It’s a New Day for Dentistry
Dental practices and industry leaders react to the COVID-19 impact and prepare for the ‘new normal’ with an increased focus on safety and infection control
In March, like countless practice owners around the country, Dr. Dory Stutman was forced to lay off his team and close his practice with the exception of emergency treatment. This was uncharted territory for the renowned cosmetic dentist in Massapequa Park, NY. “I have never had the experience of actually being unemployed,” he said. Dr. Stutman used the time to reflect and learn, while asking the same questions as many others around the country:
When can I reopen and how will my practice have to adjust?
As the coronavirus pandemic gripped the nation, most practices closed their doors or remained open strictly for emergency care. The near shut-down followed what had been a period of consistent growth for the dental profession thanks to rising demand and technological advancements. The cosmetic dentistry market alone totaled over $20 billion with over 7% growth annually. More than ever, patients wanted to improve their smiles.
But with COVID-19 resulting in social distancing guidelines and regional lockdowns, many dentists hunkered down and made productive use of their time by turning to continuing education, cleaning and organizing their practices, and applying for government assistance. But perhaps more than anything, they struggled with the uncertainty of when they would be able to see patients again and what the practice would look like in a world so profoundly impacted by an ongoing pandemic.
“When the pandemic ends, dentistry and life won't go back to normal, ever. There will be the new normal,” said Dr. Todd Sarubin of Sarubin Family Dental in Pikesville, MD.
But what will this “new normal” involve? And what changes, such as enhanced infection prevention, will the practice have to employ for the short and long terms?
“I believe we are already doing a great job in dentistry,” said Dr. Tarun Agarwal, a popular speaker who practices in Raleigh, NC. While he feels that dental practices’ standard universal precautions are effective for safety, he could envision reasonable changes to requirements for masks, arm coverage, eyewear, and room cleaning.
As clinical director for a multisite practice, Zach Korwin, DMD, FICOI, has been working with his team on an array of changes as they wait for lockdown restrictions to end. “The changes that we have to implement are not drastic, but it’s going to take time to get used to doing things in a different way,” he said, referring to plans that call for everything from extraoral suction to staggering patient visits for social distancing. A newly organized PPE system may involve wearing an N95 mask covered by another mask, with the N95 being sterilized each night until it is no longer usable, and the other mask changed after each patient.
"Reassuring patients who are uneasy will be key."
-Adam Beno, DMD
Fort Myers, FL
While dentists wonder how their own protocols will have to change, they are also considering how patients will be different during and after the COVID-19 crisis, and how that will impact patient communication?
Adam Beno, DMD, who operates a practice in Fort Myers, FL, thinks patients will fall into two categories. “While some may be eager to get back on their normal hygiene maintenance schedule, I believe others will be hesitant to schedule their appointments,” he said. “There will likely be questions and concerns regarding their safety, and they may question what our infection control protocols entail.”
Calming patient fears will be part of the new normal for dental practices. Eric Shirley, President of Patterson Dental, said it is critical that patients are comfortable returning to the dental practice. They will need to know that the office has the right processes, materials, and equipment in place to provide a safe and secure environment. “This is a time when we have to think like patients as well as business people. The patient returning now for a cleaning is going to think, ‘Is it the same environment? How is it different? How do I know that chair that I'm sitting in has been cleaned? How do I know the instruments are clean and sterile?' I think those kinds of questions will be asked, at least in the short term.”
Dr. Beno agrees that patients need to know that the practice has taken all necessary precautions to ensure their safety. “Reassuring patients who are uneasy will be key, and we will be prepared to tell them how we have even increased our already diligent infection control practices as well as the frequency in which they are employed,” he said.
While it remains unclear to what extent COVID-19 will change dentistry going forward, the pandemic has already had an impact. In addition to the increased focus on infection prevention and products geared toward a safer practice, the industry is seeing a surge in the use of technologies that deliver services such as teledentistry and offer greater patient communication.
In this article, we highlight some of the products and services that warrant attention as dental practices ramp back up in a world that has been considerably altered.
Personal Protective Equipment
The CDC's interim recommendations call for using the highest-level of PPE available. Dental professionals are advised to wear gloves, a gown, eye protection such as goggles or a face shield, and either an N95 or a combination of a surgical mask and face shield.
Looking ahead during the pandemic, many dentists anticipate some degree of enhanced protection.
