list. For many of the nation’s 200,000+ dentists, this prolonged shutdown resulted in having to furlough staff, dental assistants, hygienists and receptionists.

Now, as states are beginning to allow dentists to reopen, a new challenge has emerged: how to conduct business in close proximity to patients while providing a safe environment for both staff and patients alike.

What Steps Should You Take?

There are a number of stories of dentists struggling to reopen while balancing uncertainties like safety, patient needs and operating costs. Many are realigning their offices to address new and stricter health and safety guidelines. And, given the unique nature of even routine dentistry involving wide sprays of respiratory particles, dentists are employing an array of protective precautions in an attempt to provide the safest healthcare environment possible, including:

• Having staff and patients wear masks at all times
• Limiting the number of patients per day – giving enough time between patients to adequately clean the areas in
  use
• Limiting the number of people in waiting rooms
• Testing staff for COVID-19
• Screening patients by phone a day or two ahead of the appointment for any sign of illness
• Checking for fever at the clinic entrance
• Adding plastic screens at the front desk
• Adding more distance between waiting room chairs
• Adding curtains in the operating area

What about Airborne Threats?

The Centers for Disease Control and Prevention (CDC) has provided detailed background on the airborne threat facing dental clinics and included guidelines for reference. From the CDC web site’s “Guidance for Dental Settings”:

Regarding the Transmission of COVID-19

SARS-CoV-2, the virus that causes COVID-19, is thought to be spread primarily through respiratory droplets when an infected person coughs, sneezes, or talks. Airborne transmission from person-to-person over long distances is unlikely. However, COVID-19 is a new virus, and we are still learning about how it spreads and the severity of illness it causes. The virus has been shown to persist in aerosols for hours, and on some surfaces for days under laboratory conditions. COVID-19 can be spread by people who are not showing symptoms.

Regarding the Risks in a Dental Setting

The practice of dentistry involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. Surgical masks protect mucous membranes of the mouth and nose from droplet spatter, but they do not provide complete protection against inhalation of airborne infectious agents.

In May, the ADA hosted a webinar to warn colleagues that “current research suggests the coronavirus might linger as aerosols, smaller respiratory droplets not heavy enough to fall from the air. If it does, spray from one procedure could mean leaving infected particles in the air for the next procedure, threatening the safety of multiple patients.”

They recommended that dental practices take protective measures including air purifiers, and well-directed heating and
cooling systems.