After the initial outbreak of COVID-19 shut down almost 200,000 dental practices in the United States in early 2020, the industry needed to quickly develop an effective response that would not only allow practices to reopen safely but also ensure that patients could access the oral care they needed. The overall pandemic response, which involved coordination between federal, state, and professional associations, created a vital blueprint for how dentists could move forward safely – with or without a proven vaccine.
Within a year since the first U.S. patient was diagnosed with COVID-19, the usual infection prevention protocols in healthcare settings had to be adapted to include the new, more infectious risks presented during the pandemic. Because the virus spreads through the air in respiratory droplets, dentistry quickly became a high-risk profession. As such, the guidelines created to account for these risks ultimately needed to protect patients as well as clinical and front office staff.
Tools of the trade
Investment in personal protective equipment (PPE) became a priority for dental practices, both small and large. As we learned more about how the virus passes from human to human, it became clear that protection from aerosols, which are a normal part of dentistry, would become paramount. Protective gear, sterilizers, and disinfectants have become the foundation of the new normal all healthcare professionals are embracing. The tools making the most impact against COVID-19 range from PPE, like masks and face shields, to cleaning solutions, including surface disinfectants and sterilizers.
Here’s what oral health professionals need to know:
N95 respirators: This specific type of respirator forms a seal around the user’s nose and mouth to protect against airborne particles and liquids. Some N95s have exhalation valves that can make breathing easier; they are not recommended when sterile conditions are required.
Face shields: These clear plastic shields provide clinicians with protection against spray and splatter without interfering with the field of vision. They should be large enough to protect the entire face and head. Look for anti-fog shields and those with methods of wear – such as wrapping around one’s head or resting on shoulders – for added comfort.
High volume evacuator (HVE) isolation shields and systems: These systems help maintain clean, dry working areas while blocking any aerosols that might be expressed from a patient’s mouth. In addition to the suction process, shields also are now used to establish a barrier that prevents respiratory droplets from being released into the air. Overall, the systems are estimated to cut back about 90% of aerosols escaping into the air thanks to high-volume suction, isolation, and moisture control features.
UV sterilizers: Ultraviolet (UV) light can be used to eliminate 99% of pathogens from surfaces by penetrating microscopic organisms and destroying their acids. There are many models of these sanitizers, ranging from portable and wall-mounted solutions to wands, robots, and desktop products. The biggest advantage of UV light is that it can reach everywhere. Surface disinfectants: Disinfectant sprays and wipes can kill most pathogens, which is essential to preventing infection transmission. The solutions are designed to clean and disinfect surfaces in high-traffic and clinical areas. It is advised
that all countertops and dental units be cleaned and wiped down with an Environmental Protection Agency (EPA)-approved surface disinfectant. As alternative, use barrier protection on the same surfaces, such as chairs and trays.
When caring for well patients, Occupational Safety and Health Administration (OSHA) makes the following PPE recommendations:
Nonaerosol-generating procedures
- Work clothing (e.g., scrubs, lab coat, smock, gown)
- Gloves
- Eye protection (e.g., goggles, face shield)
- Face mask
Aerosol-generating procedures
- Gloves
- Gown
- Eye protection
- NIOSH-certified, disposable N95 respirator
When caring for patients with suspected or confirmed COVID-19, OSHA makes the following recommendations:
Nonaerosol-generating procedures
- Gloves
- Gown
- Eye protection
- NIOSH-certified, disposable N95 respirator
Aerosol-generating procedures
- Gloves
- Gown
- Eye protection
- NIOSH-certified disposable N95 respirator
Navigating the new routine
Because tooth decay doesn’t stop during a pandemic, clinicians have had to adapt to meet the needs of patients while meeting the new and unprecedented challenges during the past year. From shutdowns and quarantines to reopening and rethinking how entire practices are structured, COVID-19 has demonstrated that the healthcare industry can develop new solutions to alleviate risks while still providing the same trusted care.
The financial and emotional toll of this pandemic may never truly be calculated, but for dentistry to be able to reach patients in need of treatment, surgery, and even basic checkups, the new measures have proven to be effective and lifesaving. They also will likely change the way the profession moves forward. The new skills and clinical knowledge that have been mined as the result of COVID-19 clearly demonstrate that the dental professionals can evolve to meet the demands of even the most unexpected health crises.
For example, restrictions on aerosol-generating procedures created the opportunity to take less invasive approaches to care. In addition, fewer patients are being admitted to a practice at any one-time, short telephone triages are being carried out to determine if patients are a risk even before arrival, and new protection measures have become the norm.
While PPE also has been upgraded to account for COVID-19 risks, other tools and solutions have been introduced, such as using dental dams to reduce the amount of aerosols that are formed, and administering oral rinses to patients before any procedures, which has been proven to reduce the risk of infection, most notably in a surgical site. Oral rinses also can reduce the presence of the virus in the oral cavity.
Overall, the lessons learned from a pandemic are helping to reshape the way dental professionals treat patients, with an emphasis on new and improved infection prevention, safety, and peace of mind. By mitigating risk, the dental industry continues to treat patients using proven safety measures. And though most dental professionals agree that the new normal is likely to continue even after a vaccine is available, the lessons learned will undoubtedly shape the dentistry in decades to come.
Selected references
Nasseh K, Vujicic M. Modeling the impact of COVID-19 on U.S. dental spending – June 2020 update. Health Policy Institute.
American Dental Association. COVID-19 economic impact on dental practices.
California Dental Association. COVID-19 information and FAQs. April 7, 2020.
Bhanushali P, Katge F, Deshpande S, Chimata VK, Shetty S, Pradhan D. COVID-19: Changing trends and its impact on future of dentistry. Int J Dent. 2020.
Occupational Safety and Health Administration. Dentistry workers and employers.
Patient Safety Network. COVID-19 and dentistry: Challenges and opportunities for providing safe care. August 31, 2020.
U.S. Food & Drug Administration. N95 respirators, surgical masks, and face masks. August 20, 2020.
Kaiser M. UVc sterilization works in large health-care settings. What about dental offices? Dentistry IQ. July 21, 2020.
OSHA Review, Inc. Environmental surface disinfection: CDC’s guidelines for dental offices – simplified. TDA Perks Program. April 3, 2018.
Watt RG. COVID-19 is an opportunity for reform in dentistry. Lancet. 2020;396(10249):462.
Passarelli PC, Rella E, Manicone PF. Garcia-Godoy F, D’Addona A. The impact of the COVID-19 infection in dentistry. Exp Biol Med. 2020;245(11):940-944.
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A version of this blog post appears in the January 2021 publication of OnTarget. Read the latest issue and current promotions: pattersondental.com/dental/ontarget
