Print & Go Guidance!
By Timothy Hyland
COVID-19 has challenged dentists the world over, fundamentally changing how they run their practices and the ways they interact with their patients.
At a time of global pandemic, safety of course remains paramount--for patients, for dentists, and for everyone on their staff. All are working to ensure that safety has placed significant demands on dental offices, mandating that strict protocols be put into place to help prevent viral spread.
According to guidance from the Centers for Disease Control, dental practices should screen all patients for COVID-19 symptoms before allowing them into their offices; encourage social distancing at all times; mandate that all visitors wear face coverings while indoors; and implement universal use of Personal Protective Equipment (PPE), including eye coverings, for all clinical staff, among many other recommended practices. Implementation of these practices, the CDC has said, can go a long way to keeping patients and staff alike safe.
But the reality of this pandemic is that even when practices are following all the guidance available to them, the virus can and will still spread.
Such was the case for one DOCS community member who recently contacted us with a question about how to move forward after learning that one of her patients had tested positive for COVID shortly after being treated at her office.
How do we handle [a] scenario where a patient is seen in the hygiene or restorative chair and reports afterwards a positive COVID 19 PCR test after they were seen by us for an aerosol producing procedure?
Patient was asymptomatic and only took test for travel reasons. Patient answered all COVID pre-screening questions negatively and temperature was good!
We used all the following protocols:
- Pre procedural rinse: hydrogen peroxide 1.5% for one minute
- Use of high-volume suction during the entire procedure
- Post procedural rinse with hydrogen peroxide
- Use of ultra-low volume Fogger in the operatory with hypochlorous 200 ppm after the procedure
- Team members dressed in full PPE inclusive of KN95 masks and shields.
Patients are fogged when they enter the practice. Patients are always required to wear masks except when in the chair for their procedure, and all team members are in masks all day except when they eat lunch. Our entire office is fogged at the end of each day in addition to after each patient visit.
- Will the provider hygienist/dentist need to quarantine for 10-14 days?
- When would it be safe for the provider to get a test to confirm negative status after known contact for 40-60 minutes or more!
In response, DOCS faculty member and resident COVID expert, Leslie S.T. Fang, MD, Ph.D., first noted that the dentist and practice was doing everything correctly here. All their protocols and precautions were proper.
You did everything perfectly and deserve a gold star. However, with asymptomatic carriers, we will always get into this bind.
The good news is, with full PPE, you and your staff should be safe. With fogging, I believe that the next patient is safe as well.
- You and your staff should be tested
- If negative, test 24 hours later
- If both tests are negative, there would be no need for quarantine
- You are probably obligated to tell the next few patients in that chair on that day that they should be tested, indicating that the risk is extremely low. And complete the contact tracing information for medicolegal reasons.
There is no question whatsoever that you have gone above and beyond standard of care, but these things happen.
Lesson going forward:
This is why I emphasized in-office COVID testing. These rapid antigen tests will be coming online to allow for cheap and rapid in-office testing prior to dentistry. Please refer to my recent webinar on testing: Hunger Game, hunt down the virus or it will hunt you down.
In the coming months, and as numbers across the country continue to rise, it is very likely that your practice will encounter a COVID positive patient. Dr. Fang believes that soon dental professionals will have access to rapid antigen tests that could add an important layer of protection for everyone in a medical setting—a layer of protection that figures to go a long way in helping us stem the spread of this virus.
In the meantime, continued vigilance and adherence to guidance from the CDC and ADA are the best weapons against COVID-19.
Dr. Fang has graciously granted DOCS permission to re-open access to his popular webinar, "New COVID Tests: A Game Changer" as a follow-up to the question above. It is included free of charge to DOCS Members until mignight EST on November 18.
If you are not yet a DOCS Member, you can sign up for our 2-month trial for just $1 and get immediate access to Dr. Fang's webinar. Click HERE to sign up.
Author: Contributing writer Timothy Hyland has more than 20 years' experience as a writer, reporter, and editor. His work has also appeared in Fast Company, Roll Call, Philadelphia Business Journal, and The Washington Times.