Dr. Stutman predicted the availability of PPE will be a concern. “Social media has been describing our future PPE to be between typical—as used in the past—and something akin to a Chernobyl-disaster HAZMAT suit with negative-pressure rooms,” he said. “I feel that PPE will be a little more stringent than before, and the supply will quickly catchup.”
Dave Sproat, CEO of Young Innovations, said he expects demand for PPE and other infection control items to continue to be high. "While the infection control guidance continues to evolve, we are ensuring our product portfolio is aligned with what the market will need," he said.
Young is among several companies working to meet the demand for PPE. Its portfolio includes Defend, which offers a variety of high-quality masks, shields, and gloves. Its combination Level 3 Dual Fit Ear-Loop Face Mask with Shield is designed for procedures with moderate to heavy amounts of blood, fluid, spray, and/or aerosol exposure. The chin contour reduces gaps for maximum protection.
Henry Schein’s selection of private- label infection control products include the Criterion glove line, designed to meet all practice needs, whether exam or surgical, latex or nonlatex. A wide range of mask varieties include the Maxima Procedure Masks Level 3, with a high filtration rate, fluid-penetration resistance, and a full-width, flexible nosepiece. The Henry Schein Disposable Face Shields are optically clear, full-length visors for increased protection against splash, spatter, and aerosols. Bodywear includes the knee-length Maxi-Gard Cover Gowns, made from quality SMS fabric that meets OSHA fluid-resistance requirements.
"It's going to take time to get used to doing things in a different way."
-Zach Korwin, DMD, FICOI
Newington, CT
Patterson Dental’s private brand features a wide variety of protective equipment. For example, the fluid-resistant Patterson Pleated Earloop Masks with Shield feature a form-fitting, pliable chin band to reduce gaps and maximize protection, a moisture-absorbent nosepiece, and optically clear face shield. The Patterson TactileGuard Ultra 3G nitrile exam gloves provide latex-free comfort and are designed for excellent chemical and barrier protection. Patterson Cover Gowns are fluid resistant and have extra length for maximum body protection during dental procedures. Pac-Dent, whose portfolio includes infection control products such as iBrite Hand Sanitizer and the iMask Premium Face Mask, is now offering the Personal Infection Protection & Clean-Up Kit, with essential supplies to help minimize the spread of disease-causing germs. The package includes disposable full-chair sleeves, ASTM Level 3 face masks, alcohol prep pads, disposable exam-quality vinyl gloves, biohazard waste bag, and iWear Plus Ultralight Disposable Eyewear.
Cranberry's infection control solutions include the Repel 4-ply face masks for ASTM Level 3 protection with high fluid resistance. The unique HydroGuard layer ensures secure protection and optimum bacterial and particle filtration. For its gloves, Cranberry employs the proprietary One Direction packaging, which allows each glove to be dispensed by the cuff, minimizing direct skin contact with the finger and palm surfaces of the glove, while reducing the risk of cross-contamination.
Richmond Dental’s Level III Path-O-Guard Face Mask meets ASTM standards for Level 3 surgical face masks with 98% bacterial filtration efficiency and resistance to penetration by synthetic blood. The 3-ply spun-bound fabric provides comfort, filtration, and ideal breathability.
Surface Disinfectants
Rooms and equipment must be cleaned and disinfected in accordance with the CDC’s Guidelines for Infection Control in Dental Health-Care Settings. In response to the pandemic, the CDC issued interim recommendations stating that the use of EPA-registered, hospital-grade disinfectants are appropriate for the novel coronavirus strain. The following products are listed by the EPA or product manufacturers as effective for use against SARS-CoV-2, the virus that causes COVID-19:
Young’s Opti-Cide3, available in wipes, spray, or pour bottles, is a ready-to-use cleaner and broad-spectrum disinfectant compatible with more than 30 common dental surfaces. The virucidal, fungicidal, and bactericidal product can sanitize hard, nonporous surfaces in 10 seconds with a 2-minute TB kill time. Also from Young, Birex Quat surface disinfectants have the same sanitizing and TB kill time, eliminating 99.9% of germs on hard, nonporous surfaces.
CaviCide from KaVo Kerr has a broad spectrum of kill and is effective against TB, HBV, HCV, HIV, viruses (hydrophilic and lipophilic), bacteria (including MRSA and VRE), and fungi. KaVo Kerr's CaviWipes contain durable, nonwoven, nonabrasive disposable towelettes pre-saturated with CaviCide.
