Working from home is one way to curb the spread of the novel coronavirus, but not every profession makes it possible. One example? Dentistry.
Dentists, dental hygienists and other dental professionals face an especially high risk of occupational exposure to the virus.
“During the current outbreak, we have really good ways to prescreen patients: by taking their temperature, asking them questions regarding travel in the last two weeks, asking how they’re feeling and if they have flu-like symptoms,” said Fotinos Panagakos, the vice dean of administration and research for the West Virginia University School of Dentistry. “But they may still answer ‘no’ to all of those questions, and their temperature may be normal, but they may still be infected though they’re not showing symptoms yet.”
Patients’ coughs and sneezes aren’t the only ways dentists can come into contact with the virus either.
“In dentistry, many of the procedures that we do require using a handpiece to drill a tooth, or an ultrasonic scaler to clean the teeth,” Panagakos said. “The water used can form an aerosol. If you aerosolize something, it’s going to end up in the air. You can just imagine what that means if a patient is carrying the virus.”
But dental professionals have a range of tried-and-true precautions they can take to minimize their exposure to infectious material during treatment and help protect their patients from it. And there are things patients can do, too.
If you have a dental appointment scheduled for the next few weeks, should you cancel it?
“The American Dental Association just issued a recommendation that all dental offices suspend providing elective dental care for the next three weeks. It’s to minimize the risk of coming into contact with somebody who may be infected and preventing that spread.
“Call the dental office—if your office hasn’t reached out to you already—to determine whether you should come in or not. If it’s a cleaning or a checkup, it can be delayed another two weeks to a month. That’s not going to be a big issue. If you’re having an actual dental emergency that involves pain, if you have swelling or if you have an apparent infection in your mouth, contact your dental provider right away and find out how they’re managing those emergency cases. Most offices may see you, or they may refer you to another location that’s seeing emergencies. For example, we [at WVU Dental Care] may end up starting to see emergencies from private practices that are closed within the Morgantown area. We’re anticipating a potential uptick in emergency patients over the next couple weeks. But we’re here to provide care for the community; that’s what we’re all about.”
If you do have an emergency dental concern, how can you safeguard the health of your dental care providers during your visit to the office?
“If you’re sick, you shouldn’t come in unless it’s an absolute emergency. I would say to consider not only the clinicians who are going to be managing your care but also anyone else you may come into contact with along the way. So, that’s the first step. Call the office ahead of time to let them know you have an emergency and are also not feeling well. If you feel fine but you think you may have been exposed to the virus because of a family member who is ill or someone else you came into contact with, I strongly recommend to call the office ahead of time and let them know that this is a possibility. ‘Hey, I’m in this situation. I’m in pain. What should I do?’ And they may still see you. They may just take some extra precautions before you come in. It’s always good to communicate before you show up at the office.”
Are regular surgical masks enough to protect dental professionals from the virus, or do they need more robust protective equipment?
“There are masks, like the N95 respirator-type masks, that are more protective than the surgical masks that are routinely used by dental professionals. Those can be worn, but they need to be fit-tested to wear them. It’s not just taking one out of the box and putting it on. If you don’t have the ability to do the fit test, it could pose a challenge to using this mask. Plus, they haven’t proven to be 100 percent effective in preventing respiratory infection after coming into contact with a patient who has a viral respiratory disease.
“There was a study published in the Journal of the American Medical Association, where they actually compared routine surgical masks that we usually see clinicians and healthcare professionals wearing—as well as people out and about on the street—against an N95 mask in settings where healthcare professionals were exposed to patients who had a known viral respiratory infection. The level of infection that was transmitted to the professional was eight percent for the surgical mask and seven percent for the N95 mask. So while the mask provides protection, there are other ways a healthcare provider can become infected. In the dental office, aerosol could result in the virus landing on exposed skin, like the face, or the hair. The person could touch this later, and pick up the virus. That’s why they tell you to wash your hands and not touch your face, beyond just protecting the respiratory system.”
If surgical and N95 masks aren’t always sufficient, what steps can dental professionals take to keep from catching the virus?
“For any patient, regardless of what’s happening right now, we use what the CDC and OSHA define as ‘standard precautions.’ For the most part, because we’re in the oral cavity, we’re going to wear eye protection that has side shields, or a full face mask, to prevent things from getting into the eyes as much as possible. We’ll wear a surgical mask; we’ll wear gloves; we’ll wear a gown over our clothes. The gown needs to come up to the wrist and meet the glove so there’s no exposed skin in that area. Those are standard precautions whether we’re managing a patient with bloodborne infection or a patient with a respiratory disease or a patient who has some other infection. That hasn’t changed at all.”
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