At the beginning of the COVID-19 outbreak, the Occupational Safety and Health Administration (OSHA) released a note regarding worker exposure. OSHA had listed the occupations most at risk for contracting COVID-19, and among them were dentists. Dental professionals are at risk of inhaling aerosols produced when instruments come into contact with the oral cavity.
As a result, the Centers for Disease Control and Prevention (CDC) strengthened guidelines for infection prevention in dental settings. The additional policies include the following:
- postponing non-urgent outpatient visits
- implementing teledentistry sessions
- setting triage protocols and other screening for those entering the dental clinic.
Included in the CDC guidelines is the proper use of personal protective equipment (PPE) and limiting clinical care to only one patient at a time.
Dentists have to wear full protective equipment when treating patients. This includes gloves, a mask or high-level respirator, a protective gown, and eye protection. The CDC has a recommended sequence for the donning and doffing of PPE.
- Dentists must first perform hand hygiene before putting on a gown or covering. Doing so protects against blood and saliva.
- Next, dentists must don a mask or respirator, and then a face shield or goggles;
- The last step is to put on clean surgical gloves.
Only then can the dentist enter the patient’s room.
The sequence for removing PPE is as follows:
- The dentist must remove and discard surgical gloves and protective gown;
- He or she must exit the patient care area;
- The dentist must perform hand hygiene once outside the patient room;
- They may remove the face shield or goggles, followed by the mask;
- Lastly, the dentist must perform hand hygiene one more time.
The One-Patient Policy in Dental Care
Since a complete set of PPE must be worn for each patient, dentists will not be able to attend to multiple patients at a time. This used to be a more efficient strategy before the time of COVID. Dentists used to give one patient local anesthetic and then move to another room to finish a different procedure while waiting for the anesthetic to take effect.
Using the old method would mean that a dentist would don a new set of protective equipment when reentering a patient’s room. The new normal for dental practice, therefore, is “Seat, Treat, and Complete.” Dr. Mic Falkel of the Onpharma Company coined this term. The one-patient policy will effectively reduce the risk of spreading the novel coronavirus to other patients and the rest of the dental staff.
Taking Care of the Business of Dentistry
How can dental practice remain efficient when the new protocol is to see only one patient at a time? How can dentists still successfully manage the business of dentistry without scheduling multiple patients?
Dr. Falkel recommends using buffered anesthesia to reduce the time it takes for each dental procedure. Before, dentists used the time it took for local anesthesia to attend to other patients. Now, dentists will seat the patient, inject the buffered anesthetic, and complete the procedure.
Buffering, or the alkalization of local anesthetic, is the raising of the anesthetic’s pH level. This leads to decreased time for onset and reduced injection pain. Each patient who comes to the dental office wants the safest and most comfortable procedure. When local anesthetics take more time to take effect, dentists sometimes begin a procedure with the patient still not completely numb. This creates a negative experience for both the patient and the dentist.
Dr. Falkel shares two ways to buffer anesthesia.
The first, he calls the “do-it-yourself” method. A dentist can buy medical-grade sodium bicarbonate that comes in a vial and then transfers the solution to the cartridge that contains the anesthetic. This raises the pH or alkalizes the acidic solution, reducing the anesthetic’s onset time.
The dentist needs to take out some of the anesthetics from the cartridge before adding the bicarbonate via a stainless steel syringe, as the cartridge’s volume is fixed. Various equipment will already be out on the table even before the beginning of the procedure. It can be cumbersome to the dentist and stressful for the patient.
The second method recommended by Dr. Falkel is to use a buffering system currently in the market. Many options are available, such as Anutra Medical, which comes with its plastic syringe, and therefore may require some time for dentists to be comfortable. The other option, which Dr. Falkel thinks is the best, is the Onset buffering system by the Onpharma Company. According to him, it is not only the most convenient, but is also the most cost-effective.
Buffered anesthesia, therefore, is the game-changer to the one-patient policy.
The new normal for safety and efficiency is to seat, treat, and complete. When dentists reduce the overall time to complete a procedure and focus on only one patient, the patient also becomes safer, as less time is spent inside the dental clinic. This also improves the overall patient experience, which is at the forefront of any dental practice.
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Sources:
Benco Dental. (2020, December 14). What if you did not have to wait for your anesthetic to work? [Video]. YouTube.
https://www.youtube.com/watch?v=NV2saoykpNo&feature=youtu.be
Centers for Disease Control and Prevention. (2020, December 4). Guidance for Dental Settings
Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. CDC. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
Davidian, D. (2017). Using Buffered Anesthesia and Injection Techniques to reduce Pain and
Improve Effectiveness [E-book]. Dental Learning Systems. https://sprigusa.com/wp-content/uploads/2018/05/Using-Buffered-Anesthesia-and-Injection-Techniques-to-Reduce-Pain-and-Improve-Effectiveness.pdf
Goodchild, J., & Donaldson, M. (2019). Novel Direct Injection Chairside Buffering Technique for
Local Anesthetic Use in Dentistry. National Center for Biotechnology Information, 40(7),
e1–e10. https://pubmed.ncbi.nlm.nih.gov/31478693/
Occupational Safety and Health Administration O?cial Website. Worker Exposure Risk to
COVID-19. Available online: https://www.osha.gov/Publications/OSHA3993.pdf (accessed on 20 April 2020).
