I always felt secure working in dentistry; safe from business cycles that can affect other businesses but not dentistry. Dentists carried a belief that we operated within a resilient, recession-proof industry; after all, when a patient breaks a tooth or loses a crown, it needs to be fixed. March of 2020 dealt a substantial blow to dentistry’s ego. When public authorities mandated the shutdown of dental practices, I was stunned that we would shut down and sit at home for an indeterminate amount of time.
A full year into the COVID-19 pandemic, has the dental industry done enough to provide a safe environment for our frontline workers and patients? Do we now have a better understanding of the risks of transmission? The answer is yes, and my dental team and I would like to share what we’ve learned and what we’ve done in establishing cutting edge aerosol management and a “new normal” in our clinics.
We asked, “What did we miss as healthcare providers? How was an entire industry so ill-prepared for a large-scale event that would affect our continued operation?” Hindsight being 20/20, it’s clear what must be done to safely open our clinics – we need to make the management of aerosol in the workspace a central priority for the safety of staff, patients and administrators alike. Though few cases of COVID-19 were traced to dental offices, the risk of viral transmission due to aerosol-generating procedures involving hand pieces and ultrasonic scalers is undeniable. Aerosol can potentially spread viruses and bacteria around the treatment area. Cross-contamination can occur from the patient to the dental team, and then to the community.
Our industry was facing its “adapt or die” moment. While I am a practicing dental clinician with a focus on surgery and implants, I am also the CEO of Dentalook, a dental support organization providing centralized management services and support to dental practices across Canada. We have a team of over 250 people. Recognizing the severity of the pandemic’s spread, Dentalook asked all its clinics to self-isolate and quarantine a week ahead of the mandated closures. The uncertainty and fear were real. Patients cancelled appointments, and team members were anxious about their working conditions.
Implementing New Measures
In meetings with our leadership and experts, the goal was established that our clinics were going to be safe, risk educated, and ready for business well before the shutdown was lifted. We committed to developing our own protocol, one that might be different than those authorities would eventually establish, but would be in harmony or perhaps even more thorough. In early April, we had a protocol draft in place. We knew our patients wanted to see a certain level of preparedness and safety precautions in our clinics and it would be important for them to understand the mitigation efforts we made.
While progress has been made, I have observed that the dental industry continues to struggle to define and address the issue of splatter and aerosol management. These two issues are dissimilar and require separate mitigation efforts. Splatter consists of water, blood or saliva droplets that quickly spread with velocity, with enough size and weight to land upon surfaces and clothing. Airborne aerosols, however, are less than a third of the thickness of a human hair; they stay suspended in the air much longer and have the potential to carry viruses and bacteria.
Gaining a Better Understanding of Aerosol Management
Much of my understanding of airborne spread of infectious agents stems from the research of microbiologist Syed A. Sattar PhD, Founding Director of the Centre for Research on Environmental Microbiology (CREM Co). Standard PPE measures and room air filtration are effective, but do little to reduce the air clearance time between patients. “Fallow time” is the conversion phase of aerosol to droplets that settle on surfaces. Aerosols generated during dental procedures can remain airborne for upwards of two hours.
My team and I began to tackle these two issues. To mitigate splatter, we adopted PPE such as face shields, gloves and gowns, along with the use of surface disinfectants. To manage aerosol, we looked at solutions such as complete room separation, N95 masks, air filtration systems, and an extraoral suction system that is placed close to the patient. We knew we needed innovation to solve the issue of aerosol spread. Our team collaborated with BriteHive Solutions and CREM Co. to conduct research on the efficiency of capturing aerosols at-source using extraoral suction combined with a transparent protection screen (The Aerosol Guard).
Now, a full year later, as we begin to emerge from the COVID-19 pandemic, we breathe a little easier knowing our clinics follow adaptations of this original protocol and those of our authorities. We will continue our research into aerosol contamination, and the development of technologies and measures we can take to keep everyone safe and prevent viral transmission in dentistry.
About the Author
Dr. Sam Mazahreh, is the founder and CEO of BriteHive Solutions. Dr. Sam Mazahreh (aka “Dr. Sam”) is a gifted oral surgeon and serial entrepreneur having established two important and synergistic companies benefiting the Dental Industry. His Dentalook organization provides centralized management services, important strategic insights, and mentorship to dental practitioners across Canada. With this support system in place, dental teams can prioritize patient health and comfort in order to provide the very best care and services to the communities they serve.
