Is It Safe to Go to the Dentist During the COVID-19 Pandemic?

Even before the pandemic, dental providers were already required to use strict hygiene practices, such as standards developed by the Occupational Safety & Health Administration (OSHA). These include sanitizing surfaces and equipment with EPA-approved disinfectants specifically designed for use in the healthcare setting. In response to the COVID-19 pandemic, a wide range of new safety precautions are now in place. When scheduling your dental cleaning, checkup or procedure, ask about the following infection control measures, many of which are advised by the CDC and the ADA:

• Staggered appointments. To help ensure safe social distancing between patients, the CDC advises dental providers to limit “clinical care to one patient at a time [per clinician] whenever possible.” In facilities with multiple treatment rooms, it’s possible that other patients will be receiving care from other providers in other rooms during your visit. However, your provider should not go back and forth between rooms. The office should also build in adequate downtime between patients to allow clinicians to thoroughly sanitize and disinfect rooms and equipment between patients.
•  Screening for COVID-19. Ask if the dental providers have been tested for the coronavirus and what the results were. Also ask what steps your provider takes to screen patients. In our practice, we ask patients to wear a face covering when they arrive, take their temperatures and use a symptom questionnaire to screen for signs of the disease. We also ask if they have been told to self-quarantine after exposure to an infected person. However, it is possible for people who are not yet showing symptoms of the virus to transmit it, so even the most rigorous screening will not eliminate all risk.
• Reducing exposure to other patients. Many practices have abolished the waiting room and removed all shared objects, such as magazines. In our practice, patients are asked to remain in their cars until the previous patient has left. After we sanitize the room, we telephone the patient to let him or her know that we are ready. We also have a virtual payment process so patients don’t need to interact with front office staff at all. 
• Measures to minimize aerosols. The CDC has advised dental providers to take all possible steps to avoid the release and spread of airborne pathogens. Along with using the Releaf device discussed above to keep our patients’ mouths dry during aerosol-releasing procedures, our practice also revaluated the types of equipment we use. For example, while we continue to use the ultrasonic scaler, we stopped using a tooth polishing tool that produces a high volume of spray. Some practices use a different type of external suction device that goes around the patient’s face, such as Xuction.
• Doubling down on PPE. Many practices now use a shield positioned in front of the patient to block some of the aerosols and some use other types of shielding between patients and providers as well, or a combination of measures. As advised by the CDC, our providers wear eye protection, face shields, N-95 masks, full body surgical gowns, gloves and other PPE (personal protective equipment). Practice recommendations also advise providers to change PPE between patients to help avoid cross contamination.
• Improved air quality. Since it’s impossible to eliminate all airborne particles during dental care, the CDC advises providers to work with a HVAC professional to increase filter efficiency to the highest possible level without impeding air flow. The agency also suggests that providers consider using a portable HEPA air filtration unit during and immediately after aerosol-generating procedures. Another option the agency has  recommended is using a technology called upper-room ultraviolet germicidal irradiation to zap bacteria and viruses.

Pre-rinses and home care. To reduce the viral load in our patients’ mouths, we have them use disinfectant pre-rinses containing peroxide or iodine before their dental care. For patients who use Perio-protect trays for the treatment of periodontal disease, we ask them to wear the trays to their appointment to help reduce harmful pathogens in the mouth. We also tell all of our patients to use the salt-water gargle and nasal lavage advised by the BaleDoneen Method to help abate COVID-19 before their appointment. Recent evidence suggests that this simple home-care technique can significantly reduce the spread of respiratory infections, including those caused by coronaviruses, a discovery that may have important implications in combating the transmission of COVID-19.