Is dental care safe during COVID-19?
Dental offices have traditionally had high adherence to infection control procedures using personal protective equipment (PPE) and cleaning surfaces with high level disinfectant. This combination has resulted in a history of safety. Given the many unknowns about COVID-19, we are committed to doing all that we can to increase safety for our patients and our team, including the use of N95 respirators. For the person providing dental care, without proper precautions his or her job is considered a very high-risk interaction requiring close contact by the Occupational Safety and Health Administration. We at Anna V O'Keefe DMD PA are stringently adhering to CDC and OSHA guidelines to reduce risk for our team and for our patients. Please see below for how our office is adhering to these guidelines.
Should I really still make my dental appointment a priority in times like these?
Dental problems rarely become less involved or less expensive over time. As with many things in life, the more diligently one maintains one's mouth, the less likely an issue will arise or the earlier and therefore more conservatively we can address it. Careful, consistent homecare (brushing, flossing, wearing protective mouthguards), combined with the regular hygiene visits and the conservative dentistry we provide in our office, will often help our patients avoid larger issues.
During this period of government-mandated emergency-only care, many of our patients have stayed healthy and stable. For the patients who have suffered from abscesses, cracked teeth, or developed other problems, the pandemic created real challenges in an already stressful time. Dr. O'Keefe often tells her patients that she would like to keep their life boring dentally, and that is especially true during these times.
We are all weighing the risks and benefits of leaving our homes to do necessary tasks. This is a personal decision and should also be an informed one. Our hope is these FAQs provide the facts to enable our patients to make a decision based on science combined with their own personal experience.
We also do not know what lies ahead in the coming months. Should another government-mandated closure occur, we know that the patients who have been consistent with their recommended care at home and in our office will be less likely to develop issues.
What is an aerosol and how does it relate to COVID-19 and dental care?
An aerosol is a spray of fluid droplets. During some procedures in dental care, such as cleanings and fillings, an air-water spray is produced.
COVID-19 is thought to be transmitted through respiratory droplets. When someone with the infection coughs, sneezes, or speaks, particles or droplets containing virus material may be transmitted to another person, or may be transmitted to a surface, which is touched later by another person. Virus particles may also enter the saliva.
While virus material has been found in saliva after coughing, it is not clear to what extent virus particles exist without coughing. There is data that these particles exist in saliva, but further research is needed to understand ways to minimize risk. It is also not clear to what extent saliva becomes incorporated during production of an airwater aerosol produced by dental instruments, and if it does, what risk diluted viral material from the saliva presents in the aerosol.
What dental procedures produce an aerosol?
Procedures using high and low-speed handpieces, air-water syringes, cavitron or other sonic scalers, or polishers all produce aerosol. Therefore, our hygienists will not be utilizing cavitrons or other sonic scaler or polishers during any hygiene appointments. This means that the hygienist's work does not produce the amount of aerosols they once did; this does not remove the existing risk of entering a room whose previous occupant had not been wearing a mask.
What procedures do not produce an aerosol?
Suture removal, snipping protruding orthodontic wires, examination, radiographs, removal of debris via cotton or brush, drying with gauze, simple extractions, atraumatic temporary restorations, or silver diamine fluoride placement do not produce an aerosol. However, if these procedures lead to coughing, that will produce an aerosol and create the risk of transmission of COVID-19.
Can you guarantee that COVID-19 will not be transmitted to me during my visit to the dental office?
The precautions we have put in place (described in the next sections) help to reduce but do not remove the risk of COVID-19 transmission. COVID-19 has a long incubation period during which the carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given current limitations in virus testing. Dental procedures present the possibility of spreading potentially infected bodily fluids through water spray. This spray can linger in the air for unknown periods of time, which can cause the unwitting transmission of the COVID-19, regardless of the highest sanitation procedures being followed. Due to the frequency of visits of other dental patients, the characteristics of the virus, and the nature of dental treatment, we all have an elevated risk of contracting the virus simply by leaving our homes, interacting with other people, or being in a dental office.
How can dental patients and providers be safe with procedures unlikely to produce aerosol?
We are screening patients for any symptoms to minimize the risk of coughing resulting in droplets. We do not treat symptomatic patients. If a patient has tested as currently positive with COVID-19, we will reschedule his or her visit for a future time beyond the 14 days of isolation required. We will instead manage his or her conditions using telehealth and treat them once they have tested negative for active infection.
As our personal protective equipment, we use a N95 respirator, goggles or face shield, gown, and gloves, and perform frequent handwashing as recommended by the CDC. We also use a head covering or wash our hair frequently.
How can dental patients and providers decrease their risk of transmission of COVID-19 with procedures likely to produce aerosol?
In addition to the above recommendations, we ask our patients to perform an antiseptic oral rinse (diluted peroxide, chlorhexidine, others) pre-procedure. We always have and continue to use a rubber dam whenever possible. Procedures that cannot be performed with a rubber dam or effective isolation, including cavitron scaling and polishing, will continue to be postponed. Procedures on removable prosthetics (dentures, mouthguards) are appropriate if intraoral adjustment is not required.
We have also implemented a number of changes to our facility (and a fresh coat of paint!) These include walled-in treatment rooms to significantly reduce aerosol dispersal, as well as additional suction devices outside the mouth to capture aerosols before they can spread in the room. We also have put in place mechanisms to move air out of the building and cycle in fresh air.
Finally, we have always followed strict policies regarding the disinfection of our instruments and the surfaces in our office. We anticipate the above protocols and equipment to provide greater safety from aerosols for both our patients and our team.
Here is an edited list of websites that can provide much more general information regarding COVID-19: