Dentists and Covid-19
Since the Covid-19 pandemic started, the Centers for Disease Control and Prevention (CDC) and the American Dental Association have asked dentists to forego routine and elective procedures in favor of emergency situations. This helped minimize the risk of infection to patients and staff and reduced the demand for personal protective equipment (PPE); dentists do, after all, have to get up close and personal to do their job.
Now, along with other establishments, some dental offices may be opening up for more routine procedures—the cavity that needs filling, or the cleaning you’ve been putting off. With contact comes the risk of Covid-19. “There are always risks because the coronavirus is highly infectious,” says registered dental hygienist JoAnn Gurenlian, PhD, chair for the American Dental Hygienists Association’s (ADHA) Task Force on Return to Work.
So, when should you schedule your dentist appointment? These tips will help you decide when (or whether) you should return to the dentist’s chair.
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Be aware of the higher risk of Covid-19 exposure
Because Covid-19 is transmitted primarily by respiratory droplets and because dentists, hygienists, and patients are in such close contact with each other, the risk for contracting the novel coronavirus in these settings is higher than, say, in an ophthalmologist or dermatologist’s office. “Any procedure involving the oral cavity or nose or sinuses is a high risk. Even a simple exam is considered high risk,” says dentist Likith Reddy, MD, director of the residency training program in oral and maxillofacial surgery at Texas A&M College of Dentistry in Dallas. Also, certain dental instruments can spray particles that might be infected with Covid-19. “Procedures that involve a drill or tools like that create droplets and aerosols and they can spread viruses easily,” he adds.
Expect to be prescreened for Covid-19
The CDC urges dental practices to assess patients’ health before they arrive in the office. This includes not just symptoms like a fever or dry cough, but also risk factors like whether you’ve been exposed to someone with the virus. “They’ll call you on the telephone, or maybe email, or text,” says Gurenlian, who is also a professor and graduate program director of the department of dental hygiene at Idaho State University. “They’ll run through that with you 24 to 48 hours prior to the appointment.” You should then ask them the same questions: Do any staff members have symptoms of Covid-19? Have they been in contact with anyone who has Covid-19? Have they been tested? “That’s very reasonable,” says Gurenlian. And if you develop symptoms of Covid-19 within 14 days of your appointment or if you’re diagnosed with Covid-19, call your dentist right away so they can do contact tracing, advises the CDC.
Wait outside for your dental appointment to start
Official guidelines recommend that people generally stay six feet away from each other to avoid being infected. For this reason, you’ll likely be asked to wait in your car (or outside) until your appointment begins. That way, there will be fewer people in the waiting room. You should also notice changes in the office, like a plexiglass barrier between you and the receptionist, hand sanitizer to use as you walk in (and out), and fewer items that can carry infection like magazines, toys, pens, and clipboards. Any waiting-room chairs should be placed six feet apart, says the CDC. (Here are 10 ways to stay human during the pandemic.)
Limit the number of people who go with you to the dentist
For the same reason, this is not the time to take the spouse, kids, grandparents, and extended family to the dentist with you. “Go on your own, if you possibly can,” says Gurenlian. If needed, a caregiver can guide you in then return outside for the duration of the appointment. Similarly, parents can escort younger kids into the office before withdrawing outside. Older kids should be able to check themselves in without you, says the ADA. “In most cases, mom and dad don’t need to be in the same room with the child,” says Gurenlian. “You really want to minimize your exposure.”
Practice proper Covid-19 hygiene and etiquette
This goes without saying. Covid-19 etiquette involves covering your cough or sneeze with a tissue, immediately throwing the tissue away in the nearest trash receptacle and washing your hands, according to the CDC. (The dentist’s office will likely ask you to disinfect your hands as you walk in and when you leave.) These are good practices all the time as are not touching your face, washing your hands frequently with soap and water, if possible (or an alcohol-based sanitizer if not, wearing a mask in public, and keeping a distance of six feet from other people. Learn about other aspects of dental etiquette.
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Make sure the dental practice has adequate PPE
At the very, very minimum, the dental office needs to be well supplied with PPE like gowns, N95 masks, face shields, and gloves, says Dr. Reddy, who is also heading his institution’s task force for Covid-19 response. “[The staff] should be all suited up as if they look like astronauts with gowns and gloves to limit their exposure,” adds Gurenlian. Be prepared for the possibility that some smaller practices may have trouble getting enough PPE in this day and age, says Dr. Reddy.
“If you are in an area where there are active cases and the practice does not have adequate PPE, you should not go to that appointment for a regular dental exam, says Gurenlian. “There is no need to take that risk at this time.” She adds that offices should have a two-week supply.
Ask about other Covid-19 infection-control procedures
The CDC also recommends that dental patients be treated in separate rooms where possible—or at least areas with floor-to-ceiling barriers. The patient’s head should be near the outgoing air vents, away from any hallways. If it’s the practice has a cubicle layout, then the patient’s head should be near the rear wall. The office should also be limiting the number of patients who are in the office at the same time. Hospitals have negative pressure rooms and plenty of PPE to protect patients and healthcare providers, says Dr. Reddy. This is not always true of smaller dental practices. Find out if your dentist is complying before you go.
And by this, it’s advised to wear a mask when you first enter (though obviously you’ll need to take it off later) as well as eye goggles. “You should have goggles that wrap around the sides of your eyes like in a pool,” says Gurenlian. Wear clothing that you can easily throw in the washing machine as soon as you get home, she adds. “That spray is on you now and you may want to launder your clothing when you go home. The aerosols are going to drop to the floor.”
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Dental appointment times may be more spread out
To allow enough time for cleaning between patients, there may be fewer appointment times or longer waits between patients. “We wait 15 minutes after a patient leaves before doing any cleaning because the aerosols have to drop from the air to the floor,” says Gurenlian. Then disinfectant has to sit for a while before it’s wiped off. “We want a gap of time,” she adds. That may be half an hour or more. The number of rooms, number of staff, and layout will all play into this.
Ask yourself if you really need to see the dentist now
Just because a dental practice is open doesn’t mean it’s a good idea to get a routine procedure. If you’re someone who generally does a good job taking care of their teeth, it might be worth postponing, says Gurenlian. If you’ve been having regular check-ups before the pandemic, if you brush and floss regularly, this may be a time to just keep doing what you’ve been doing. Unless a dental emergency comes up, “People should consider waiting,” says Dr. Reddy. How long you wait will depend on a number of factors including your community’s transmission rate.