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5 Things RDH's are worried about when their office is opening again

If you were to think of a highly risky profession during COVID-19, it would probably be that of the dental hygienist.

Every day, dental professionals spend a lot of their time next to patients’ mouths, cleaning and polishing teeth with instruments that spray saliva all over the place. Actually, this is the main reason why the Center for Disease Control and Prevention (CDC) provided interim guidance for dental practices wishing to reopen for non-emergency dental care. These guidelines include recommendations for the provision of dental services to individuals with COVID-19 and those without, as well as updated information touching on patient management and workplace controls.  

The Department of Labor attests that dental professionals are among the workers most at risk of getting Coronavirus, ranking even above some health care workers. As if that was not bad enough, a separate study listed dental hygienists in specific, as one of the riskiest jobs more than dentists themselves. So, should this group of professionals be concerned with the ongoing reopening of practices?  

1. Concerns about the nature of their job 

It is understandable why dental hygienists are scared of returning to work this soon. For instance, hygienists are the ones who do the actual cleaning of the teeth and lots of other aerosol producing procedures. Proximity of dental hygienists to patients is an issue in the new normal of dentistry.

Some few weeks ago, the president-elect Texas Dental Hygienist Association, Janessa Bock, said their main concern in regard to returning to work was the fact that, in a dental office setting nearly everything generates aerosol. Aerosols that, some experts claim can remain in the air even for two hours! 

Kyra Reames, an RDH in the River Valley, also thinks that resuming elective dental care at this moment puts everyone’s health at risk — especially taking into account the nature of their jobs. “I wouldn’t have my mom, or my husband, or child in my chair at 5 o’clock after having so much still left unknown about this virus,” she says.

Bock and Reames represents the opinions and fears of many hygienists. However, regardless of the safety concerns, they are still being asked to report back to work.

As a hygienist who is well aware of the occupational risks you are exposed to, what can you do differently? Evidence suggests that the COVID-19 virus can even spread between asymptomatic individuals. Meaning that, people could still visit your dental office feeling okay, without being aware they are carrying the virus. Do you have any training to handle such cases?  

The American Dental Hygienists’ Association has at least, called on governors who are encouraging reopening of practices, to ensure that hygienists have plenty of access to protective wear.  But is this enough?  

2. High chances of losing both your job and the unemployment benefits

Now, here is a catch-22 situation. Dental hygienists are likely to lose both their jobs and unemployment benefits if they don’t report back to work. First, employers have no otherwise but to terminate contracts of those that won’t honor the report-to-work directive.  

Secondly, as long as your governor has reopened up your state for business, you don’t have an option but to go back to work. Otherwise, you are likely to lose your unemployment benefits if you don’t. So, it either, you put your life at risk or barely hold on financially to provide for your family. In other words, it is really a messed up situation to be in, as a hygienist.

That said, at least, as a salaried professional class, hygienists are far better off in various aspects than many low-income workers at the moment.

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3. Hygienists and dentists can’t test patients to monitor and prevent the spread of COVID-19 virus

The possible risks of contracting COVID-19 are evident. However, the CDC itself attests that caring for patients needing airborne precautions like those who are suspected of having or who have already contracted Coronavirus, “is not possible in most dental settings as they are not designed for or equipped to provide this standard of care.” Where does this leave the dental practices?

Hygienists and dentists have the biggest risk of exposure equal to nurses, respiratory therapists, and doctors. Dental professionals, thus, should equally be recognized as frontline workers. But as things stand, hygienists and dentists cannot legally administer COVID-19 tests.

Gabriela N. Lee, DDS, of LLM Dental Associates in midtown Manhattan, was quoted saying, “I personally would love to be able to test myself, my team and my patients for active COVID-19 as well as antibodies to see our status prior to treatment. While it is an ideal venue and would be a big service to our patients and the larger community, we are currently not able to do this.”  

4. Shortage of personal protective equipment (PPE)

In cases where dental hygienists have to perform emergency procedures, the CDC advises that they don industry-certified personal protective equipment. However, most health care professionals in medical institutions across the country are currently facing shortages of this kind of equipment.  

Unfortunately, many dental practices donated their gloves and masks to hospitals when the Coronavirus crisis started, and are now lacking in supply for their own staff as routine practices resume. Practices are particularly having difficulties getting enough N-95 respirators, which are vital for hygienists’ safety.  

President of the Washington Dental Hygienists Association, Jennifer Zbaraschuk, advises that N-95 masks should be donned by hygienists and changed after seeing each patient. However, presently, this precautionary measure might not be observed due to the ongoing shortage.

5. Most hygienists have been left with fewer choices to make 

Everybody is aware of the ADC’s interim guidance for reducing the risk of COVID-19 transmission. However, some states are not helping the case either. The Georgia Board of Dentistry, for instance, through an executive order, astonishingly punted the issue to individual dentists, saying that “determinations regarding individual patient care must rest solely with the individual practitioner.”  

As you might have guessed, the decision here is for the dentists to make. They are meant to decide for themselves whether to resume operations or not. But dental aides and hygienists — who work for dentists — are even left with fewer choices to make. If your boss needs you back at work even for non-emergency procedures, you have no option but to heed the call. Like we mentioned, if you refuse to go back, you might risk losing their unemployment benefits as well as your job.  

Also, keep in mind that, as a hygienist, you are also part of healthcare workers. Meaning, you have an ethical mandate to ensure that patients’ safety is observed at all times. Like many of your colleagues, you may believe that reopening too soon conflicts with this mandate. And, that all the required patient safety precautions may not be observed. But do you have any other option other than to listen to your employer?

So, what is the way forward?

The point is not that hygienists don’t want to resume work. They just need to ensure that their safety, as well as that of their patients, is well observed.

During these overwhelming times, everyone in the dental industry needs to support each other. Hygienists should talk to their employers or dentists about their worries when it comes to reopening.  Equally, dental hygienists also should understand that everybody is facing additional risk. And as long as the proper measures have been put in place, it is only ethical to resume duties and provide the necessary dental care to ailing patients. We can bounce back even stronger if we all learn to adapt to change.

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