The new normal at the dentist’s office
There is absolutely nothing routine about visiting the dentist anymore – even if it’s for a routine cleaning and checkup – in the wake of COVID-19. Patients visiting dental offices are being met with a new normal.
Patients visiting Dr. Antoine Clarke’s Bahamas Center for Gum Diseases can expect to have their temperature assessed. If the thermometer reads 99 degrees or higher, the patient is denied service and asked to reschedule.
This is just one of the new protocols set by the Bahamas Dental Association to be adopted by dentists around the country. It is also among a number of recommendations by the Centers for Disease Control and Prevention (CDC) and American Dental Association (ADA) as the world battles the new coronavirus global public health pandemic.
“The new protocols and procedures put in place are not only to protect my staff, but the patient as well,” said Clarke.
CDC and ADA guidelines say patients have to wear a face covering when entering a dental office. Dentists are to limit the number of people who accompany a patient to an appointment; and where possible, the patient is advised to make the visit alone.
Dental offices have also been advised to remove items in office waiting rooms such as toys or reading material to limit potential transmission through high-touch surfaces; and to encourage social distancing practices by minimizing the number of patients in the waiting room by spacing appointments thoughtfully, and asking patients to wait in their car until the dental staff is ready to treat the patient.
Dental staff members are also advised to wear additional personal protective equipment (PPE) as appropriate, such as surgical masks or N95 masks, full-face shields or goggles with side shields to ensure an environment that is as safe and healthy as possible for patients and for the dental team. Dentists are also encouraged to place hand sanitizer generously around the office for use and ensure surfaces are cleaned regularly.
In accordance with recommended guidelines, Clarke has installed air filtration systems throughout his office to purify the air. He and his staff wear full PPE gear and patients have to wear their face mask until they get into the treatment room.
“We don’t want to spread anything, and we don’t want patients to spread anything to us,” said Clarke.
Once a patient has received treatment, the periodontist said they wait 15 minutes after the patient has left, then sterilize the room.
With a reduced number of patients booked daily, Clarke said the days of people waiting in the waiting room have changed.
“Even though my waiting room is big, I try to limit one patient at a time. Also, I’ve installed plexiglass which protects my staff and the patients.”
Pediatric dentist Dr. Kristen Darville said the COVID-19 virus has not changed the basic “universal precautions” that dentists implemented on a daily basis in the past. She said they have always insured patients and providers have been protected from infectious diseases, however, the new coronavirus, she said, brings an additional amount of PPE to the dental office as well as additional safety precautions.
At My First Dentist Pediatric Dentistry, Darville said, patients are screened verbally on the telephone prior to their appointment to ensure that any patient(s)/parent(s) that have been quarantined, in contact with persons in quarantine, display symptoms of fever above 99.5 degrees Fahrenheit (37.5 degrees Celsius) or respiratory illness remain at home and reschedule their appointments.
“Parents/patients are asked to call in when they arrive, and are given the okay to enter once the office is within the recommended capacity for adequate social distancing,” said Darville. “There is a limit of one parent to patient with scheduled appointment, meaning no additional kids or parents allowed in the office.”
She said limitations have also been placed on the number of patients in the office, with social distancing implemented in both reception and operatories. The pediatric dentist encouraged parents to fill out forms online and pay online or over the telephone to reduce personal interactions at the front desk, despite them having sneeze guards in place.
The dentist said masks are required to be worn and hands washed upon entering the office. Patients are also required to pre-rinse with one percent hydrogen peroxide or peridex prior to being seated.
Her office has also installed air purifiers in the operatories with time allotted between patients for adequate sterilization.
To protect patients as well, any of her team members with signs of fever or respiratory illness are required to remain at home. Darville’s team members are also subject to having their temperatures taken at the office prior to seeing patients.
When in office, staff members at the pediatric practice are required to wear full PPE – masks (specifically N95 or KN95), face shields (with or without eyewear), gloves, bonnets/head covers, gowns and shoe covers.
“These are among the main protocols we have implemented that may be amended over time, but until we hear otherwise, this will be our new norm,” said Darville.
Dr. Kendal Major’s patients at the Centre For Specialized Dentistry undergo a pre-screening process before they’re allowed to enter the door, which entails the patient calling or texting the office from the parking lot, and a member of staff going out to greet them in what the periodontist terms their “concierge service”. The patient is given a series of screening questions – if the patient’s temperature is acceptable and their screening answers are all in the negative, they are then taken into the office. Before entering, patients are given shoe covers to put over their footwear.
The same protocol that patients are put through, Major said he and his staff also do daily, which means they answer the questions and have their temperature taken and logged. The periodontist said the process is for the protection of him, his staff and the public.
While new protocols and procedures have been added in the coronavirus era, Major said dentists have always been cautious about infection prevention.
“Dentists since the ‘80s have been pretty prudent and have exemplified optimal standards in infection control because of the past history of the HIV/AIDS crisis, Ebola virus and Hepatitis C, so we are accustomed to protecting ourselves, our staff and our patients.”
At Centre For Specialized Dentistry, they have reduced the number of seats in office from six to three, and removed all magazines, coffee stands and water bottles to remove the risk of contamination. Plastic covers everything in treatment rooms and patients rinse with one percent peroxide and water, which he said kills the virus. After every patient, he said, treatment rooms are sanitized.
Major and his staff now all wear full PPE (personal protective equipment) – head cover, goggles for their eyes, face shield, grade three of N92 mask and a disposable gown on a daily basis.
The getup in which the periodontist now works, he said, makes his working environment “hot”, time consuming and expensive, but he said it had to be done.
To ensure they optimize safety in the office, they have ordered air purifiers, which he said is the best thing that can be done to ensure clean air.