Dr. Justin Pfaffinger: Dentistry’s new protocols
Face shields, temperature checks and plexiglass — dentistry’s new normal? If you’ve been one of the fortunate patients to see your dentist these past few weeks, I’m sure you’ve noticed that there are quite a few new precautionary measures in place at your local office.
California’s Department of Public Health (CDPH) issued specific guidelines on May 7 regarding the reopening of dental practices to non-urgent, preventative care. These guidelines were to serve as the general umbrella of new protocols that every dentist in California was to minimally adhere to. Each county’s Public Health Officer was then directed to release their own separate statement to its respective dentists that either repeated verbatim the State’s guidelines or imposed further restrictions. No county was allowed to have less-restrictive protocol.
Dr. Kenneth Cutler, Nevada County’s Public Health Officer, chose to repeat the State’s guidelines verbatim. I spoke with Dr. Cutler directly leading up to his decision, discussing the state of dentistry in Nevada County and the public health effects of urgent-only care. Due to the low incidence of COVID-19 in Nevada County, with only 41 cases and the last confirmed case on April 28, Dr. Cutler felt it prudent to follow the State’s guideline to reopen dental practices.
It has been five weeks since the last confirmed COVID-19 case in Nevada County and every day that goes by without another new case brings increasing relief. My dental practice resumed preventive care two weeks ago, on May 18, with a reserved approach to reopening. Instead of our typical four hygienists working each day, we chose to resume practice with only two. And instead of keeping each doctor’s schedule fully booked, with little time in between patients, a slower schedule was implemented. It was uncertain how our patients would react to California’s “all-clear” to resume hygiene visits and regular dental care, so we felt it appropriate to reopen slowly, allowing our dental team extra time between patients to execute the new additional safety precautions to keep our patients safe. Before the quarantine our hygienists were seeing on average 130 patients every week, so after eight weeks of shutdown, our hygiene waiting list has grown quite long! I suppose it’s not surprising then that we have no shortage of patients eager to return to get their teeth cleaned. It has been overwhelming the response of the community since preventive health care has been reinstated, it seems that the return to normalcy is desired.
However, there is a “new normal” in how dental offices will be operating as we continue to reduce the spread of COVID-19. All employees are screened daily for symptoms of COVID-19, including daily temperature checks. Our patients now wait in their cars and not in our waiting room, being allowed in the building once they’ve completed a COVID-related health questionnaire, had their temperature taken, and placed a facemask on. Any red flags on the questionnaire or a temperature above 100.4º F and their appointment will be rescheduled. Once inside the practice they’ll be greeted by our receptionists, behind plexiglass of course, bottles of hand sanitizer on the counter, and a dental assistant to walk them down the hallway to their designated room. The doctor will enter the patient’s room with a face mask already on, and a face shield as well if you are undergoing any procedure that generates aerosols, a fine spray emitted into the air during the use of a dentist’s drill or hygienist’s ultrasonic water picks. Aerosol management is the key to reducing the spread of COVID-19 within a dental office, and that is why we have installed the Purevac HVE system for our hygienists, a very powerful suctioning device that reduces 93-96% of all aerosols. Our office also now has an UltraHEPA filtration system, which filters all the air in the office continuously down to particle sizes of 0.003 microns.
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“Universal precautions” has always been the standard of care within dentistry, an approach to infection control to treat all human blood and body fluids as if they were known to contain infectious pathogens. Generally speaking, universal precautions covers the washing of hands, changing of gloves, gowns, and other PPE, sterilization of instruments and disinfecting all surfaces within an operatory after every patient. These precautions are not new, but they are ever important.
We know that many local dental offices have added many similar precautionary measures and hope that you find your dental office a place where you feel extremely cared for and protected against the transfer of any disease. We always strive to keep our staff and patients safe, all while maintaining your best oral health. We can’t wait to greet you with our smiles before putting on our surgical masks like we used to, but for now, know that we are happy to see you in the office once again!
Dr. Justin Pfaffinger, DDS, is a dentist in Grass Valley.
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