Recently I’ve observed a number of dentists (and have been told about others) who have not modified the way they practice during these difficult and scary times. Hopefully, they are few and far between. But, I feel a deep responsibility to you, the patient, to give you the information to know for sure if your dentist’s office is safe during COVID.
Oh, how I pine for the halcyon days before COVID when one could meander down the streets of the Big Apple taking in the sights and peering through the windows of the shops and boutiques that beckoned passers-by to enter.
I miss grabbing a bite and a cold one on the fly at my local dive bar or relaxing at my favorite bistro bustling with patrons. I miss people-watching, that is when you could see everyone’s faces. “Back in the day” we needn’t wear masks.
Life, as we knew it before COVID, as mundane and routinized as it may have seemed back then, has been on hiatus. It’s hard to believe that six months have passed since the “great shutdown.”
Thankfully and happily, in New York, the viral tidal wave of despair and destruction seems to be receding. Vestiges of the good old days are gradually being restored, although midtown Manhattan remains mostly vacant, theatres are shuttered, and restaurants are hanging on for dear life. But now you can get a haircut and actually go shopping. There is an experiential difference between standing online to shop in a real store versus shopping online.
Three months ago, dental offices in New York City got the green light to provide routine and comprehensive care to the general public. Hallelujah! Yes, you can now visit your dentist and have that long-overdue cleaning or continue a treatment plan that was on pandemic pause. If you had your last dental cleaning before the pandemic began, you probably are feeling the effects of your long overdue appointment.
If you were in the midst of a long-term treatment plan when the shutdown happened, you could be experiencing a twinge-ing reminder of “treatment interrupted.” (After you finish this article, you may want to peruse “Caring For Your Teeth During Quarantine“)
But, is it truly safe to have dental care during these times when thoughts of viral infection are never far away? Or perhaps more to the point, is it safe to have dental care in your dentist’s office while the pandemic’s pall is still lurking?
It was truly traumatic for those of us who reside in the Greater New York City area – we experienced such dark hours, days, and weeks while the virus took its destructive toll. Some people are still reluctant to venture far from home. If going to the supermarket gives you pause, then the idea of sitting in a dental chair, face sans mask, within inches of your dentist, dental assistant, or hygienist could be “a bridge too far.”
The Perils of Aerosols and Droplets
In days past, the familiar air and water spray of the dental drill and the mist of the ultrasonic cleaner were just innocent by-products of dental care. But considering the “plague that is upon us,” all that spraying does not seem so innocent. But, with all the clamor about the perils of aerosols and respiratory, many people are even hesitant to step into an elevator – even an empty one:
“Did the previous passenger wear a mask?” “Did someone sneeze or cough in there?”
So, it’s not a stretch to say it’s scary to step into a dental treatment room with the knowledge that a preceding patient was treated there.
“Is dental spray with potentially virus-tainted aerosols still lingering in the air?”
During COVID Dental Care Is Safe – When…
Truth be told, routine or even comprehensive dental care is safe, even today. But when, and only when, the dental practice adheres to the safety protocols handed down by the CDC, the American Dental Association, and the other organizations charged with ensuring the public’s health.
So, this is the question that should be at the forefront of your mind:
“Has my dentist implemented the necessary safeguards to help ensure the safety of not only patients but of the entire dental staff?
My hope and belief are that most dentists have implemented safeguards. But, an educated patient in the context of COVID-19 is a safe patient, and it’s best to err on the side of caution.
Today, it’s not business-as-usual for dental practices. There’s a new game in town, and it is called SARS-CoV-2, the novel coronavirus responsible for COVID-19.
Is Your Dentist’s Office Safe?
5 Clues You Should Look For
Dental offices are accustomed to disinfection, sterilization, and infection control. But, these are not normal times, and taking extra precautions is critical. As I said, it is not business as usual.
In these pandemic times, modifications in the workings of the dental office are required. They include decreased patient volume to allow for social distancing and more time between patients for the staff to thoroughly disinfect the room.
If the practice is following proper safety protocols, most of them will be obvious to you. Here’s what you should be looking for:
1. Are Patients Being Screened?
Fact: if the virus is prevented from entering the office, it can’t be spread in the office. In the hierarchy of safe practices to reduce infection risk, every patient, staff member, and the doctor must be screened before and upon arrival. This is by far the most effective way to prevent the virus from entering the office.
