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Is it safe to treat patients yet?

As of June 19, every US state has given dental offices permission to reopen following the COVID-19 outbreak for any type of procedure. Dental practices in Texas were able to return to full dental practices much earlier on May 1.

The statistics show that many patients are thrilled dental practices are back to normal and are eager to maintain their healthy white smiles. An ADA survey completed by thousands of dentists revealed that patient volume is currently at almost 60% of what it was prior to March 15th, when practices were forced to stop all non-urgent treatment.

But despite being legally able to open, not all dental practices are keen to welcome patients just yet. With everything going on, it’s natural that many dental practice owners and employees are concerned about their safety. After all, people who work in this industry are at a high risk of being exposed to the virus.

No one wants to put the wellbeing of themselves or their staff in danger. But there’s only so long you can keep your dental practice doors closed before they’ll remain shut forever. It’s a horrible situation to find yourself in, but for many dental practice owners it’s their current reality.  

To help you make the right call for your practice, here’s everything you need to know about treating patients while the coronavirus is still a threat.

Why it isn’t safe 

Infectious disease specialist and spokesperson for the Infectious Diseases Society of America Dr. Gregory Poland declared that some exposure to the disease within dental practices will be inevitable. He continued to explain, “The hope is that recommendations for their practices that all dentists should be following will mitigate that risk.”

The reason there is at least some element of risk in dental offices is due to the nature of the treatments carried out. Dental professionals regularly use drills, ultrasonic scalers and air-water syringes which create aerosols. If the person treated is infected with COVID-19, the contaminated aerosols can remain in the air for up to three hours, easily spreading to dental staff and other patients.

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Despite the transmission of infected water droplets being possible, it’s unlikely that patients will come into contact with them. It’s much more probable that dental professionals will be the ones to contract the virus through aerosols.

When practicing aerosol-generating procedures, the water droplets that are produced are directed away from the patient and into the air surrounding the dental staff. Laurie Anne Ferguson, dean of the College of Nursing and Health at Loyola University New Orleans and a nurse practitioner, explains: “All that drilling and suctioning, it’s the provider, it’s not the patient, getting aerosolized secretions.”

If staff aren’t equipped with suitable masks and face shields, there’s a good chance the infected droplets will travel into their system. In Texas, the TDA is working closely with Governor Abbott and the Texas Division of Emergency Management (TDEM) to ensure there is plenty of PPE available for all Texas dentists, so this shouldn’t be an issue.

While the possibility of a single member of staff contracting the virus is bad enough, it’s certainly not the end of the story. According to the CDC, someone can be infected with COVID-19 without showing any symptoms for 4-5 days. This means your dental hygienist could contract the virus and unknowingly treat patients for another five days before even becoming aware of her symptoms.

If every person she passed the virus onto also continues on with their lives as normal for another five days without realizing they have the virus, the results could be disastrous.

Why it is safe

In a discussion with NPR, dental officer for the CDC’s Division of Oral Health and member of the CDC’s COVID-19 Response Infection Prevention Control Team Michele Neuburger confirmed there have been zero cases of the virus being transmitted inside a dental practice. Since all dental practices throughout the US have been permitted to fully open for over one month, this can only be good news. 

There are ways you can massively lower your risk of contracting COVID-19 while still treating patients. The CDC regularly updates their guidance for dental settings which you should follow to keep yourself, your staff and your patients safe until the virus is fully under control. The guidelines include:

  • Full PPE for staff.
  • Face masks for patients.
  • Screening patients for symptoms.
  • Taking patients’ temperatures.
  • Limiting the number of people in the waiting area.
  • Providing hand washing stations.
  • Installing physical barriers in reception areas.
  • Removing non-essential items from the practice.
  • Properly sterilizing and disinfecting equipment after use.

Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital, explained that when someone wears a face mask, their risk of becoming infected is lowered by 65%. Combine the use of a face mask with a face shield and the odds are lower still. Avoid using aerosol-generating equipment and the chances of your or a member of staff contracting the virus is even smaller.

Not treating patients may have terrible consequences

Before dental practices were allowed to open for non-urgent treatment, ADA gave a statement warning that the longer dental offices were forced to remain closed, the more likely untreated diseases would get worse, increasing the complexity and cost of treatment. To help curb the problem, they didn’t extend their recommendation to restrict elective treatment past April 30.

Howard Golan, a dentist in Williston Park, N.Y., explained that postponing regular checkups or treatment for dental pain has the potential to turn a small, almost harmless cavity into a severe root canal or tooth extraction. In turn, this costs the patient more money and is a more complicated procedure with a lot more pain. In some extreme cases, letting dental care slide can result in serious infections and sometimes even death.

The mouth is the window to your overall health. And failing to maintain proper oral care can cause all kinds of nasty diseases and illnesses that affect many different parts of your body. When harmful bacteria is present in the mouth, it easily spreads to other parts of the body through digestive and respiratory tracts.

Without regular professional teeth cleaning, bacteria builds up in the mouth, causing diseases which stop the body’s immune system from fully functioning. Without a properly working immune system, people are at risk of contracting many different diseases, from cardiovascular disease to diabetes mellitus. Failure to keep on top of good oral health even puts people at risk of developing COVID-19, the exact reason patients were advised to delay elective dental treatments to begin with.

Until there’s a reliable vaccine publicly available, the best way to avoid contracting the coronavirus is to maintain a strong and healthy immune system. And in order to do so, you need to be very careful when it comes to your oral health. 

Nothing is risk-free

Determining whether or not it’s safe to treat patients right now is tough. Yes, there is definitely some risk involved opening your practice while the virus is active. But there are measures you can put in place to keep the risk down to a minimum.

If you do decide to open up your practice for elective procedures, be sure to follow the latest advice given by the CDC and do everything you can to keep everyone in your practice safe. Your staff and your patients will thank you for your hard work when all this is behind us.

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