Changes in dental practice in the Covid era

Ann Enkozi usually enjoys seeing a dental hygienist, but she was relieved when the dental clinic in Santa Monica, California canceled her cleaning visit last spring.

She’s wary of keeping her promise anyway, worried that someone else’s finger or instrument will explore her mouth when more than 25,000 Americans are infected with the coronavirus every day. It was.

“It’s too close in its mouth and nose area,” said Enkozi, a 70-year-old Santa Monica-based marketing design consultant.

When she returned to the dentist’s office in September for cleaning, she was asked to wash her hands and use antibacterial mouthwash. According to federal health guidance, it may help control the spread of aerosols and scattered bacteria during treatment.

Undoubtedly, dentistry is one of the more intimate medical professionals. Patients need to keep their mouths wide open while dentists and hygienists poke inside with mirrors, scalers, probes, and until recently these wrinkle-inducing drills.

Such drills and other power units such as ultrasonic scalers and air polishers generate airborne droplets and aerosol sprays that float in the air and carry viruses that can endanger patients and staff. May carry.

Today, dental clinics operate in a significantly different way than they did before the pandemic. Since resuming in May and June, we have followed federal guidelines and industry group recommendations aimed at curbing the Covid epidemic.

More than 1.4 million cases have been reported in Los Angeles County, where Enkoji lives, and more than 500,000 cases have been reported in New York City.

While vaccination has new potential, there are new concerns about more contagious variants of the virus and a one-month schedule for deploying the vaccine to the general public.

Many dental offices have been open for the last few months, and dentists and hygienists wear face shields, masks, gowns, gloves, and hair covers that resemble shower caps. They set aside power units that eject aerosols, instead hygienists rely on traditional hand tools to remove the patient’s accumulated plaque and tartar.

In the new practice, patients are usually called a few days before their visit and asked if they have Covid symptoms. They may be told to wait in their car until they are visible. Their temperature can be measured before entering the dental office and masks should be worn with all measures recommended by the US Centers for Disease Control and Prevention, except during treatment.

The dentist’s office now looks different. Many dentists allow only one patient to enter the office at a time. At Staten Island’s Exceptional Dentistry, there are no magazines in the waiting room and a plexiglass shield on the front desk, said Dr. Craigratner, owner of an office in the Tottenville area.

Also, manual scaling is more labor intensive than applying an ultrasonic scaler, and some patients have longer visits due to the accumulation of tartar, dirt, and plaque on their teeth due to pandemic-related visit gaps. It may continue. President of the New York State Dental Association.

“That’s a shame, but I understand,” he said.

This revolution in dental protective equipment is being compared to that associated with HIV/According to a journal article, the AIDS pandemic when many dentists first started wearing gloves and masks JDR Clinical and Translational Research..

Dr. Donald L. Chi, a pediatric dentist at the University of Washington and a professor of oral hygiene science and medical services, said: “Dental has changed. It’s amazing how it has changed in the last few months.

Covid-19 barely touched the United States in early February last year when Dr. William V. Giannobile, Dean and Professor of Harvard School of Dental Medicine in Boston, spoke to a Wuhan counterpart in China. ..

The dean of the Wuhan Dental School, where the coronavirus was first reported on New Year’s Eve 2019, asked Dr. Giannobile if he could help republish his team’s findings in the United States.

The author of the article Journal of Dental Research, Presented basic safety measures that would later be adopted by thousands of US dentists.

“They have shown that the provision of dental care is safe and that guidelines can be put in place to triage patients and provide dental care,” said Dr. Giannobile.

These guidelines include pre-visit questions and temperature checks, as well as the current ubiquitous use of staff protective equipment, and the use of masks by patients. “In areas where Covid-19 is endemic, non-urgent dental practice should be postponed,” said a Wuhan researcher. This is advice approved by the CDC and the American Dental Association early last year.

The spring closure of the dental business has caused many difficulties in many dental practice. Marko Vujicic, Chief Economist at ADA, said that only 3% of these offices in the United States remained open in March and April, with more than half of the dentist’s jobs disappearing due to furloughs and dismissals. Stated.

“This was an unprecedented event in dentistry,” said Vujicic. However, when the door opened in late spring, the number of patients surged.

His association provides virus testing nationwide and seeks permission to administer the Covid vaccine. According to an ADA study, dentists were allowed to receive the vaccine in 20 states, including California, Connecticut, New Jersey, and New York.

Dentists are ranked high on the priority list of eligible people to be vaccinated and have Phase 1a status in 40 states. The CDC recommends that dental hygienists and assistants also be included in the vaccine priority list.

