As most dental practices close out the year, we’re doing everything possible to complete our treatment plans for our lucky insured patients with jobs. With cases of COVID-19 surging across every state in the United States, though, most of us know people who have or have had COVID-19, and most of us are experiencing pandemic fatigue. But now we can see light at the end of the tunnel thanks to four reasons to be hopeful.
More Testing Options
By the end of November, 291 COVID-19 tests were approved under the Food and Drug Administration’s Emergency Use Authorization (EUA), with 225 molecular tests, 59 antibody tests, and seven antigen tests, as well as a new process for speedier approvals of tests. These templates provide the FDA’s current recommendations for submitting new tests for EUA.
There are also pre-EUA submissions for antibody testing using dried blood spots. Does the antibody know what time it is for home specimen collection using these point-of-care or home tests? The answer is soon, although we do not know how long antibodies will last either for new vaccines or for people who contracted COVID-19. Our best guess, at the moment, is at least six months or so.
Some recent reports indicate that patients can contract COVID-19 a second time, which is worrisome. Recently, the FDA authorized the first serology test detecting neutralizing antibodies from recent or prior SARS-CoV-2 infection, the cPass SARS-CoV-2 Neutralization Antibody Detection Kit.
In our practice, we performed an in-office point-of-care test for the mother of our dental assistant because Massachusetts required a negative test result before she could fly home. We took care of her with a surprise new root canal, in addition to the test, which involved a finger stick, a drop of blood in a well, and a few drops of the reagent in the other well. A few seconds later after rolling the plastic test template slightly, the window showed pink, meaning she was negative. It was so easy, like a pregnancy test and immediate. No lines, no wait, we joked, and no pregnancy!
Vaccines Are Almost Here
Vaccines will begin distribution when the Centers for Disease Control (CDC) will implement a phased allocation of COVID-19 vaccines in the very near future. The Advisory Committee on Immunization Practices at the CDC has reviewed data and approved vaccine distribution. When the FDA reviews and approves the vaccine soon, it will be released based on the priorities established by the CDC.
For example, four vaccines are in Phase III clinical trials, with two mRNA COVID-19 vaccines from Pfizer and Moderna expected to be approved within the next month. Six other vaccines are in Phase I/II clinical trials.
It should be noted that a similar category of mRNA vaccines has been effective against Zika virus, various flu strains, rabies, and cytomegalovirus. The CDC also has released information on how these mRNA vaccines work.
The FDA has been busy too. With the likelihood of two vaccine approvals soon, the FDA released an infographic on the process of vaccine approval, “The Path for a COVID-19 Vaccine from Research to Emergency Use Authorization,” and a webpage, Face Masks, Including Surgical Masks, and Respirators for COVID-19.
The latter provides a comprehensive overview of protection from the droplets and aerosols generated during medical and dental procedures, as well as patient speaking, talking, singing, and shouting. Also, the Occupational Safety and Health Administration has launched a website covering what it is looking for during its inspections, if you need motivation.
Let’s get clear about quarantine and isolation too. Recently, the governor of my state of Georgia, Brian Kemp, had to quarantine 14 days after exposure to Rep. Drew Ferguson (R-GA), a dentist, who contracted COVID-19. Rep. Ferguson isolated for 10 days. Rep. Rick Allen (R-GA) also has tested positive for COVID-19. There are currently 13 members of Congress in quarantine who have tested positive. So, there is no going back to the old days.
As we wait for the vaccines to be distributed and for an unknown amount of time after that, it will be prudent to follow current CDC guidelines. They call for healthcare workers to quarantine for 10 to 14 days, following a 15-minute exposure without mask; or, if there are symptoms, isolating from others for 10 days; or, if there are severe symptoms, isolate for 20 days after severe symptoms resolve. This is believed to help in reducing transmission.
Recently, the CDC offered new options depending on local prevalence and hospital bed availability. Basically, because prevalence of disease may vary, some options for quarantine based on local prevalence and hospital bed availability could shorten previous quarantine guidance.
