Dentists, like other medical professionals, have been making concerted efforts to reopen their practices as safely and quickly as possible as COVID-19 shutdown restrictions are being eased. According to a survey by the American Dental Association”™s (ADA) Health Policy Institute, as of the week of June 15, patient volume nationwide was at 65% of pre-COVID levels, up from 38% in mid-May.
The survey was sent to 70,000 dentists and 19,000 of them responded. The ADA reported that 97% of dental offices that participated in the survey were open for elective care, an increase from 90% in the first week of June. In early April, only 3% of dental practices had been open for elective procedures.
The ADA invited 13,000 dentists to participate in another survey panel. Those results, broken down by state, showed that in New York as of June 15: 24.1% of the dentists were open and doing business as usual; 70.2% were open but with lower patient volume than usual; 4.1% were closed but seeing emergency patients only; and 1.6% were closed and not seeing any patients.
In Connecticut as of June 15: 18.8% of the dentists were open and doing business as usual; 73.8% were open but with lower patient volume than usual; 6.3% were closed but seeing emergency patients only; and 1.3% were closed and not seeing any patients.
It wasn”™t until May that the U.S. Centers for Disease Control and Prevention (CDC) released its interim guidance for reducing the risk of spreading the novel coronavirus in dental settings. The guidance contained recommended protocols to protect patients and staff. The CDC was a month behind the ADA, which issued its own interim guidance in April. The ADA called for building on infection control protocols already used in dental offices while using the highest level of personal protective equipment available.
“In my opinion, they don”™t go far enough, not by a long shot,” Dr. Kenneth Magid of Advanced Dentistry of Westchester at 163 Halstead Ave. in Harrison told the Business Journal about the guidance.
“The first thing we”™ve got to do, and everybody is doing this, is we”™ve got to screen the patients on the phone with a whole series of questions to make sure they are not high risk,” Magid said.
“We don”™t use our reception room; they come in our parking lot, they call the office. When we”™re ready for them we tell them to come in. They”™re met at the front door of the office. Their temperature is taken, pulse-ox (blood oxygen level) is taken, more questions are asked. They”™re sanitized. They wear masks and they”™re conducted right into the treatment room. At that point we have as much control as we can bringing them in.”
Magid said that of major concern are procedures such as cleanings with ultrasonic scalers that produce aerosols carrying particles and any virus lurking in the patient”™s mouth into the air.
“The problem then really all stems from the fact that we produce aerosols. We take the stuff in the mouth and we aerosolize it. We protect ourselves by wearing N95 masks, face shields, surgical gowns, head covering, so we”™re barrier protected ourselves. But now you”™re going to create that aerosol and you”™ve got to do something about it,” Magid said.
He said the high-speed suction tube a dentist puts in a patient”™s mouth helps, but aerosols still get out of the mouth.
“What we did was order devices that use high-volume evacuation that goes next to the mouth, within six-inches of the mouth, and literally pulls the entire aerosol away from the face, away from my face, away from the patient”™s face, sucks it into this device that runs it first through ultraviolet (UV) light treatment, then very fine HEPA filtering including titanium oxide treatment, and when it exhausts it you have air that has been thoroughly disinfected,” Magid said. He said the devices are used with all six of the dental chairs in the practice”™s treatment rooms, three chairs for hygiene and three for other dental procedures.
Magid also said of concern was the general air quality in the facility.
“In every room we have put a device that takes all the air in that area, and we have calculated it by cubic feet, takes all that air and again sucks it into a device, UV, HEPA filters, titanium oxide chamber, runs it through all of that, then basically turns over all the air in the room constantly. In fact, it literally turns over the entire room in eight minutes,” Magid said.
He said that the quality of the air being released into the room is what you”™d expect to find in a hospital”™s operating rooms.
“Basically I”™m a scientist,” Magid said. “I”™m a doctor but this has always been my direction. I hold a number of patents in dentistry. A number of the devices used by almost every dentist are based on my patents, a bleaching light for bleaching teeth, for curing filling materials, for the light that”™s in the drill that they use, those are all based on my patents. I”™ve been on the team that created a number of the lasers that are used in dentistry. I shepherded digital X-ray through the FDA (Food and Drug Administration) in regard to the United States.”
Magid also is an associate professor and assistant director of honors esthetics at the New York University College of Dentistry. He is assistant director of cosmetic dentistry at NYU and teaches the subject.
Magid”™s daughter Sabrina is a dentist and is with him in the practice, although she”™s been on maternity leave and is due back in August. The practice has three personnel at the office”™s front desk, in addition to three dental hygienists and three assistants.
Magid also uses an additional technique to guard against COVID-19: fogging with hypochlorous acid, chemical designation HOCL. A mist of the acid is sprayed into the air and on surfaces from a hand-held electric misting machine. HOCL is a widely used agent that is effective against viral, bacterial and fungal pathogens. In fact, it”™s produced by white blood cells in the human body to help in fighting infections.
“What we”™ve done is added HOCL to a much broader program. I looked at this whole problem with coronavirus and said, ”˜I”™ve got to handle this comprehensively,”™” Magid said. “We didn”™t have anything this contagious before and we didn”™t have anything with the deadly consequences of this virus before.”
Magid said his office is seeing fewer patients now because it allows 15 minutes between each appointment for sanitizing and other preparations.
“We thoroughly wipe and disinfect every surface, we autoclave (sterilize) every instrument, we”™ve dealt with the aerosol we created, but the last part of the puzzle was saying, ”˜If there”™s anything I may have missed, what can I do?”™” He said that fogging the entire room and even fogging staff members with HOCL between patients provides one more layer of antiviral protection.
“The question always was, ”˜Are patients going to feel comfortable enough to come back?”™” Magid said. “The answer patients have told me over and over again is that in many ways they feel safer in my office than they do in their own homes. They know what we”™ve done; they feel absolutely safe in our office.”