For you, the patient, the screening practice should begin on the phone when your appointment is scheduled. You should be asked a series of questions that help determine your current health status and potential exposure to the virus. These questions deal with the disease’s symptoms and possible exposure to it by social contacts or recent travel from hotspots. If any of your answers raise concerns, your dentist should ask to speak with you before your appointment is scheduled.
2. Are There Obvious Changes In The Reception Area & Waiting Room?
You should notice obvious physical changes when you arrive. The waiting room should have minimal available seating. There should be no books or magazines on display and no toys for children as they are potential vectors for contact spread. There should be an abundance of hand sanitizer ready for use.
You should see protective barriers like plexiglass sneeze guards and signs posted reminding you about safety tips such as proper cough etiquette.
And, everyone in the office, including the administrative staff, should be wearing a mask at all times.
3. Is There A New Policy Regarding Patient Arrivals?
To minimize the number of persons in the office and allow for physical distancing, you may be asked to call the office when you are in the immediate vicinity to ensure that your treatment room is ready. If you live in the suburbs, you could be asked to wait in the car.
You should be required to wear a mask upon entering the office. Your temperature should be taken (as is the entire staff’s, every day), and you should be asked to perform hand hygiene.
You should see fewer patients than normal in the office. We shoot for zero people in the waiting room. Ideally, you should be immediately escorted to the dental treatment room to keep the waiting room empty or minimally occupied to allow for social distancing. If your treatment room isn’t quite ready, you should have a very short wait.
(Again, it is not business as usual.)
4. Are There Obvious Changes In The Treatment Room?
Since all dentistry occurs in the treatment room, it is literally ground zero. As such, the door should be closed immediately when you’re seated. This isolates the room from the rest of the office. Again, you should be asked screening questions because a lot can happen in the 24-48-hour period since you made your appointment.
And, the treatment room should be spotlessly clean.
(I’d like to emphasize, again, that dental professionals are well-trained and well-versed in infection control protocols. We have been contending with, and safeguarding against, exposure to HIV, hepatitis, and other blood-borne pathogens for decades.
But, the transmission of COVID-19 is a different animal. It is passed from person to person by way of respiratory droplets that gain entry through one’s eyes, nose, or mouth. Droplets containing the virus can contaminate surfaces and may remain viable for an extended period. Hence the importance of frequent hand hygiene, and, of course, allowing time for thorough disinfection between patients.
5. What’s Being Done About Dental Aerosols?
The practice of dentistry is synonymous with aerosol production. Our tools of the trade – the drill, the ultrasonic cleaner, and the air and water syringe – all produce aerosols. Thankfully, several new modifications and technologies have been designed that mitigate the potential peril of coronavirus-infused dental aerosols.
Sure, personal protective equipment (PPE) is of critical importance (more about that coming up), but what about the air you’re breathing while you are sitting in the dental chair without a mask?
(Note: I haven’t yet figured out how to treat a patient with a mask on, but I’m trying!)
Engineering Changes You Should See In The Treatment Room
During the shutdown, I spent a significant amount of time researching solutions to make my office safe for my staff and patients when we finally re-opened. I ultimately invested in two systems, and, after having them in place for the past few months, I am convinced that using them together provides a clean and healthy environment in my office.
In my opinion, it behooves every dental practice to implement these safeguards. Here’s what you should be looking for at your dentist’s office:
Extra-Oral Suction Systems
In my opinion, extra-oral suction systems are must-have pieces of equipment for every dental office. The device is essentially a specially designed vacuum that suctions-up the air containing most, if not all, the aerosols and droplets generated during a dental procedure. It then draws this potentially contaminated airstream into a hermetically sealed receptacle where it is then purified by a series of filters, including a HEPA filter. The airstream then passes through an ultraviolet light chamber that kills any residual virus before it is released as pure, clean air.
Extra-oral suction systems eliminate viral contaminants at the source. They help to prevent them from floating in the room air for anyone to breathe. They also minimize the potential contamination of exposed surfaces such as countertops.
You should be able to see an extra-oral suction system positioned at the chair side, like in the photo above. You can’t miss it.
