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Dentists Emphasize Safety in Preparations For Returning to Work

Many dentists didn’t wait for Gov. Gavin Newsom’s announcement last week that reopening could start in weeks. They have been preparing and in many cases upgrading their equipment, facilities and policies despite a lack of a clear timetable for when their profession would return to work. They have had a drastic drop in revenue as only emergency procedures are performed due to the COVID-19 pandemic.

Dr. Dan Roberts, who has been practicing for 38 years and a business owner for 28 took the opportunity to invest $10,000 in his office, Encinitas Perio, which employs 12 people. The upgrades in most cases are about dealing with the fallout from COVID-19.

Equipment

Roberts, a periodontist, added a HEPA Ionizing air filter in all surgical operatories and hygiene rooms that can filter out viral particles. He is using tools to better isolate the areas being worked on. He uses an Isolite system that is attached to a powerful continuous suction that is supposed to prevent 99% of all aerosols from escaping the mouth. Surgical assistants are also using an additional high volume suction that should get the remaining 1% of aerosols. “The key is to get the aerosols before they get out of the mouth,” Roberts said. “It is like having a vacuum cleaner in your mouth.”

Face shields are now worn in addition to masks. In procedures where aerosols are more likely, higher quality N-95 masks are used.

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There are no mandates, said Dr. Kami Hoss co-founder and CEO of The Super Dentists, which has six locations, including Oceanside, Kearny Mesa and Chula Vista and employs 200, everything we are doing is voluntary.

The Super Dentists offices have taken many of the steps above and done such things as even in non-aerosol-generating procedures keeping dental chairs at least seven feet apart.

The Super Dentists are adding additional filtering and installing UV (ultra violet) systems — to destroy pathogens — in all of its HVAC systems.

Many practices are also employing laser thermometers to check patients’ temperatures when they arrive for a procedure.

Rapid Testing

One thing both practices would like is testing. Rapid testing would be a big help and give a picture of community health that could be very useful to health authorities. Some have suggested that such a test could even be covered by insurance companies.

“Staff must not only be safe,” Hoss said, “they must feel safe, too.”

Dr. Roberts of Encinitas Perio says his entire staff has always has had to be OSHA (Occupational Health and Safety Organization) certified. “All (our staff) are equally trained in PPE. Everyone is trained to deal with bloodborne and airborne pathogens. I feel as an industry, we are well equipped,” Roberts said.

Both practices have dealt with possible pathogens for years. It is just part of the job. For safety sake, you should assume everyone has the virus.

Even the check-in and office procedures are being overhauled by proactive dentists. Arrivals are questioned about recent travel, possible symptoms and other screening questions at both The Super Dentists and Encinitas Perio.

Digital Check-In

Check-in can be done digitally or over the phone. Plexiglass-type barriers are now used to protect the administrative staffs. Patients and family members wait in the car till notified.

“As a periodontist, a specialist, I have a lot of patients 60 plus which comes with a higher risk,” Roberts said. “I want to keep them safe.”

“These additional infection control products have been estimated to add $15 to the cost of a typical appointment, plus an additional $5 in labor costs required to disinfect our treatment rooms properly. Unfortunately, insurance companies have balked on paying an ‘infection control fee’ to cover these type of expenses in the past” said Robert Bey, an Encinitas dentist.

“Perhaps our greatest cost, however, will be in lost procedures as we work hard to minimize the number of individuals in the office at any one time (social distancing). This may mean no more “double booking” of patients, nor having multiple dental hygienists treating patients as the same time, This still has to be determined, and I don’t know how the put a number on this financial loss, but I don’t see us being able to schedule patients like we used to until a COVID-19 vaccine is readily available,” said Bey.

The Perpetual PPE Problem

Challenges remain especially for smaller or less well equipped offices. “Getting PPEs (personal protective equipment can be difficult for some because (dental) offices are closed so the dentists are not given priority,” Hoss said. “I assume when the offices are open, they will be given priority. We (Super Dentists) are in good position to open up, but I can’t speak for those who don’t have the resources we do.”

Dr. Roberts found a silver lining. “Dentist are coming together (virtually) and putting on a remarkable education at little or no cost,” Roberts said. They are sharing information so everyone can try to be ready for treatment.

In the meantime, dentists deal with what so many small businesses deal with — when can they return to work.

“We in small business have no idea how long this will be,” Roberts said. “We are ready to come back in whatever capacity we safely can.”

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