Dentists are starting to see patients return for routine procedures. Seattle dentist Kathleen Saturay has increased the layers of protective gear she wears when treating patients.
Elaine Thompson/AP
hide caption
toggle caption
Elaine Thompson/AP
Dental offices are starting to see patients return for routine procedures. Seattle dentist Kathleen Saturay has increased the layers of protective gear she wears when treating patients.
Elaine Thompson/AP
Add dental visits to the list of services you can book now or soon as cities, counties and states continue to modify months-long stay-at-home orders aimed at reducing COVID-19 infections and hospitalizations.
Dental practices were largely closed across the United States following a March notification by the American Dental Association and the Centers for Disease Control and Prevention to close their offices to all but urgent care. Many were completely closed.
The hope was that by allowing dentists to continue treating serious cases — such as severe tooth pain and infections — those patients would stay out of emergency hospitals, where doctors were busy with seriously ill coronavirus patients. And because the personal protective equipment needed by dentists and other health care providers was in short supply, regular dental checkups and cleanings were deemed unnecessary, at least initially.
More recently, however, restrictions on regular care they have relaxed In many places. So, is it really safe to go to the dentist now?
The risk of transmission of the coronavirus cannot be completely eliminated
Dr. Gregory Polandinfectious disease specialist at the Mayo Clinic and spokesperson for the Infectious Diseases Society of America, says he believes some infections in dental settings are likely to be unavoidable.
“But the hope is that practice recommendations that all dentists should follow will mitigate this risk,” Poland says.
Concern about the risk of transmitting COVID-19 while visiting the dentist is understandable. Dental settings have “unique characteristics that warrant specific infection control considerations,” he says Michele Neuburgerdentist for the CDC’s Division of Oral Health and a member of the CDC’s COVID-19 Response Infection Prevention Control Team.
“Dental healthcare staff use tools like dental [drills]ultrasonic peeling and air-water syringes that create a visible spray that may contain droplets of water particles, saliva, blood, microorganisms and other debris,” says Neuburger.
Large droplets can land directly on others in the exam room and can contaminate frequently touched surfaces. The spray could also contain small “aerosol” droplets of COVID-19 if a patient has the virus. And these droplets can remain in the air for up to three hoursaccording to some estimates, and possibly transmit the virus to dental staff or the next patient unless strict precautions are taken – such as providing personal protective equipment for staff and disinfecting the treatment room, instruments and surfaces between patients.
So far, no cases of COVID-19 have been identified in dental offices
Despite these potential risks, the good news is that both the World Health Organization and the CDC say there have so far been no confirmed cases of COVID-19 transmitted in a dental office. And that includes the CDC’s monitoring of news stories that suggest such infections, Neuburger says.
In mid-May, in sync with the American Dental Association, the CDC issued more guidelines for dental offices, which continues to be updated periodically.
Ron Greenberg, 62, a computer science professor at Loyola University in Chicago, went back to his dentist in early June. “I’ve been anxious to go anywhere since mid-March,” he says. But when he finally broke down about his overdue checkup, the dentist’s office had “a lot of procedures” that made him feel better. A staff member called with a list of questions about his health a few days before the appointment and then again on the day of his checkup.
Greenberg was told to call the receptionist from his car when he arrived, then wait to let an employee open the front office door — so he didn’t even have to touch the doorknob.
“They took me straight to the hand sanitizer,” he says. “Next it was a temperature check… Everyone wore masks until I had to take my masks off to be worked on. And the hygienist and dentist had full face shields for when they were working close.”
Greenberg says he felt confident enough after taking all those extra precautions to schedule a follow-up appointment several days later to repair a chipped tooth.
CDC Guidelines: Avoid power tools where possible
Greenberg’s visit included many of the precautions recommended by the CDC. These, edited for clarity, include:
- Screen patients before each appointment and when they arrive for symptoms of COVID-19 — such as cough and fever — and defer if they have symptoms that could indicate they have the virus.
- Use each patient’s car or a spot outside the office as a waiting room.
- Remove items such as toys, magazines and coffee stations [which can be infection sources] from the waiting rooms.
- Masks are required for patients and anyone with them while in the practice area and immediately after procedures and checks.
- Place a plastic or glass barrier between the patient and reception staff.
- Avoid using power tools when possible — some practices no longer use polish to clean teeth, for example.
- Leave out only the instruments needed for each individual patient so that other instruments cannot be contaminated.
- Use rubber barriers over the patient’s mouth for procedures where possible to limit spray of secretions.
- Use multiple dentists when doing aerosol procedures when possible to speed up the visit and minimize exposure.
- Install high-efficiency particulate air filters to improve room filtration, which research shows can reduce the transmission of airborne virus particles.
Although a weekly survey from the American Dental Association of dentists nationwide found that their patient volume had reached 65% of pre-COVID-19 levels as of June 22, dentists know that at least some patients are still worried enough to stay away, even and if you are in pain or delayed for important procedures such as gum surgery.
Delaying checkups or care for dental pain can potentially turn a small cavity into a root canal or tooth extraction and add treatment time, higher costs and even more pain, says Howard Golan, a dentist in Williston Park, New York, who who recently reopened his practice. after seeing patients only for urgent care since mid-March. In rare cases, he says, missing out on dental care can lead to serious infections and even death.
Dentists have a legitimate interest in taking all possible precautions.
“Dentists are usually 12 to 18 inches away from their patients,” he says Louis G. DePaola, associate dean of clinical affairs at the University of Maryland School of Dentistry in Baltimore. “To do their job dentists have to lean close to what is currently the most infectious part of a person if they have COVID-19 – their mouth.”
Protecting the health of others working in the office is also paramount.
What about the orthodontist?
Daniella Smith of Silver Spring, Md., saw her dentist for a cleaning in late May, and that’s when she resumed orthodontist visits for her two children, ages 12 and 15.
“I was impressed by all the new measures,” Smith says, including the staff opening all the doors and not using the high-strength polish when cleaning. Children were advised to brush their teeth shortly before coming to the office to reduce saliva spraying during an appointment.
“With all the time and money spent on the kids’ braces, we really didn’t want their teeth to move back,” says Smith, “so we were making appointments when the office reopened.”
Ideally, dentists would test their patients for the coronavirus before their appointments and reschedule anyone who tests positive. But “point-of-care” tests that can give results in about 15 minutes can produce false positives, he says Marko Vujicicchief economist and vice president at the American Dental Association’s Health Policy Institute.
“We’re keeping our eyes on the trials to see if there will be an effective way to actually determine the status of COVID patients before treatment,” Vujicic says. “Until then, we advise dentists to be very careful as instructed when treating patients.”
“I think everyone is looking for the best science as we move forward,” he says Connie Whitepresident of the Academy of General Dentistry and interim dean for clinical programs at the University of Missouri-Kansas City School of Dentistry. National Institute of Dental and Craniofacial Research calls for research proposals related to the coronavirus, among other things, on ways to improve disinfection and prevent disease transmission.
Meanwhile, White and other dental leaders also say they realize the continued rise in coronavirus cases in the U.S. could result in dental practices being forced to close again in some areas.
“I hope not, of course,” says White. But with openings and closings in flux, it’s a good idea to make sure any dental procedures started during an appointment can be completed soon after. “Patients should discuss with their dentist what is necessary to do right now and what can wait,” advises White.
Remember, infectious disease specialists note, that we all have important responsibilities as patients, too, to let the dentist know before or on the day of the appointment if we feel ill in any way. We’re all in this together – if you’re sick, stay home.
