Phase one reopening of dental offices?


There are a lot of discussions among dentists about how and when we should reopen our offices. The American Dental Association , our local dental societies,  the CDC  and  local departments of health , will surely offer their advice as time goes on, but for now what are my thoughts (being closed for over a month, I've had plenty of time to think this over)?

The answer to when is likely to be When the active virus load in the general population is low and this can only be determined by accurate testing of our population. Hopefully easy and accurate tests will become available. Unfortunately, there doesn't seem to be a centralized effort, by the federal government , to develop one accurate test. To the best of my knowledge there is no federal "testing czar" who has been appointed and so far our president has taken the approach of allowing private industry to fast track their development of tests. There seem to be a large number of tests being developed by multiple vendors but we presently do not have the capacity to test even 10 percent of our population.

If dentist offices do choose to start seeing patients prior to our ability to test our population, how should they proceed. Carefully, seems to be the answer. The good news is that most dental offices already practice universal precautions and all dentists are required to either sterilize instruments that are placed in patients mouths or use disposables. Assuming that adequate amounts of PPE (personal protective equipment) are available, dentists would be well advised to wear an N95 mask as well as a face shield  and probably surgical disposable head covering as well, when providing treatment.  Our patients  in the waiting area should wear masks and practice "social distancing".   Staff should ask s appropriate questions when confirming appointments or before patients are to be seated in a dental operatory. Temperatures of patients could be taken in the waiting room using a non touch thermometer.

While treating our patients attempts should be made to minimize aerosols. When performing cleanings it would be prudent for us not to use our cavetron  and to refrain from using prophy paste at the end of the session to polish. Both will tend to create and aresol or splatter. Simple hand scaling should be utilized to clean our patients teeth. This may require additional time with some patients, in order to achieve a clean mouth.

At least initially, dentists should if at all possible utilize a rubber damn when performing operative procedure and keep things simple. After all we just need to keep our patients comfortable until suitable vaccine is developed or appropriate anti viral medications can be developed for treating patients with the Corona 19 virus.

After treating a patients, a staff member will have to carefully wipe down the room with appropriate disinfectants. This may take additional time, so in the near future additional time may be required in order to adequately disinfect our operatories  between patients. This should not be a problem since it is likely that most offices will experience fewer patients booking appointments, at least until a vaccine is available.

Clearly as time goes on innovative techniques and devices will be developed that can help us treat our patients safely and sooner or later this virus will "burn out" or we may develop a herd immunity. For now patience seems to be called for and 2020 will not be a banner year for most businesses and dentistry will not be the exception. For now our first priority needs to be the safety of our patients, our staff and ourselves, since while most tooth problems tend not to be immediately life threatening, exposing ourselves and others to the Covd19 definitely is!





from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2020/04/phase-one-reopening-of-dental-offices.html - http://lspindelnycdds.blogspot.com/

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