Essential Steps to Prepare for the Reopening of Dental Offices

May 12, 2020

williams-larryCDS member, Dr. Larry Williams, served as the Public Health Emergency Officer in the Navy Region Midwest, where he prepared and trained for pandemic flu outbreaks, in addition to the H1N1 swine flu outbreak in 2009. Leaning on his years of experience and knowledge surrounding healthcare emergencies, Dr. Williams shares important COVID-19 information for dentists and dental professionals as they prepare to reopen their offices to patients. In the first article of his series, Dr. Williams offers a reopening checklist and detailed information on PPE to help guide practices as they begin to take steps forward to ensure a safe reopening.


Dr. Williams’ Reopening Checklist

  • PPE: Assess current stock of PPE and amounts of supplies already on hand. If additional supplies are needed, begin going through the proper channels to obtain essential equipment to protect staff and patients.
  • Safety Protocols: Given the evolving nature of the situation, it’s important to review pertinent infection control guidelines that have been updated by the CDC, OSHA and your state regularly. Also reference and study ADA and ISDS guidelines to see where any gaps may be with current safety protocols in your office and adjust accordingly.
  • Communication to Staff and Patients: Go over any new and improved protocols with staff to ensure everyone is up to speed and alleviate any fears they may have by ensuring that proper barriers between staff and patients will be maintained. Communicate with patients to assure them that proper safety measures are in place and they will not be at risk of infection by coming to the dentist’s office.

Adequate PPE is the First Step Towards Ensuring the Safe Reopening of Dental Offices

During this pandemic, ensuring frontline responders and healthcare workers have critical PPE has been an all hands-on deck effort, with many professionals in the dental industry assisting in this call to action by donating supplies from their personal inventory. You might be one of the amazing dentists who stepped up and donated PPE in this time of need and that is something to be proud of even if it means you might be a little slower to open your practice. Attaining proper PPE will be essential to any dental practice before patients can be seen again – your patients will expect it and you will need to have it to practice safely. CDS has also compiled a list of suppliers with PPE products that can be viewed here.

Remembering that the threat caused by the COVID-19 virus is airborne/aerosol, our existing infection control procedures must be updated to add an aerosol threat to our bloodborne pathogen protocol. In this regard, dentists should be thinking ahead and begin preparing to reopen their offices by assessing their current inventory to ensure they have supplies to meet this aerosol threat and, if not, take steps to attain it:

Masks

  • According to the CDC, N-95 Surgical masks (moisture resistant) are intended for moist aerosol environments, such as those found in dental offices. Standard N-95 masks are not water resistant and must be changed when they get wet.
  • ASTM Level 1, 2, and 3 are not indicated for aerosol environments but can be used in non-aerosol environments. According to both the CDC and OSHA, the use of an ASTM Level 3 mask puts the user at moderate risk of exposure to COVID-19.

Gloves

The current glove guidance remains sufficient for the current COVID-19 world. As always, be sure to wash and sanitize hands before donning gloves and after removing them.

Gowns

When practices do begin to open and see patients again, it is important to note that nothing should be worn from the dental office into your home. Disposable gowns will be essential to help ensure scrubs and clothing stay clean. Clothes and scrubs worn from home and used in the practice should be laundered in the practice or have a linen supplier pick up your clothes to be laundered.

Face shields

These can be hard to get right now, but are a good tool to provide an additional layer of protection if they can be attained. Some people are being very industrious and using a 3-D printer to create the shields.

Eye protection

Loupes may not work properly with a face shield. This needs to be evaluated before any treatment is planned.

As I stated previously, obtaining N95 masks may be challenging for dentists since this type of mask is currently experiencing a shortage, therefore ASTM Level 3 masks plus a face shield are recommended as they could be easier to find. If N-95 masks are used, fit-testing is something that dentist offices should consider looking into to ensure employees are protected from airborne pathogens they may encounter while on the job. Fit testing can be done through a partnership with local hospitals or a traveling service. It can be pricey but well worth the investment to ensure staff’s face masks fit properly.

Another new resource that is becoming available are services to decontaminate N95 respirators at no cost.

In the Chicagoland area, this service is being offered free of charge by Battelle CCDS in their recently opened Waukegan location. The only cost to healthcare providers is shipping. Battelle’s goal is to have decontaminated N95 respirators ready for shipment back to the originating healthcare provider within 72 hours of receipt. Find more information.

As dentists, we need to practice what we preach and under no circumstances should corners be cut when it comes to the reopening process. No amount of money will replace an employee who gets ill because of improper or inadequate PPE – the same goes for a patient. The CDC is also recommending that all dental office personnel are screened before work starts in the practice.

Similarly to the AIDS/HIV epidemic in the 1980s when wearing PPE became common practice in dentistry, we will see lasting changes to the dental industry because of COVID-19. The issue of gathering the proper PPE before the reopening process is paramount.

References as of April 27, 2020