Expanded use of HCQ for front line workers in India. As a preventative, not a cure.
I donât worry about getting coronavirus from my dental hygienist. She wears a mask. But that patient in the next room, a room with a big opening and no door, might be infected , and those whirring instruments might aerosolize the virus.
I have about 150 face shields, which can be disinfected and reused, 250 N95s on order (and hope they are legit), 2000 level 3 surgical masks, 300 level 2, thousands of gloves. Cavicide wipes are also in short supply. I have 2 hygienists and 2 assistants working on any given day. What came through the coalition is per location: there just isnât enough to go around per dentist. Many of us started purchasing in late February, but the N95 requirement hit everyone by surprise. I check my supply company daily to see what might be in stock.
One reason I am delaying hygiene is also my shortage of N95s. Most dentists have never used those. And now we canât get them. I hope the standard goes to level 3 mask and face shield. The filtering ability is the same as N95, the fit is not as tight. Believe me, it is hard enough breathing through a level 3 with a headband (not ear loop). I have hair bonnets for those that want them, shoes are always left at the office. Surgical gowns are also in short supply, but all staff already wear a long sleeve coat with cuffs over scrubs. I have enough that we can change them frequently because I have a washer and dryer in the office.
I have also purchased safety glasses for staff to wear over their regular glasses. I have a medical grade air filter in each treatment room and sneeze shields around my front desk.
I went to dental school when no one wore gloves or masks, except in surgery. We really didnât get sick, and didnât even think about it. We washed our hands a lot. AIDS changed that.
Dentists are masters of infection control. Everything that can be sterilized is, disposables are not reused (except N95s now and they are covered with a level 3 which is disposed), all surfaces and non-disposable supples are wiped down, all uniforms stay in the office.
What DH, a retired dentist, is hearing is that finding PPE, especially N95s is difficult. He (and I) knows how stressed he wouldâve been to have to shut his practice for 2+ months, except for emergencies, and to now have to meet all the new protocols for infection control. I hope your re-opening goes as smoothly as possible, @dentmom4.
Yes, my relative is having a hard time acquiring real N95s (lots of fakes out there) at reasonable prices. The prices have really shot up due to covid-19. He is a solo dentist with a few staff. He says CA dental Assn is trying to help acquire some n95 masks.
Everything is hard to get. Not Dentist but we order from Henry Schien and the like. Many things like masks we canât get. We check in with our rep daily. We have enough for now
Gloves I use a company that we can get 4 boxes at a time. Wipes for the office is not bad but we stocked up. What about using just a regular mask and a face shields. Of all places Etsy has some decent oneâs.
@shellfell. So many of my colleagues are planning almost business as usual from day 1. I am not. I just donât believe it is prudent until we see how the virus spreads when more businesses are open and people are gathering in closed spaces. Dental personnel are at high risk for exposure. We are going to get it from them, we are not going to be infecting people easily. I also donât have the financial struggles that so many do: school loan, practice loan, building mortgage, plus all the personal expenses.
I will bring back my urgent patients first for an exam, little to no drilling, then move to non-aerosol procedures: deliver crowns, dentures, begin implant crowns. Lots of time between people to get the flow and PPE changes more streamlined. Some hygiene patients back toward the end of June. Iâd like to delay my over age 75 patients longer.
The 10-week shutdown was not too stressful other than having to delay treatment that I would have preferred take care of. My emergency fund is being used sparingly and my staff is on unemployment. I am going to need more to do in retirement, thoughâŠ
I think youâre being smart, and thatâs probably how DH wouldâve handled it as well. Obviously you need to consider the health and safety of yourself and your staff, as well as your patients. No need to rush into a full schedule with all dental procedures.
Iâm sympathetic to dentists wanting to protect themselves and their staffs. They should. But what is the protection for me, a patient, being infected by another patient?
@âCardinal Fangâ. By protecting themselves they are protecting you. Rooms /chairs have always been cleaned between patients. Maybe now more attention to door handles and they like. Patient appointment spacing will be used to give enough time to clean the rooms
If a medical practice has been following CDC guidelines prior to this pandemic, surprisingly, very little has to be added. IE : now I wear a mask seeing patients (not a dentist) etc etc. Sure we are all investing in plexiglass screens, separators and the like (hmm should invest in plexiglass) ⊠Lol.
I am sure trusted dentists offices have upgraded their cleaning /disenfecting rooms between patients protocols etc. But in reality they hopefully were doing this prior also.