DenMat has introduced a hard-surface cleanser to complement its recently launched 80% ethyl alcohol hand sanitizer. Formulated with 1.5% bleach and a powerful surfactant for removing dirt and grime, the new Hard Surface Cleanser is safe and effective in the removal of germs and viruses from surfaces such as marble, tile, plastic, fiberglass, and metal. Hard Surface Cleanser features a mild lemon scent.
In 60 seconds, DisCide Ultra from Palmero Healthcare is effective against TB, viruses (HBV, HCV, RSV, HIV-1), bacteria (MRSA, VRE, E. coli), and fungi (C. albicans). Specifically formulated to resist evaporation, it is noncorrosive, nonstaining, and leaves no residue. Meeting OSHA’s bloodborne pathogen standard, DisCide Ultra is available in spray and towelette formats to ensure efficacy when liquid and towelettes are used in tandem.
From Air Techniques, Monarch Surface Disinfectants, available in wipes and spray, offer fast, broad-spectrum efficacy. The ethanol based, bleach-free formula kills TB, viruses including the human coronavirus, bacteria, and fungi in just 1 minute. The large 7×9- inch wipes cover more surface area for efficient cleaning.
Air Purification
Considering that aerosols containing bacteria and viruses can remain in the air for hours, many dentists are turning to air purifiers to decrease pollutants and increase safety. Surgically Clean Air’s JADE Air Purifier uses multi-stage air-purifying technologies that work together to clean, purify, and re-energize the air. The filtration system captures viruses, dust particles, pollen, mold, allergens, odors, bio-aerosols, and other pollutants found in the air within dental practices. Check out our article on the Jade Air Purifier.
High-Volume Evacuation (HVE)
Concerns surrounding the invisible dangers of COVID-19 have prompted discussion of aerosol containment in the operatory. Dental professionals routinely use tools such as high-speed handpieces, lasers, ultrasonic scalers, air polishers, and prophy angles that create aerosols containing blood or saliva with the potential to carry viruses and bacteria. These aerosols can linger in the air as droplets or, later, as dust particles.
The CDC recommends the use of high-volume suction to minimize droplets, splatter, and aerosols, as studies have shown a reduction in aerosols by at least 90% with the use of HVE when compared to a saliva ejector.
Zirc offers several products that provide isolation while eliminating most aerosols from being emitted. The handsfree Mr. Thirsty One-Step has a built-in bite block, tongue retraction, and airway and cheek protection, in addition to high-volume suction. Another weapon for aerosol protection, Zirc’s Insti-Dam, offered in both relaxed-fit and original, has a pre-punched hole and a built-in flexible frame that allows the dam to be folded to the side for taking radiographs or providing suction for the patient. Another product, Pink Petal, slides onto your saliva ejector to provide continuous, hands-free suction with no additional attachments required.
The Isolite, Isodry, and Isovac isolation systems from Zyris also offer protection from aerosols with continuous evacuation of saliva and debris. The Isolite 3 offers brighter illumination and a robust head design, as well as a smart adapter that allows you to use your existing HVE line. DryShield, now available in autoclavable or single-use options, combines the tasks of high suction evacuator, saliva ejector, bite block, tongue shield, and oral pathway protector in one device. Each mouthpiece size features a matching interchangeable bite block, giving the patient a firm place to rest while enabling the dentist to customize for an ideal fit.
From Dentsply Sirona, the Purevac High Volume Evacuation System enables a one-handed approach to evacuating fluid and debris while facilitating retraction, visibility, and illumination during dental procedures. The Purevac HVE has been shown to remove 90% more harmful aerosols during ultrasonic scaling compared to low-volume saliva ejectors.
Ivory ReLeaf from Kulzer allows for safer dental and hygiene procedures by minimizing aerosol risk as well as backflow. The hands-free HVE suction device, which is latex- and BPA-free, conveniently connects to existing dental vacuum systems.
Teledentistry
As a means of delivering patient care and education at a remote location via digital communication, teledentistry has proved useful for many clinicians during the pandemic. Dr. Bryan Laskin, a Minneapolis practitioner and founder of technology companies such as OperaDDS, said teledentistry has played a crucial role in 4 primary areas: triaging patients so dentists only see cases that are emergent; keeping the team and patients safe by reducing potential for cross-contamination in the office; making it more efficient when an office visit is warranted, as the practice will have a clearer idea of the care needed; and ensuring revenue—in most states, the practice can bill for teledentistry exams.
Dr. Laskin sees more practices using teledentistry as a result of COVID-19.