So, quarantine could end after 10 days, instead of 14 days, without a COVID-19 test, only if the person has no symptoms or, after seven days, with a negative COVID test, with no symptoms. There is still a residual risk for these shorter options, but, with symptom monitoring, it is low.
Enhanced Infection Control
Unlike the spring when we didn’t know very much, we now have the interim guidelines from the CDC and the ADA. These guidelines are not final, because we are still learning about the virus. But dentists have upped their game on infection control.
During a June 2020 survey of 2,195 dentists, 99.7% said they had implemented enhanced infection prevention and control procedures, including disinfecting all equipment and surfaces that are commonly touched, checking staff and patient temperatures, screening patients for COVID-19, encouraging distance between patients while waiting, and providing face masks to staff.
While 99.6% of dentists reported using personal protective equipment (PPE) when treating patients, 72.8% used PPE as recommended by interim guidance from the CDC. During the time evaluated by the survey, there were limited supplies of PPE, particularly N95 or equivalent masks.
Remember the Hierarchy of Controls from the National Institute of Occupational Safety and Health? It says that eliminating the risks of disease via administrative controls is more effective than PPE. Remember that teledentistry eliminates risks and, as an administrative control, it is more effective than PPE. Yes, that’s right!
Teledentistry Stands at the Ready
If a dentist or staff member must quarantine or isolate, then what? Teledentistry, that’s what. Fortunately, virtual visits are fast becoming an evolving benefit, and safe entry point, for patients.
When Dr. Paul Glassman of California recently created a new teledentistry policy document for the ADA House of Delegates, there was much debate. I did my part by working with the Georgia Dental Association to ensure that both synchronous (live) and asynchronous (store and forward) teledentistry were included in the new ADA teledentistry policy, which the House of Delegates approved. Insurers are encouraged to pay for teledentistry. Some are paying for teledentistry, and some aren’t.
So, maximizing patient contact in the chair and ensuring that we maximize care for each patient is important. I have grown to prefer seeing fewer patients and providing more customized care for each patient. Plus, teledentistry appointments, scheduled at 15-minute increments between care appointments, enables me to see my patients without looking like an astronaut.
I am now concentrating on developing my webside manner. Yes, I miss taking off my gloves and mask and talking to my patients eye-to-eye. But using a teledentistry platform such as TeleDent by MouthWatch provides a safer, more convenient way to connect with them after treatment.
Teledentistry can be used during quarantine and isolation too to keep a practice going as cases surge. But unlike in the spring, we know we can use it as an ongoing patient and practice benefit, just like our new infection control practices.
We can easily eliminate what annoys patients most about their regular dental visits. There is no waiting room, the patient intake is done online, and the billing is handled digitally with automated systems. Patients like this!
Patients also like us more, and my staff is less stressed. Wow. We can focus on patient care! So here are some good things about the aftermath of COVID-19, despite its terrible toll.
After the next few bad weeks, there should be light at the end of this dark pandemic tunnel, with vaccine-acquired and naturally acquired antibodies becoming our protection. With widely adopted teledentistry, when the next pandemic comes, it won’t be so much of a risk. Meanwhile, we can keep providing the best oral care with teledentistry as a best practice with lasting benefits.
Dr. Scarlett is an infectious and chronic disease prevention specialist, practicing dentist, and author. For 30 years, she has provided expert guidance on infectious diseases and infection control as a consultant to the CDC, the World Health Organization, the Pan American Health Organization, the United States Agency for International Development, the American Red Cross, and many consumer health companies. Retired from the US Public Health Service as a CAPTAIN (0-6) after more than 20 years of service, including two years in the US Army Dental Corps, she proudly served as disease detective/epidemiologist at the CDC. During the Ebola outbreak of 2014-2015, she provided expert infection control guidance and training for the CDC to health workers and Public Health Service officers deployed to West Africa. Since 2005, she has been providing expertise and leadership to the CDC on pandemic preparedness and response, working with the CDC’s emergency operations center, various CDC centers and institutes, and various private and public sector partners to mitigate epidemic impact on daily life and workplaces. She can be reached at firstname.lastname@example.org and (404) 808-9980.
Disclosure: Dr. Scarlett is a consultant for MouthWatch.