The COVID-19 pandemic has everyone on high alert, and many of you may be wondering about your safety if you were to visit us for your orthodontic appointment. In this post, I will explain what we know about COVID-19 and how we are modifying our practices in order to limit its spread.
COVID-19 Background Information
The Centers for Disease Control and Prevention (CDC) is a great resource for information on COVID-19. If you haven’t already, be sure to review how it spreads, the symptoms, and what you can do to protect yourself. The virus spreads when a cough, sneeze, or simple act of speaking creates respiratory droplets. These can be inhaled by another individual or wind up in their mouth or nose (possibly indirectly through contact with contaminated surfaces).
Knowing how it spreads allows us to determine how to protect ourselves. The CDC recommends that we stay 6 feet apart from one another, to wash our hands often, to avoid touching our faces, to wear masks or facial coverings when around others, to clean and disinfect frequently touched surfaces with an EPA-registered disinfectant, and to cover our sneezes and coughs. For the most part, this is the etiquette that’s been expected when you go to public places like the grocery store or your local hardware store. Some stores are enforcing these guidelines strictly, whereas others may be a little looser with the rules.
COVID-19 Prevention in the Orthodontic Office
So how does that compare to your dentist’s office or at our office? We are able to ensure that everyone is sufficiently spread out within the office, since we are in full control of the foot traffic going in and out. Only your health care providers will come in to close proximity with you. We will only do so wearing the appropriate personal protective equipment (PPE) which consequently protects us from one another. Also, remember that we’ve been practicing infection control all day, every day since long before this pandemic, so you can rest assured that our office is going to be a safe environment for you.
Most of us have reduced our schedules significantly in order for everyone to maintain a healthy distance from one other. At Smile Makers Orthodontics, we’ve reduced our schedule so that only one patient will ever be in the office at a time in the initial week back. As we get accustomed to and more efficient with executing the new rules and guidelines required of us by the Texas State Board of Dental Examiners (TSBDE), we will slowly build up our schedule in order to see more patients while still maintaining the recommended social distancing.
So what are we doing differently at our office to ensure your protection?
Pre-screening for COVID-19 Symptoms:
Part of the new TSBDE rules requires that we screen all individuals, patients and team members, with a health questionnaire and take their temperatures, upon arrival to the office. Those that have symptoms or have a high temperature will be asked to return home, so you can have the peace of mind that all who are permitted to enter our office are free of any symptoms. Our efforts do not end there because individuals can still be positive and spread COVID-19 without displaying symptoms.
Required mask or facial covering:
All individuals in the office are required to wear masks (or an equivalent facial covering for our patients) at all times. The only exception is when a patient is asked to remove their mask in order to undergo treatment. Recall that COVID-19 passes from an infected person to another person through respiratory droplets. With a mask on and in the absence of coughing or sneezing symptoms, respiratory droplets should be well-contained from spreading in to the surrounding air and surfaces.
Reconfigured chair arrangement:
Our operatory chairs have been reconfigured to be 12.5-13 feet from the next chair, well beyond the recommended 6 feet. When we build up to a fuller schedule, patients will be far away from one another if they are ever in the office simultaneously.
Limited procedures for now:
Because COVID-19 can be transmitted through the air, the highest risk procedures within dentistry involve the generation of aerosols from our air-driven, rotary handpieces and/or our air-water syringes. For now, we will be focusing on only seeing patients for procedures that do not generate aerosols. The majority of the procedures that we do in orthodontics do not generate aerosols or splatter. Procedures that have the potential to generate splatter and/or aerosols will be postponed for now until we implement more changes to the main operatory.
We purchased an air purifier for the main operatory back in February prior to our office closure in order to improve the air quality in preparation for allergy season and seasonal illnesses. The purifier has 6 stages of filters, including two HEPA filters and one germ filter. We have also purchased additional air purifiers for some of the other smaller spaces within the office.
Increased isolation in the future for higher risk procedures:
We are continuing to add new equipment and reconfigure our operatory in response to COVID-19. Before we resume procedures that generate aerosols (e.g. rinsing while putting on braces, removing glue when removing braces or repairing broken brackets), I plan to extend the partial wall at the end of my operatory up toward the ceiling with an acrylic barrier, creating a semi-private area where aerosols can be contained.
I have also purchased a high volume evacuator (HVE) specifically for use during aerosol-generating procedures. This device will be able to limit the spread of aerosols during these procedures, decreasing the risk of exposure to those in the immediate vicinity. While an aerosol-generating procedure is taking place, we will schedule so that no other patient is in the operatory or, at most, one other patient will be seated 25-26 feet away in the furthest chair on the opposite side of the operatory and the other side of that wall for a procedure that does not generate aerosols. Eventually, I plan to finish out my private room in order to convert it in to a completely isolated and fully-private operatory dedicated to aerosol-generating procedures.