In my office very little has changed. We donât use the waiting room anymore right now. Patients are spaced out etc. Everyoneâs wearing gloves etc
We reviewed our CDC booklet when all of this started and we have always done just about what we are doing now.
My relative who is a dentist is male, over 70 and has heart issues and pacemaker. We are concerned for him, especially as it is so challenging to get proper PPE at OK prices. As mentioned above, dentistry poses great risks to the dental personnel, as things do get aerosolized and the personnel is with the patients for extended periods of time, repeat all day. Iâm thinking relative may retire sooner than he had planned, but who knows?
I understand that dental practices are well-equipped to protect me from getting a disease by touching something. But this virus spreads through the air. What are they doing to protect me from viruses that are aerosolized from another patientâs mouth while that other patient is having their dental treatment in the next room over? That was the biggest danger to me if Iâd gone to my dentist in early March, and I donât see how itâs being addressed.
I wonder why someone over 70 with multiple health issues, isnât retiring. What is his reasoning? He is eligible for Medicare and full retirement benefits from social security
My BIL is a physician. I have to say that Iâm happy my husband has a pension, retiree health benefits and will retire in 2 years. My bil as a business owner, doesnât have those luxuries.
For any procedure that creates aerosols, my assistant is using a high volume evacuation system right next to the tooth I am drilling. That will suck up at least 90% of the aerosol created. The hygienists use a slower speed suction, but mine will now use the HVE. All my rooms are equipped to do any procedure.
Our new guidelines ask us to treat each patient start to finish before we start on the next one. It is easy enough to seat you and dismiss the previous patient so patients will not cross paths. Since we are used to running between rooms, that will be a new change. A webinar I heard yesterday suggested that when a patient is dismissed, we close the door for 15 minutes to contain any remaining aerosols and then disinfect. I run my furnace fan 24/7 and I now have a medical grade HEPA filter in each treatment room that turns over the air 4 times an hour.
Yesterday, the CDC came out with the statement that it is very unlikely that you will get COVID19 by touching a surface. My rooms are separated far enough that the aerosol droplets will hit the floor way before they get to another room. Our disinfection protocols have always been excellent, so not much change for us there.
The greatest risk is patient to dental personnel transmission since we are in the office and treatment rooms all day. No one will be waiting in the reception area and ALL patients will wear a mask until we ask them to open their mouth.
These are new changes for all of us. As the summer progresses, we will learn more about transmission, infection, and treatment. The ADA calls this the âinterim return to workâ guideline. We may see something different when fall arrives. Maybe when a vaccine is widely available we return to the standard precautions we used in January. Itâs anyoneâs guess.
This seems good. I wonder if my dentist is doing it.
Good luck, @dentmom4. I canât imagine being a dentist in the COVID era. Seems like one the most risky professions of all. Thank goodness for people like you.
@âCardinal Fangâ I am sure your dentist uses HVE (I donât know any one who doesnât!) Dentists who work alone also might use an ISO-lite, Mr. Thirsty, Dry Shield. Those products hook up to high vac suction. Hygiene is different: they usually use a weaker suction straw. Mine will now be using their HVE.
@Nrdsb4 Thanks. We do what we do. Yes, it is risky; hopefully our PPE is sufficient and our patients will be cognizant of their health and stay away if unsure. Big reason we will be asking a lot of questions during our pre-appointment confirmations and again at the appointment. I will not be treating any known COVID19 positive patients until they are well and have 2 negative tests.
@evergreen5 - I wonder if there are any studies about ivermectin used as preventative. In dogs, itâs considered effective (against heartworm) with a once-monthly dosage â so it would be very nice if it worked the same way in humans against Covid-19. (Just taking one pill once a month).
Are the air exchange rates and hepa room filters voluntary? I would love if my dentist were as fastidious as @dentmom4 .
If she is as attentive to her room cleanliness as teeth she must be one awesome dentist.
Also, like @Knowsstuff mentioned about a testing method. On This Week in Virology, i heard about a blow out test, like spirometry, that can be used to test for covid. I heard the downside is, just like with spirometry, the user frequently coughs afterwards. This presents challenges as no one wants to be coughed on.
@silverpurple The air filters are voluntary. There is no evidence they reduce covid virus particles, but I think patients will appreciate seeing them and they canât hurt. And thank you for the complimentâmy staff also excels at cleanliness.
I would really like to see a quick saliva test for patients. As staff, we would have to test daily.