In New York City, New York University School of Dentistry suspended a direct visit last winter, but resumed an emergency case in late June. Since then, he has treated more than 700 patients a day, said Elyse J. Bloom, vice dean of the university. She also said that mandatory virus testing for students and faculty members helped keep the number of positive cases at the university significantly lower than in New York City.

Fear of unemployment has spread throughout the industry.

“This was a very scary time for many,” said Jo Ann Gurenlian, a professor of dental hygiene at Idaho State University, who heads the Return to Work Task Force of the American Association of Dental Hygienists.

More than half of dental hygienists, dental therapists and oral hygiene professionals reported they were not working In the June 2020 survey Conducted by the International Federation of Dental Hygienists. Half said they were deeply concerned that they did not have enough personal protective equipment to treat their patients.

The patient has also been worried. Some dentists have found that they are brushing their teeth during sleep and treating stressed clients who need devices to prevent chipping and fractures.

“Honestly, I made a lot of nightguards,” said Dr. Todd C. Kandall, who has built up family care for 13 years with eight staff in East Stroudsburg, Pennsylvania, hiding in Poconos. ..

Dr. Kandall was forced to end his practice in mid-March and received a federal loan allowing him to resume on June 1. In the meantime, he said he tried to diagnose the patient’s condition over the phone. Now most of his patients are back.

He and his staff will follow the CDC guidelines by wearing a clean gown for each patient and replacing it later. They wash all gowns in the office.

He installed many CDC-recommended upgrades, including a highly efficient particulate air (HEPA) filter unit, to trap particles. He then purchased several suction systems to remove droplets and aerosols, as well as UV light to help disinfect.

Dr. Kandre also chose to discontinue use of nitrous oxide, a gas used to gently soothe and relax anxious dental patients. In the past, he rarely used gas, but with the outbreak of Covid-19, he became worried about his system, an older type that was not worth the risk of exposing patients.

Lin Uehara, 55, a business manager for family dentistry in Hawaii, said living on the island caused transportation problems to obtain the protective equipment that employees needed.

“Our masks and gloves are distributed by our major dental suppliers,” said Uehara. The gown I ordered four months ago has finally arrived. And the price is soaring. “I used to pay about $ 15 for a glove box. Now they charge us $ 40 to $ 50 a box.”

But like any other dentist, she is now a veteran of uncertainty. “That’s what we do,” she said, if lack of protective equipment meant a reduction in the number of patients.

The Uehara family has offices in Honolulu on Oahu and Hilo on the Big Island of Hawaii. The pandemic blockade undermines that practice. The family travels between the two islands on a commercial jet, poses another risk.

The resumption proceeded slowly, but the patient returned. “I heard laughter in the office,” says Uehara.

The proliferation of coronavirus cases in children also poses challenges for pediatric dentists.

In early December, the CDC strongly approved a school-based program in which dentists apply a thin coating called a sealant to the back teeth of children in grades 3-5. Such sealants are especially useful for children at risk of tooth decay and for children whose families cannot afford a private dentist.

Dr. Chi, a pediatric dentist and professor at the University of Washington, looks to more conservative ways for dentistry to deal with tooth decay, as some drills and tools can increase the risk of transmission. I said there is.

Dr. Qi, who practices at the Odessa Children’s Clinic in Seattle, said he avoided drilling by placing silver fluoride diamine on the teeth of babies’ babies to prevent cavities from growing.

He can also choose a stainless steel crown to prevent the growth of cavities. To apply such a crown, it is usually necessary to paralyze the teeth, use a drill to remove the cavities, shape the teeth, and then attach the crown.

A more conservative approach: Place the crown directly on the baby’s teeth without removing rot or changing shape. Evidence suggests that it is as effective, quicker, and more cost-effective as the traditional approach, Dr. Chi said.

“Covid really encourages dentists to consider all the options they need to treat a dental disorder,” he said.

However, some dentists may choose to quit their profession. The ADA conducted a study asking how dentists would react if a patient’s examination did not change for several months.

“According to our data, 40% of dentists over the age of 65 will seriously consider retiring within the next few months if the number of patients remains current,” Vujicic said. The doctor says.

However, over time, some patients have learned to adapt.

Enidstein of Staten Island has visited Dr. Ratner’s clinic five times since resuming for implant surgery and a new crown. A self-proclaimed addict who has an alcohol spray in her notebook, she took her pen and paid by check.

“I’m done, thank God,” she said. “I can meet him and all the girls in the office, but I’m in good shape.”

Changes in dental practice in the Covid era

Source link Changes in dental practice in the Covid era

Back to top button