“There was a slow, steady trend to modernize many aspects of delivering dental care prior to this pandemic,” he said. “Now that we have been forced to react to the current environment, the timeline has compressed, such that dental offices are getting up to speed with regard to technologies that are in just about every other industry.”
"We are going to do everything in our power to compassionately, competently, and confidently take care of our patients and our staff."
-Todd Sarubin, DDS
Pikesville, MD
Dr. Laskin’s OperaDDS now offers the COVID-19 Pre-Appointment Screening and Teledentistry Kit so dentists can pre-screen patients via email or text. The Teledentistry Emergency Triage Form allows patients to securely send photos and videos for the doctor to review and make an educated decision on whether an emergency appointment is warranted.
A clinician-focused teledentistry solution, the TeleDent platform from MouthWatch enables live streaming video consultations to facilitate remote treatment planning, supervision, and collaboration in real-time and asynchronously at the provider’s convenience. With secure patient messaging, clinicians can screen patients, offer clinical expertise, and determine next steps on any device before scheduling an appointment.
Welcoming Back the Patient
Many patients will be reluctant to return to the dental setting in the wake of COVID-19, and some of those who do will be concerned about the safety measures taken with regard to infection control. This means patient engagement will be paramount. “It will be imperative for practices to get out in front of what we already do and inform and educate our patients and the general public,” said Dr. Agarwal.
Practices should develop and deliver patient messaging using the technology and tools available to them.
“It’s an important time to be utilizing your communication services,” said Andrea Gallimore, Product Marketing Manager for Henry Schein One, adding that software tools are available to let patients know your policies and guide- lines, or when you’ll be open. “You want to make sure you’re putting out messaging about your COVID-19 policies, and utilizing the campaigns and newsletters within your communications service to send those mass emails out and get your message out to your patients.”
Henry Schein One offers patient communication systems such as Demandforce, Lighthouse 360, and Dentrix Patient Engage. Demandforce can help practices quickly and easily communicate critical updates to their patients with an all-in-one solution, using tools such as informative emails, one-off messages, two-way texting, business listing management, automated email reminders, and desktop notifications. Lighthouse 360 helps to keep practices’ schedules full and automates repetitive daily tasks like appointment reminders. During the coronavirus pandemic, many practices can take advantage of services such as cancellation messages for closing the office or cancelling several days of appointments at once, and custom eBlasts to patients.
Shirley said it will be important to make patients feel comfortable and communicate messages around infection control guidelines, standards, and training.
“The clinical team and the office manager have a lot of tools at their disposal that they can use to help their patients be more comfortable with the environment,” he said. RevenueWell is an online practice marketing and patient communication suite that allows practices to stay connected with their patients. Prebuilt campaign templates allow crucial information and resources to be sent out to patients, while RW Messenger enables one-on-one contact for the dental team and patients. New tools offered include the RW WebPhone—a HIPAA-compliant way to place and receive phone calls without using cellphones.
RevenueWell also now includes a way to provide teledentistry, whether for quick follow-up consultations or sessions to determine if an emergency patient needs to be brought in.
Solutionreach, another leader in patient engagement, recently announced the release of its SR Telehealth solution to help providers remain HIPAA-compliant while streamlining the process of virtual visits—from scheduling through the encounter.
Brighter Days Ahead
Looking at a "long, slow road" ahead, Dr. Sarubin is ready to move forward. “I know in our practice and those of my colleagues and friends, we are going to do everything in our power to compassionately, competently, and confidently take care of our patients and our staff,” he said.
In New York, Dr. Stutman said the past couple months have been a time to slow down, reflect, and appreciate what we have. “Our experience has given us the confidence that, yes, we can find a way to get by and come out better in the end."
The Benefits of Using Pre-Sterilized Products
Dental phobia has long kept a sizable chunk of people away from the dentist, but with the added concerns surrounding COVID-19, patient paranoia can be expected to reach an all-time high. As a result, dentists are advised to shift their marketing and patient communication messaging to ease consumer fears and help patients understand the high standards of infection control in place in the practice.
Practices can further their image as a safe, clean setting by making a commitment to sterile, single-patient-use products. SS White offers a full line of pre-sterilized burs, polishers, and endodontic files that reduce the risk of cross-contamination and eliminate the time and costs involved in sterilization. And by purchasing products that are made in the United States, you’ll avoid further supply-chain delays and the risk of “gray market” or fraudulent products.
To learn more about how you can save time and give both your team and your patients some much-needed peace of mind, see our story Dental Companies Step Up In Time of Need.
