After months of only handling emergencies, America’s dental offices are starting to reopen. All 50 states now allow dental providers to offer all procedures, including routine checkups and teeth cleaning, according to the American Dental Association (ADA). To combat the spread of SARS-CoV-2, the virus that causes COVID-19, dentists and hygienists are taking many new precautions to protect patients — and themselves — from exposure. To guide this effort, the ADA and the CDC have issued new infection control guidelines for dental practices. However, many patients still wonder if it’s safe to get dental care, especially in the parts of the country where rates of the new coronavirus are rising.
Although the new safety procedures can make going to your dental provider feel different than it did in the past, taking excellent care of your teeth and gums remains one of the best ways to protect your overall health — and reduce your risk for heart attacks, strokes, dementia and other life-threatening conditions. To help you weigh the risks and benefits of getting dental care during the pandemic, we talked to an expert: Patti DeMatteis, ASDH, RDH, co-owner of Dental Hygiene Excellence and managing partner of the Heart Attack and Stroke Prevention Center of Central Ohio. Here are her answers to common questions and concerns of patients.
How risky is dental care?
Dental procedures, including teeth cleaning, are considered potentially high risk. That’s because COVID-19 is primarily spread through exposure to respiratory droplets from an infected person, either by inhaling the droplets or by touching surfaces or objects that are contaminated with the virus and then touching your mouth, nose or eyes. Because dentists and hygienists work inside the patient’s mouth, using high-speed instruments that can create vaporized aerosols, there is a significant risk of spraying viral particles around the treatment room and onto the providers themselves. Ultimately, dental providers may be at far greater risk of being infected by their patients than vice versa.
To protect both patients and staff, dental offices have upgraded their air filtration systems, upgraded personal protective equipment and use new dental devices to minimize the release of possibly pathogenic aerosols in the dental environment. For example, to keep the patient’s mouth as dry as possible during dental and hygiene procedures, our practice and many others have started using a high-volume suction device called Ivory Releaf in addition to the standard low-volume suction devices we were using before the pandemic. The Releaf has a leaf-shaped mouthpiece that is placed in the patient’s mouth to suck up fluid before it vaporizes into the air.
Before using the Releaf on our patients, we tested it by using it on our staff. When I recently had a dental cleaning, performed by a hygienist and the hygiene dental assistant in our practice, the additional aerosol management measures worked so well that my face was totally dry afterwards. We have also implemented many other protective practices that will be discussed more fully below. As a result, I felt completely safe during my cleaning — and during a recent crown procedure.
What steps should dental practices take to protect patients and staff from COVID-19?
Even before the pandemic, dental providers were already required to use strict hygiene practices, such as standards developed by the Occupational Safety & Health Administration (OSHA). These include sanitizing surfaces and equipment with EPA-approved disinfectants specifically designed for use in the healthcare setting. In response to the COVID-19 pandemic, a wide range of new safety precautions are now in place. When scheduling your dental cleaning, checkup or procedure, ask about the following infection control measures, many of which are advised by the CDC and the ADA:
- Staggered appointments. To help ensure safe social distancing between patients, the CDC advises dental providers to limit “clinical care to one patient at a time [per clinician] whenever possible.” In facilities with multiple treatment rooms, it’s possible that other patients will be receiving care from other providers in other rooms during your visit. However, your provider should not go back and forth between rooms. The office should also build in adequate downtime between patients to allow clinicians to thoroughly sanitize and disinfect rooms and equipment between patients.
- Screening for COVID-19. Ask if the dental providers have been tested for the coronavirus and what the results were. Also ask what steps your provider takes to screen patients. In our practice, we ask patients to wear a face covering when they arrive, take their temperatures and use a symptom questionnaire to screen for signs of the disease. We also ask if they have been told to self-quarantine after exposure to an infected person. However, it is possible for people who are not yet showing symptoms of the virus to transmit it, so even the most rigorous screening will not eliminate all risk.
- Reducing exposure to other patients. Many practices have abolished the waiting room and removed all shared objects, such as magazines. In our practice, patients are asked to remain in their cars until the previous patient has left. After we sanitize the room, we telephone the patient to let him or her know that we are ready. We also have a virtual payment process so patients don’t need to interact with front office staff at all.
- Measures to minimize aerosols. The CDC has advised dental providers to take all possible steps to avoid the release and spread of airborne pathogens. Along with using the Releaf device discussed above to keep our patients’ mouths dry during aerosol-releasing procedures, our practice also revaluated the types of equipment we use. For example, while we continue to use the ultrasonic scaler, we stopped using a tooth polishing tool that produces a high volume of spray. Some practices use a different type of external suction device that goes around the patient’s face, such as Xuction.
- Doubling down on PPE. Many practices now use a shield positioned in front of the patient to block some of the aerosols and some use other types of shielding between patients and providers as well, or a combination of measures. As advised by the CDC, our providers wear eye protection, face shields, N-95 masks, full body surgical gowns, gloves and other PPE (personal protective equipment). Practice recommendations also advise providers to change PPE between patients to help avoid cross contamination.
- Improved air quality. Since it’s impossible to eliminate all airborne particles during dental care, the CDC advises providers to work with a HVAC professional to increase filter efficiency to the highest possible level without impeding air flow. The agency also suggests that providers consider using a portable HEPA air filtration unit during and immediately after aerosol-generating procedures. Another option the agency has recommended is using a technology called upper-room ultraviolet germicidal irradiation to zap bacteria and viruses.
Pre-rinses and home care. To reduce the viral load in our patients’ mouths, we have them use disinfectant pre-rinses containing peroxide or iodine before their dental care. For patients who use Perio-protect trays for the treatment of periodontal disease, we ask them to wear the trays to their appointment to help reduce harmful pathogens in the mouth. We also tell all of our patients to use the salt-water gargle and nasal lavage advised by the BaleDoneen Method to help abate COVID-19 before their appointment. Recent evidence suggests that this simple home-care technique can significantly reduce the spread of respiratory infections, including those caused by coronaviruses, a discovery that may have important implications in combating the transmission of COVID-19.