Dentists, who would have thought the movie “Outbreak” would become reality? No, we don’t have an infected monkey running around or Dustin Hoffman running around in camo. We are dealing with something far more dangerous because we cannot see it. We don’t understand it and we cannot contain it. Worse off, there is no magic prevention. These teeny tiny genomes call themselves coronavirus - surname SARS-CoV-19, have infected almost 5 million people worldwide and have killed 323,000. What else do we know? We know that we are working in the most susceptible environment to spread the novel coronavirus. Dentistry, we know it has changed forever. But what can we, as dental professionals…….
THE PAST - AS WE KNEW IT
Let’s take two examples of life-threatening illnesses and / or infections: tuberculosis and HIV. Tuberculosis is a dangerous bacteria infection that attacks the lungs. It is spread person-to-person through microscopic droplets released in the air by a sneeze or cough. At least you can take an antibiotic for it. The CDC and OSHA recommended that dental practices have protocols in place for protecting their employees from TB exposure including withholding dental treatment to patients who exhibit active TB infections, and, at the very least, the use of an N-95 respirator for protection from this bacteria. Just as contagious, and possibly even more dangerous, is the threat of HIV. While all of you doctors have done a great job following guidelines that are chiefly designed to prevent the spread of bloodborne pathogens since the HIV/AIDS epidemic in the 80’s, that cute little infected monkey is still running around out there with no vaccine. Quick example: a dentist in Florida, Dr. Acer, transmitted HIV to six of his patients. Both the doctor and the patients had the exact same strand, yet to this day it is still undetermined how Dr. Acer transmitted the deadly disease, leaving this the only known incident of HIV transmission from a dental office.
THE PRESENT- AS WE KNOW IT
Our new norm includes constant breathing, touching, tasting, spreading, preventing and contracting an extremely contagious airborne threat to our life. Unfortunately, our industry has been elevated from “high risk” to “tremendous risk” and this new norm will soon be life as we know it. For dentists, the thought of a virus in aerosol that is highly contagious with no real preventative solutions is a nightmare. Furthermore, the idea of social distancing, or 6 feet apart, works in conversation and ultimately is becoming just that - an idea. In our practices, it’s impossible. But still, we need to get to work. So in order to open our doors again, the league has changed some of the rules. If we want to play, we have been instructed to up the PPE ante in order to participate. But, herein lies the problem - many players on the ‘team’ are still refusing to play.. At the end of the day, we can all agree that no practice wants to be the ‘first’ who had a patient that contracted Covid-19. So instead of reacting, players become semi-proactive by implementing some, or part of, the “interim” provisions recommended by league commissioners a.k.a. CDC, OSHA, EPA, local and state government health officials. Some are seeking guidance from one another through Facebook Groups, Twitter and Dentaltown. The problem is that the leaders of these social-distant-networks are not on the same page of the playbook.
It is still unknown whether the novel coronavirus is mainly transmitted through the aerosols, but Shelley Miller, Professor of Mechanical and Environmental Engineering, University Colorado Boulder is certain and writes, “Public health officials still don’t know whether direct contact, indirect contact through surfaces, or aerosols are the main pathway of transmission for the coronavirus. But everything experts like myself know about aerosols suggests that they could be a major pathway of transmission.” Bottom line - Exposure to infectious aerosols is prevalent in the dental office.
THE FUTURE STANDARD OF CARE WE WILL SOON LEARN
WE MUST CONTROL THE AEROSOL
In no way am I making light of the current situation dentists are facing right now by using sports analogies in this blog. But, this is not “The Last Dance” for us. We need to realize that the biggest threat facing dentistry is the control of aerosols that are present in every dental practice. Aerosol containment is the future standard of care in dentistry. Check out the white paper written by Dr. David Ahearn, email me for your copy!
From the reasonable to the absurd, extra-oral suction devices are gaining momentum in the dental world's fight for Covid freedom. In a recent article published by Dr. Rella Christensen in Dental Economics comments on products she noted as exceptional and can be engineered to convert a dental operatory into negative air space. She goes on to say, “Safe-T-Shield [Ergonomic Products] provides high quality vision through a plastic shield that places a transparent barrier between the heads of the clinician and the patient. The shield is attached to a suction arm that pulls the aerosols under the shield and through an arm into HEPA filtration, and then releases purified air into the operatory or outdoors.”
I believe it is only a matter of time before dental practices are considered incubators, or scapegoats, for the transmission of viral airborne aerosols. How much more ammunition do our patients need to justify not going to the dentist? They will develop a vaccine for coronavirus but it will never go away. Like the flu, many strains of Covid will pop up. It is already happening.
