Lasers Can Play a Key Role in Improving Infection Control

Howard Golan, DDS
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As dental offices reopen across the country, there is a common challenge to navigate the new normal. Many New York-based dental offices, including Golan Family Dentistry, remained open during the height of the pandemic for emergency procedures. This provided us with additional time to adjust to the new procedures that we continue to carry out today.

By June 8, all dental practices in New York were allowed to fully open by Governor Andrew Cuomo and received eight pages of reopening guidelines to keep patient and staff safety the foremost priority. Currently, the full scope of work is permitted for these offices, with no limitations on procedures as long as state guidelines are followed. These guidelines include limited capacity for patients and added disinfection time between each visit.

It will take time for dental practices to build back up to our typical cadence of patients. I remember Superstorm Sandy when our office had no power for six days. We were lucky, as some lost their homes and practices. However, it took us six months to return to normal. This is partly due to the fact that once patients get out of the habit of coming to the dentist, life gets in the way and it can be difficult to get back into a routine.

 

Infection Control & Safety Practices

To begin taking steps toward having patients get back into their routine dental care, dental practitioners first must ensure infection control and safety practices are in place and communicated. Practices are responsible for adding a multitude of safety protocols to protect both patients and staff. Some of the new protocols that my practice has implemented include air purifiers, sneeze guards, thermometer readings, gowns, better-fitted masks required throughout the office, patients waiting in their cars rather than the waiting room, and increased disinfection procedures.

Though we have been following the protocols put in place by New York and the Centers for Disease Control and Prevention (CDC), in addition to guidance from the ADA, we have added safety measures of our own to protect everyone who enters our doors. As a biologic and alternative office, we have always looked to science to exceed safety standards. This is especially important for bacterial and viral agent reduction. Many of these safety practices have already been in place for years. In fact, dental offices have historically gone above and beyond in infection control and have been personal protective equipment champions.

Aerosol-Generating Procedures

A newer discussion is around the concern in spreading COVID-19 through aerosol-generating procedures (AGPs) since the ADA has recommended reducing aerosol production as much as possible to help prevent transmission of the virus. Traditional high-speed handpieces can produce water droplets in aerosol that can carry and spread the virus.

While data about the risks of AGPs is still emerging, it is always better to be safe than sorry when it comes to the safety of our team and patients. To continue providing treatment, we use a Biolase Waterlase dental laser, which produces approximately 98% less aerosol than traditional dental handpieces.

In addition to using less water, the dental laser has a much lower radius of aerosol spray. We are also pleased that the dental laser has microbial reduction benefits, which can limit patient inflammation. This not only limits the spread of the virus, but also allows patients to feel more comfortable. As a dental laser practice for the past 15 years, it has been easy to increase laser use in additional procedures.

This includes diode lasers used for laser bacterial reduction (LBR). This noninvasive method uses high-intensity light to kill harmful bacteria without the added aerosol production from ultrasonic scalers. The CDC has recommended not using ultrasonic scalers to prevent the transmission of COVID-19. Utilizing lasers in addition to manual instruments is yet another example of how leaning into dental lasers has made both our patients and staff more comfortable being back in the dental chair. In fact, the Biolase Epic Hygiene is currently the only hygiene laser cleared by the Food and Drug Administration (FDA) for LBR.

In addition to increased dental laser use for procedures, we have enhanced isolation through rubber dam minimizers, decreasing the amount of Cavitron use, and performing more hand scaling. These changes have helped alleviate both patient and staff concerns around the use of aerosols in the practice.

Patient and Employee Response

Our practice has been fortunate to have patients that are incredibly understanding and accommodating. Communication has been vital in reassuring patients and answering any questions they might have. Elderly patients specifically have been more concerned about returning to dental practices, but sharing our protocols and safety procedures allows them to feel at ease. Patient safety has always been a priority for the dental community, so our goal is to get patients through the door and have them as comfortable as possible.

One challenge many practices are facing is bringing their full dental team back to work. Even with additional safety protocols, staff will always be at a greater risk for infection than patients. Hygienists in particular have extremely close contact with patients and patient aerosol generation. Honest communication is the best way to establish a strong relationship with the dental staff and ensure the practice will run as smoothly as possible.

Our goal has always been and will continue to be to provide excellent dental care in the safest environment possible. We will continue working toward that goal with the added concern of infection control. By combining updated infection control and safety protocols and limiting aerosol generation, dental practices can manage the challenges of reopening post-COVID-19.

Dr. Golan graduated from the University of Michigan School of Dentistry and completed a general practice residency at North Shore University Hospital (NSUH) in New York. He also trained for two years in the Implant Surgery and Advanced Prosthetic Fellowship Program at NSUH. In 2004, he received a Mastership Certification from the World Clinical Laser Institute. He lectures and teaches laser-assisted dentistry throughout the United States and Canada. He is the cofounder of the Center for Laser Education and is a faculty member with the World Clinical Laser Institute. He is founder and leader of the Laser Assisted Dentistry program at NSUH, supervising clinical training of dental residents. And, he is a graduate of the Alleman-Deliperi Center for Biomimetic Dentistry.  

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