Dental offices are safe if they follow proper infection control protocols.
Three New York dental offices with two periodontists and three hygienists treated 2,810 patients during a six-month time period from March 1, 2020, to September 15, 2020. Of those, 1,939 (69%) were recorded to be in the high-risk comorbidity (hypertension, diabetes, 65 years of age or older, immune dysregulation, and/or a history of immunosuppressive medication). Various dental treatments were administered during this study period that included aerosol-generating procedures. Control systems were put in place that included staff training, patient screening, strict adherence to standard operating infection protocols, distancing appointments, mask use, air purification, air filtration, ventilation, operatory sanitization with HOCL and UVC light, and proper personal protective equipment (PPE) use as directed by the Centers for Disease Control and Prevention (CDC) and the Occupation Safety and Health Administration (OSHA).
All staff members were protected by N95 respirator masks, a full-face shield, surgical hair cover, a full-length gown, glasses with magnifying loupes, eye shields, and surgical gloves. Nose filters and glasses or nose shield masks with protective visors were given to patients along with single-use linen gowns and hair covers prior to dental treatment requiring aerosol generation. Throughout the length of this study, strict adherence to both standard and enhanced infection control precautions were followed.
These control systems resulted in a zero transmission rate from patient to health-care worker or health-care worker to patient as signified by the absence of any COVID-19 symptoms from office staff and patients during the six-month period of this study. If the patient did not present to the dental office for a two-week post-treatment exam and to ascertain symptom status, the asymptomatic status was obtained by contact via a phone call, text, email, or dental follow-up application. Seventy-three patients called the office prior to their scheduled dental appointments upon receiving the office screening questionnaire to report they tested positive for COVID-19. None contracted the virus in any of the three dental offices followed in the study. Three staff members, each working at a different office, contracted COVID-19 during the time period of emergency treatment only and while they were furloughed and not working.
Although there has been anecdotal social media sharing of dental offices that have had staff members develop COVID-19, the etiology and tracing of those infections were not clear. In a recent survey of 2,195 dentists conducted by the American Dental Association, less than 1% (20) had suspected or probable COVID-19 infections. The potential for viral transmission in a dental office is low and a distinction must be made from AGMP and AGDP. AGMP are those procedures that agitate the airway (e.g., tracheal or bronchial intubation) and may induce the patient to cough forcibly, thereby releasing aerosols filled with a high viral infectious dose. On the other hand, AGDP are dental procedures that produce aerosols during instrument vibration, rotation, and air compression when contacting oral fluid.
Oral secretions and nasal fluid usually have lower viral concentrations than chest secretions. AGDP are often accompanied by high-volume evacuation and/or other filtration devices that may be absent during AGMP. These suction techniques lower an already low potential for transmission in the dental environment. Control systems using ventilation, intraoral or extraoral suctions, and full PPE still need to be employed, as the dental health-care worker can encounter secretions with high viral load via a cough or sneeze.
In conclusion, during the six-month period of working in all three of the dental offices during the height of the COVID-19 pandemic in New York, no dentists, staff members, or patients who were treated during this time contracted SARS-CoV-2. Of the patients, 69% had high-risk comorbidities, showing that dental care can be administered safely even in high-risk patients.
*from Perio-Implant Advisory
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