The ADA and other groups are encouraging dental practices to only provide emergency and other essential care, postponing elective treatment, because dental professionals face an especially high risk of occupational exposure to COVID-19.
“During the current outbreak, we have really good ways to prescreen patients: by taking their temperature, asking them questions regarding travel in the last two weeks, asking how they’re feeling and if they have flu-like symptoms,” said Fotinos Panagakos, PhD, vice dean of administration and research for the West Virginia University (WVU) School of Dentistry.
“But they may still answer no to all of those questions, and their temperature may be normal, but they may still be infected though they’re not showing symptoms yet,” said Panagakos.
Patients’ coughs and sneezes aren’t the only ways dentists can come into contact with the virus either.
“In dentistry, many of the procedures that we do require using a handpiece to drill a tooth, or an ultrasonic scaler to clean the teeth,” said Panagakos. “The water used can form an aerosol. If you aerosolize something, it’s going to end up in the air. You can just imagine what that means if a patient is carrying the virus.”
WVU notes that dental professionals already have protocols they can follow to minimize their exposure and their patients’ exposure to infectious material during treatment. Meanwhile, there are things patients can do, too.
“The American Dental Association just issued a recommendation that all dental offices suspend providing elective dental care for the next three weeks. It’s to minimize the risk of coming into contact with somebody who may be infected and preventing that spread,” said Panagakos.
“Call the dental office, if your office, hasn’t reached out to you already, to determine whether you should come in or not. If it’s a cleaning or a checkup, it can be delayed another two weeks to a month. That’s not going to be a big issue,” said Panagakos.
“If you’re having an actual dental emergency that involves pain, if you have swelling or if you have an apparent infection in your mouth, contact your dental provider right away and find out how they’re managing those emergency cases. Most offices may see you, or they may refer you to another location that’s seeing emergencies,” said Panagakos.
“For example, we [at WVU Dental Care] may end up starting to see emergencies from private practices that are closed within the Morgantown area. We’re anticipating a potential uptick in emergency patients over the next couple weeks. But we’re here to provide care to the community. That’s what we’re all about,” said Panagakos.
Still, WVU says, patients should consider the health of the dental team and other patients too before they make that call.
“If you’re sick, you shouldn’t come in unless it’s an absolute emergency. I would say to consider not only the clinicians who are going to be managing your care but also anyone else you may come into contact with along the way. So, that’s the first step,” said Panagakos.
“Call the office ahead of time to let them know you have an emergency and are also not feeling well. If you feel fine but you think you may have been exposed to the virus because of a family member who is ill or someone else you came into contact with, I strongly recommend to call the office ahead of time and let them know that this is a possibility,” Panagakos said.
“’Hey, I’m in this situation. I’m in pain. What should I do?’ And they may still see you. They may just take some extra precautions before you come in. It’s always good to communicate before you show up at the office,” said Panagakos.
Plus, WVU reminds dentists about the need to wear masks during any procedures they may be performing.
“There are masks, like the N95 respirator-type masks, that are more protective than the surgical masks that are routinely used by dental professionals. Those can be worn, but they need to be fit-tested to wear them. It’s not just taking one out of the box and putting it on,” said Panagakos.
“If you don’t have the ability to do the fit test, it could pose a challenge to using this mask. Plus, they haven’t proven to be 100% effective in preventing respiratory infection after coming into contact with a patient who has a viral respiratory disease,” said Panagakos.
“There was a study published in the Journal of the American Medical Association, where they actually compared routine surgical masks that we usually see clinicians and healthcare professionals wearing, as well as people out and about on the street, against an N95 mask in settings where healthcare professionals were exposed to patients who had a known viral respiratory infection,” said Panagakos.
“The level of infection that was transmitted to the professional was 8% for the surgical mask and 7% for the N95 mask. So while the mask provides protection, there are other ways a healthcare provider can become infected,” Panagakos said.
“In the dental office, aerosol could result in the virus landing on exposed skin, like the face, or the hair. The person could touch this later and pick up the virus. That’s why they tell you to wash your hands and not touch your face, beyond just protecting the respiratory system,” said Panagakos.
Though surgical and N95 masks aren’t always sufficient, WVU says, dental professionals can still take other steps to improve their chances of avoiding the virus.
“For any patient, regardless of what’s happening right now, we use what the CDC and OSHA define as ‘standard precautions.’ For the most part, because we’re in the oral cavity, we’re going to wear eye protection that has side shields, or a full face mask, to prevent things from getting into the eyes as much as possible,” said Panagakos.
“We’ll wear a surgical mask. We’ll wear gloves. We’ll wear a gown over our clothes. The gown needs to come up to the wrist and meet the glove so there’s no exposed skin in that area,” said Panagakos.
“Those are standard precautions whether we’re managing a patient with bloodborne infection or a patient with a respiratory disease or a patient who has some other infection,” Panagakos said. “That hasn’t changed at all.”