(Learn more about extra-oral suctions systems here)
Surgically Clean Air Purifiers
Because no one system is 100% fool-proof, I wasn’t about to take any chances with the well-being of my patients and staff. So, I invested in a second technology – surgically clean air purifiers.
There is an abundance of air purifiers on the market whose manufacturers promise their HEPA filters will eliminate odors, allergens, pet dander, and viruses. They are readily available at retailers such as Amazon, Home Depot, and Bed Bath and Beyond. These purifiers are perfectly suitable for home use.
But then there are air purifiers specifically designed and engineered for clinical and industrial settings. One such medical-grade air purifier was developed by a company called Surgically Clean Air. And that’s what I chose.
Surgically clean air purifiers have very sophisticated filtration systems that remove not only viral-sized particles but also process large volumes of air. I’ve placed them in each of my treatment rooms and in the reception area. Each unit has a series of six filters, an ultraviolet light chamber, and the capacity to process more than 400 cubic feet of air per minute.
In other words, the entire volume of air in each of my treatment rooms exchanged and purified more than 25 times per hour! The staff and I take pride in pointing them out to our patients when they sit down. But you can’t miss them.
(More info about surgically clean air purifiers can be found here)
A Word About Personal Protection Equipment – PPE
When I was in dental school and during the infancy of my career dentists did not wear gloves or masks – it’s so weird to think about that now.
Today, dental teams must wear masks and gloves during patient care and have been since HIV and AIDS emerged in the 1980s. But with COVID, our PPE has expanded to include not just regular surgical masks, but N95 respirators/masks or their equivalent. We also wear gloves, face shields, surgical gowns, and head coverings.
It was certainly a sweltering summer, even hotter with all the additional layers, and I am thankful to have a new and efficient air conditioning system that not only kept us relatively comfortable but also ensured good ventilation and air movement in the office.
Something to think about is this: dental teams are the ones with the most significant risk and PPE prevents infection from spreading to the dental team and protects you, the patient, during the up-close and personal contact necessary for care.
If the virus can’t get in, it can’t get out.
Some Strong Words –
Obviously, implementing all the safety measures outlined above involves a significant financial investment for your dentist. And, as you can imagine, that’s not easy after enduring a three-month shutdown. But, if patient safety is at the top of your dentist’s priority list, there’s no other choice than to make the investment.
The American Dental Association is working hard with the CDC to educate and keep all U.S. dentists informed about the nature and the mode of transmission of SARS-COV2 and the necessary protocol required to practice dentistry safely.
Sadly, I’ve observed some dentists (and have been told about others) who have not modified the way they practice during these difficult and scary times. Hopefully, they are few and far between, but…
I believe these dental practices pose a public health threat.
I recognize these are strong words, but I am passionate about this. I want you, the patient, to have the best information to make the best decisions about your health and safety for yourself and your family.
Please, ask questions, be observant, and, most of all, if you don’t feel safe – find another dentist.
Be well. Be safe.
Dr. Michael Sinkin
Acknowledgments: I would like to take this opportunity to acknowledge and express my gratitude to two extraordinary people who have become valuable resources to me.
First, there is Kate Mooney at Surgically Clean Air. We were frequent online pen-pals while I was seeking the best solution for air purification in my office. Supply chain interruptions were a distressful reality, especially during the early expansion of this still ongoing pandemic.
Kate was very responsive to my frequent phone calls, texts, and emails. She exceeded my expectations in customer relations and service. And, she went beyond the beyond and was critically instrumental in my procurement of the superb air purifiers that sit in my office today.
Secondly, I’d like to acknowledge Meredith Kimball at the CAO Group, suppliers of the Aegis Extraoral Suction System. She was so available and generous with her time while assisting me in choosing the perfect system for my office. She’s as friendly as she is efficient. I can’t thank her enough. (it’s nice to have a new friend in Utah!)
Dr. Michael Sinkin is a highly-respected general, cosmetic, and implant dentist in New York City who’s been practicing for over two decades in midtown Manhattan. Dr. Sinkin truly cares about his patients and takes great pride in making them feel relaxed and comfortable during every visit. He’s also known for his wicked sense of humor. Call for an appointment and experience a different kind of dental practice. To find out more about Dr. Sinkin, please link here.