Post COVID Dentistry – Safety & Prevention

Reopening a dental practice post COVID-19 is a welcome event. But while opening the doors is a welcome event, it's not as simple as opening the doors and getting back to normal.

We have new guidelines to follow. We have new demands from our government, team members, and even patients. Expectations of our practices have never been greater. Our patients need to be confident that they are safe in our offices. Our team members need to as well. Thus, we must take very deliberate steps to ensure our practices are a safe, welcoming place for everyone.

We've been monitoring the best and latest information for you to help you successfully reopen your practice. Here are key steps to minimize health risks when reopening your practice post COVID-19.

Prepare Your Dental Practice for New Oversight and Regulations

Regulations and oversights used to move slowly. COVID-19 changed that. In a matter of days, we were told to cancel elective dental procedures. That forced many dental practices to close completely. Others were open only for emergency visits.

As we reopen, consider whether you want to perform emergency procedures or even virtual consultations should COVID-19 flare up again. Put a plan in place should regulations return over the the next few months. Will you perform emergency procedures? Will you conduct virtual consults? If so, how? Who will handle those? Will you promote that your office is open for emergencies and virtual consultations? If so, have your messaging in place so you can get started quickly.

Similarly, connect with reliable communities associated with your practice on social media channels. There, you can connect with other people in various areas navigating the post-COVID-19 world. You can shared obtain resources and information to maintain flexibility and be in a better position to navigate any future disruptions.

Establish Additional Safety Procedures for Post-COVID-19 Heath Risks

Review the ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission. In there, you will find guidance for minimizing risks before dental care starts, during dental care, and after dental care is provided.

For example, before dental care begins, the ADA recommends you address the following three issues.

1. Dentist and Dental Team Preparation

We must have procedures in place to ensure the safety of the staff. This includes ensuring all dental health care personnel have received their seasonal flu vaccine. Any team members experiencing influenza-like-illnesses should be allowed and advised leave from work. Those who are of older age, have pre-existing, medically compromised conditions, or low immunity should take extra precautions.

Practices must also ensure that team members self-monitor, check their temperatures, and remain alert to symptoms of COVID-19.

Other preparation suggestions include:

1. Being diligent in ordering personal protective equipment. These items may be in short supply from time to time.
2. Removing magazines, reading materials, toys, and other objects that may be touched by others and which are not easily disinfected.
3. Printing and placing signage in the dental office for instructing patients on standard recommendations for respiratory hygiene/cough etiquette and social distancing.
4. Scheduling appointments apart enough to minimize contact among patients.
5. Preventing patients from bringing unnecessary companions to their appointments.

Together these preparations will minimize the spread of COVID-19 for everyone in the office. Communicate these procedures to all staff and patients so they can comply. They will also be comforted that you are taking these precautions.

2. Screening for COVID-19 Status and Triaging for Dental Treatment

While minimizing the spread is important, the ADA also recommends putting in place screening and triaging procedures.

Specifically, the safest way to reopen is a phased approach, focusing only on emergency or urgent care.

While doing so, the ADA suggests making every effort to interview patients by telephone, text, or video before their visits. Utilize these COVID-19 interview and assessment guidelines from the CDC when interviewing patients. Review the ADA interim guidelines for how to handle patients with various symptoms. The ADA recommends that patients to be seen seen in dental settings should be –

• asymptomatic patients
• patients who have tested negative for COVID-19 infection or
• recovered patients (after 3 days since the resolution of signs and symptoms)

You can make screening simpler by making use of pre-registration digital patient screening systems. These help you screen and register your patients' appointments along with their signed informed consents – all before they visit your clinic!

3. Take precautions

Precautions upon patient arrival –

When a patient arrives, request them to wait in their personal vehicle. Communicate this policy before the appointment.

Ensure team members keep adequate supplies to reduce the spread of germs, such as appropriate hand sanitisers, tissues, and no-touch trash receptacles.

Precautions during dental care –

The ADA recommends taking extra precautions during dental care as well, including the following –

A. Adhere to both Standard and Transmission-based Precautions and Personal Protective Equipment (PPE).

Standard precautions are the minimum infection prevention practices. These include:

1. Hand hygiene
2. Use of PPE
3. Respiratory hygiene/etiquette
4. Sharps safety
5. Safe injection practices
6. Sterile instruments and devices, and
7. Clean and disinfected environmental surfaces.

In addition, implement transmission-based precautions, such as:

1. Patient placement (e.g., isolation/different aerosol operatory)
2. Adequate room ventilation
3. Respiratory protection (e.g., N-95 masks) for team members, or
4. Postponement of nonemergency dental procedures.

The ADA also recommends replacing PPE frequently, with surgical masks being replaced between each patient. Wear face shields to protect yourself, especially during procedures likely to generate splashing or spattering of blood or other body fluids.

B. Adjust clinical techniques.

Ensure all team members review the ADA's guidance for clinical techniques that minimize risk of infection. These include guidance about handpieces, equipment, disinfectants, and taking other important precautions during treatment.

C. Address suspected unintentional exposure quickly and schedule appointments to minimize risk.

Follow CDC recommendations in the event of suspected unintentional exposure. This includes knowledge of instructions regarding when and where to send for testing. Include information about how to justify the need for testing and how to contact the dental practice to report results. If a test is positive, the office needs to report the exposure to all team members or patients at risk.

Additionally, schedule appointments to minimize risk. For example, the ADA suggests aerosol-generating procedures should as the last appointment of the day.

Put post-dental care procedures in place to increase safety.

Put policies in place to ensure safety post-dental care. This includes both practice procedures in between patients as well as adjusting post-operative instructions for patients.

1. Enhance safety procedures in between patients.

While practices regularly engage in cleaning between patients, take extra care to reduce transmission risk. This includes cleaning or replacing PPE and disinfecting non-dedicated and non-disposable equipment.

2. Update post-operative instructions to patients.

Review the latest guidelines regarding appropriate post-operative treatment. For example, there is controversy regarding whether ibuprofen is appropriate to take in light of data suggesting it might harm patients with COVID-19. Thus, you might consider recommending other medications to manage pain in case a patient has COVID-19 but is asymptomatic.

Teach team members to protect themselves and their families after work.

The ADA suggests team members should change from scrubs to personal clothing before returning home. Upon arriving home, they should take off shoes, remove and wash clothing, separately from other household residents, and immediately shower.

These activities will help reduce the risk that a team member brings COVID-19 to their families.

How are you preparing to reopen your dental practice post-COVID-19?

While reopening your dental practice post-COVID-19 is exciting, it must be done with safety in mind. Not only will that protect you, your team members, and your patients but it will also help you make everyone feel safer in your office.

How are you preparing your practice to be reopened? Let us know in the comments section below.