What we are doing to get to Re-opening during COVID-19
In my last blog, I was talking about the challenges that this COVID-19 has created to dental centres and clinics across the globe and the new normal that we, as dentists, dental hygienists and staff, have to face once we are able to resume our dental services for our patients in the near future. This blog is to explore about the actual steps and procedure that I, as a part of the dental professional, have to undertake to get Affinity Dental Care and team members ready for the reopening, based on the current knowledge of the disease and guidelines. Our goal is to provide wellness to our patients and we take the prevention of disease spreading very seriously.
Besides the infection prevention and control protocols that we had been practicing in my office in the pre-COVID time, we have purchased some additional equipment and devised some procedures to eliminate the dissemination of germs around in the dental clinic to prepare for Re-opening during COVID-19. Based on the Centre of Disease Control, there are 5 categories of control: namely Elimination, Substitution, Engineering Controls, Administrative Controls, and Personal Protective Equipment (PPE). We are implementing all the 5 categories in our clinic to ensure the safety of patients and staff.
The first category is Elimination. The elimination can include the use of risk assessment in the form of questionnaire about the exposure to coronavirus, the use of thermometer to check for fever, the use of rapid COVID test, and eventually vaccine. Not just all our patients will have to be screened for COVID-19 symptoms and have their temperature checked with a touchless infrared thermometer, everyone of us who works in the office is also assessed daily for the symptoms and have their temperature checked and logged. All patients are advised to use the hand sanitizer for their hands the moment they stepped into the dental practice. Before the patients open their mouth for examination, they are also required to rinse their mouth with 1.5 % hydrogen peroxide to kill the viruses and germs in their mouth and throats. After the dental procedures, patients will be given 0.12% chlorhexidine mouth rinse and are encouraged to disinfect their hands with the hand sanitizer before they leave the office.
The second part is Substitution. Covid-19 is an air-born disease and the virus is mainly found in our body fluids like saliva and nasal discharge. The aerosols generated during routine dental treatments like drilling the cavities out or washing the teeth with the pressurized air-water syringe do carry germs along with them. The use of electrically driven handpieces (the dental drills) versus the popular air-driven handpieces during cavity removal may reduce the amount of aerosols produced during the procedure. We will also look into getting dental laser to remove some of the cavities that will not generate as much aerosols. Substitution will also include replacing the old traditional high-volume suction tips with special nozzles that have more aerosol capturing power to remove the tiny air droplets during dental procedures like fillings, crowns and bridges, teeth scaling and cleaning etc.
The third category is Engineering Controls. Social distancing is one of the engineering controls. For examples: arrangements will be made to prevent patients from sitting too close to each other when they are waiting in the waiting room. Air filtration system in our HVAC system has been installed that is capable to filter out the virus. The use of our newly acquired portable fogger can effectively disinfect the air in between patient’s appointments. There will also be a chairside high-speed vacuum that has HEPA filter to remove the floating viruses. Keeping the doors to the operatories closed all the time will keep the efficiency of the air filtration systems more effective and disallow the spreading of the bad germs in the air away. The use of dental rubber dams during fillings, crown and bridges preparations, root canal treatments will significantly reduce the chance of spreading.
Then it is the Administrative Controls. It includes: 1) proper screening of the patients over the phone for patients who are of the high risk for COVID-19, booking extra time in between patients to allow adequate time to do thorough filtering of the air, disinfection of the dental equipment like the chairs, and cabinet tops, before the next patient; 2) chairside ergonomics with the idea to reduce the exposure of the dentist, dental hygienist and dental assistant being too close to the plume rising out of patients mouth during dental treatments; 3) the enhanced protocol of disinfecting the waiting room chairs, reception countertops, door knobs in between patients and mopping the floor daily with floor disinfectant.
Finally, it is the PPE that form the final barriers, we will be wearing fresh clean latex-free gloves, water resistant gown, N95 or KN95 masks, eye shields and or face shields and surgical caps while we are providing dental treatments like white fillings, composite resin bondings, cleanings, implant placements and gum surgeries.
Those are the new normal from now on at Affinity Dental Care… This is how Re-opening during COVID-19 will work.