Coronavirus and Dentistry. Are you at risk?

With the recent rise in coronavirus disease 19 (COVID-19) cases there is much fear amongst the public and professional dental community as to the risk or receiving and providing treatment. As of this article the American Dental Association along with other groups in organized dentistry have recommended a moratorium on all elective dental care. But why?

A recent article published in the New York Times showed dental providers as having one of the highest risk of contracting coronavirus. The article used data from the Department of Labor which outlines the physical aspects of various occupations and correlated that with potential risk. Dentistry requires working in close proximity to patients and exposure to disease thus the high risk of transmission of COVID-19, if a patient or provider is positive.

COVID-19 is thought to have originated from the Chinese horseshoe bat with an animal called the pangolin as the intermediate host. The pangolin is thought to be delicacy in parts of Asia and Africa and its scales are used in Chinese medicine. They are a gentle animal and are said to be the worlds most illegally trafficked non-human animal. Previously very popular and sought after in the market place, with the recent outbreak of coronavirus, the pangolin trade has crashed causing economic hardship amongst traffickers.

The coronavirus disease 19 is a respiratory virus that started with a single animal to human transmission and then continued human to human transmission. It can be spread by surface contact but is primarily spread by exposure to respiratory droplets. The incubation period is believed to be 5 to 6 days. Most cases are relatively mild with fever and dry cough. Some experience more advanced symptoms of head and muscle aches, sore throat, diarrhea, vomiting, and shortness of breath. Approximately 1/3 to 1/4 of patients in Wuhan, the city of origin, developed acute respiratory and cardiac distress and were treated in the Intensive Care Unit.

Treatment is mostly supportive in nature as the disease is caused by a virus and at present there is not vaccine or antiviral therapy. Though most patients make a full recovery, there are cases where permanent lung damage has been noted. The best therapy at present is prevention.

So what should you do? First, delay any elective dental care. This would include routine cleanings, cosmetic work, and elective dental surgeries. Further if you do need to seek emergency dental care, verify the dental office infection control protocol. All offices are required to follow existing OSHA standards and OSHA recently published further guidance on preparing workplaces for COVID-19 . These guidelines focus on developing infectious disease preparedness and response plan, increasing infection control mechanisms, Identifying and isolating sick individuals, implementing workplace flexibilities and protections, and maintaining workplace controls to include personal protective equipment.

In my office we have cancelled all appointments apart from emergencies and have asked sick employees to stay home and patients to reschedule if ill. The office is also set up to prescreen patients by asking health status and history of contact or travel to infected zones. We have added patient hand sanitizers in the waiting room, practice social distancing by asking patients to wait in their vehicle prior to their appointment, and continue to follow strict infection control and sterilization protocol before, during, and after treatment. Between patients we disinfect the entire office.

Remember, even in this time of crisis, the OSHA compliant dental office is a very safe environment. You should limit elective procedures and not be afraid to seek emergency care when necessary.

https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html?action=click&module=Top%20Stories&pgtype=Homepage

https://www.osha.gov/Publications/OSHA3990.pdf

So Many Dentists Where Do I Start?

OMG there are so many dentists! How do I decide where to go?

This is a dilemma most every person has faced in there life. As a child, it is easy. We either go to the provider our parents chose for us or we don’t go at all. As an adult, we either continue with the dentist we had growing up or we are faced with the task of choosing a new dentist. Where do we start? The first bit of knowledge we must know is the types of dentists there are and how the dental landscape is structured.

In dentistry there are general dentists and specialists. General dentists are licensed to perform all aspects of dentistry. Specialists limit their practice scope to certain areas of dentistry within which they treat basic to complex cases. As patients with autonomy you always have the choice to have work performed with your general dentist or at a specialists office.

Dental Provider Categories:

General Dentist: Focus on providing quality restorative, cosmetic, and basic surgical services and implants.

Prosthodontist: Focus on providing complex restorative and cosmetic services and implant therapy.

Orthodontist: Focus on correcting dental and skeletal occlusal disorders.

Endodontist: Focus on root canal therapy, root canal related surgeries, and implants.

Periodontist: Focus on treating gum disease and implants.

Oral Surgeon: Focus on complex dental surgical procedures, wisdom tooth extractions, pathology, corrective jaw surgery, and implants.

Dental Anesthesiology: Focus on providing in office deep sedation and general anesthesia.

Dental Office Categories:

1) Private

2) Corporate

3) Educational/Government

In a private office is locally owned by a dentist who is onsite. The patient is the customer and the dentist is focussed on providing quality care to the individual with any profit as byproduct of the natural flow of their work. The owner dentist is able to make decisions on quality of staff, instruments, and materials that benefit the patient directly. Private offices often limit insurances to those who’s reimbursements will cover more expensive materials and laboratory fees.

A corporate office is one that is owned by non-dentist business entity and includes multiple offices across many locals that often include different cities and states. Often the office is owned by a non-dentist business entity and shareholders of the corporation. The non-dentist owners and shareholders focus on increased quarterly revenue stream. The dentist is often paid based on production incentives.

The third group of offices are community health centers and educations institutions. Community health centers often focus on providing care to veterans, economically impoverished communities, or the medically compromised. They provide quality care but patients may need to meet certain criteria to qualify for care. Educational institutions will provided care to all patients at a reduced price but often at the cost of convenience and time spent.

So now you know the types of providers and types of offices. How do you determine which is right for you. You must weigh the differences and determine where you feel comfortable. Ultimately, regardless of office type or provider type you want a dentist who focusses on providing you with the highest quality care using the best materials and latest technology. We will go into what qualifies as quality dentistry and what technology is available as we move forward in different blogs so stay tuned.