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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
The Thanksgiving lessons that we should take from 2020 (yes, 2020).
By any measure, 2020 was a rough year. The coronavirus disease 2019 (COVID-19) pandemic led to global concern about overall health and safety. Practices were forced to shut down for a time, seeing only emergency patients. And when they did reopen, new safety measures meant that business was anything but usual.
As dental health care professionals sit down this year to celebrate Thanksgiving (in whatever shape or form it looks like), there are certainly some things for which they can be thankful.
Joyce Moore, BSDH, RDH, CRCST, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Massachusetts, observes that one of the first places to be thankful is that practices are able to start seeing patients again. Even though practitioners are decked out in extra layers of personal protective equipment (PPE), and there are new regulations and requirements for seeing patients, at least the doors are back open.
“We should be really thankful that we’ve had the ability to return to practice because we need to provide that care our patients need,” Moore says. “Even though it looks different than it did before, it’s good to know that, for the most part, we’ve already been doing a lot of the things to practice safely.”
Reopening to routine patient care was important not only to practitioners, but for the patients, as well.
“It was nice to see that, out in the media, there were articles highlighting how important dental care has been and continues to be,” Moore says. “It’s a bigger part of our medical care than is generally highlighted.”
A (not so) gentle nudge
When it comes to infection control, dental practices have to follow a lot of rules. Sometimes, corners are cut and those rules are not as strictly adhered to as they should be. However, an upside of the pandemic seems to be a sharper focus on adhering to those rules.
“I feel like this has brought people together,” says Lisa Kane, DMD, dental consultant at Dental Office Compliance of New England. “In fact, infection control-wise, people are doing what I’ve always wanted them to do. They’re really paying extra attention to infection control, really making sure that they are disinfecting everything and cleaning everything, and they’re focusing more on it. They’re clearing countertops, they’re taking out extraneous things that are around that can get infected. It’s kind of like what the ideal was supposed to be, and now people are taking it to heart.”
She also notices that team members are acting more out of a sense of care for others than ever before.
“People are focused right now on greater care for everyone, staff and patients,” Kane says. “When people are more susceptible to COVID-19, they’re maybe taking a step back, and other people are stepping up and taking over some of their responsibilities. People are taking care of each other more.”
“COVID-19 has really created a different type of teamwork with people in the office that wouldn’t have traditionally supported clinical staff,” Moore adds. “There’s more teamwork. People have to work together to get this done because now we’re not necessarily going out to the reception area to get the patient. We may have someone bring them in. We may have one person in the sterilization area. Teamwork has increased. People are getting together and figuring out how to make this all flow more smoothly.”
But it begs the question: Are they paying closer attention to those rules, or are they communicating better as a team?
“I think it’s both,” Kane says. “Initially, it was probably based on fear and protecting themselves, the patients, and their coworkers. I think that, unfortunately, what this has brought about is a lot of misinformation. There are a lot of people spewing information out there that’s been researched, and there’s information that’s not. I don’t know if that’s necessarily the positive part of 2020. I think that they’re just kind of deciding what they think sounds right, and then they’re freaking out about it. But, the offices that I go into are usually the offices that hire me for fit tests or office evaluations and that are really on board with everything, following the rules, and are being really diligent.”
There are a number of agencies, organizations, and groups with guidance for the dental practice. Those organizations form another outlet for appreciation.
“I’m truly thankful for CDC and for CDC guidance that they’ve provided, both socially and for the dental profession,” says Jackie Dorst, BS, RDH,infection prevention consultant and speaker. “How can we navigate through this time and minimize the impact of this new virus? In January, February, and early March, the scientists had very limited information on it, and it was scary because it was airborne disease transmission, and you can’t see the virus in the air, and what you can’t see can be intimidating in dentistry. We are very familiar with standard precautions and talking about splatters and splashes and bloodborne pathogens in saliva. I’ve even used Glo Germ as a visual demonstration of where the splatters and splashes stay, but with an airborne disease, it’s invisible.
“And that can be intimidating,” she continues. “CDC has provided us with the guidance of sanitizing your hands and wearing a mask for protection. When you don’t have a mask on, you should have 6 feet of physical distance from those people that don’t have a mask on. Again, there are all the CDC basic hygiene precautions that have protected us and reduced the number of transmissions of this highly infectious disease. So, I am very grateful for CDC guidance.”
Because COVID-19 is a novel virus, all of its secrets weren’t immediately revealed, and it is up to dental professionals to listen to newly disseminated guidance from official sources.
“There has been some confusion, often from nonscientists, with the public and even with dental patients and dental professionals,” Dorst says. “They want immediate answers, and science takes time. It takes time to do research, and, normally, research would take years on a new, emerging virus.”
“CDC, OSHA, FDA, EPA, and the ADA—those official sources provide the most reliable, up-to-date information,” Dorst continues. “I am so thankful for OSAP. I wouldn’t have the information that I have to provide the webinars and the Zoom meetings and share with dental professionals without OSAP providing the resources that they do. OSAP has really been the facilitator for the dental profession on coordinating this fire hose of information that has come out. I do have gratitude and a big ‘thank you’ to OSAP.”
Technology and PPE
Mechanical controls and PPE have taken center stage in the industry’s effort to mitigate COVID-19’s spread. There are new rules and regulations but manufacturers have also stepped up to improve technology and PPE.
“This has brought about a lot of people that have new technologies, new PPE,” Kane says. “There are a lot of people out there that have really tried to make things better for everyone—like face shields. There are so many different people trying to design face shields that are more usable with loupes and trying to have them not fog up. There’s a lot of really cool N95, too. I just found one from ReadiMask that sticks to your face but doesn’t have straps. There are all these things that are coming out now that, at the end of this, will be assets to practice.”
It just underscores how important these measures have always been, just not as pandemic management is concerned.
“A lot of the ways that people are doing things now and what they’re getting used to are great to continue,” Kane says. “This is not just something to do in an emergency or a pandemic. This is something that should be continued. And I think that now that people are focusing on dental and people are more careful with their PPE, they’re changing it more often or really being aware of and being careful when they change it. I think that that’s good.”
PPE is, of course, one way to mitigate infection control dangers. Another way is through engineering controls, like air management systems.
“Air management in the dental setting has become a significant priority,” Moore says. “And I’m really glad to see that. It can look like a lot of different things. It can be physical barriers, like sneeze guards. And then we’ve been looking at high-efficiency air filters. So, filtration has become a really big component of what practices are doing to improve air quality within the office. In some cases, we’re looking at negative pressure rooms being installed, which would typically be medical only, but if there’s a creation of significant aerosol-generating procedures, that might be something we should consider, and then increasing ventilation rates in the general environment. We’re breathing a little easier because this has now become a focus.”
No matter what form Thanksgiving takes this year, and no matter how disappointing 2020 has been,there are still things for which the dental profession can be grateful.