UPDATE CONCERNING DENTISTRY AND COVID-19

 

7/7/2020

DID YOU KNOW THAT LOSS OF SMELL IS THE SYMPTOM WITH THE HIGHEST CORRELATION TO A POSITIVE DIAGNOSIS OF COVID-19? 

The 50 year old Peace Rose is blooming in my yard at home. It does give me hope in these unusual times. Taking time to stop and smell my rose every morning is also a good reminder that my sense of smell is still intact. 

The question of if you have lost your sense of smell, along with ten others are questions we ask of our entire team every morning and our patients, two days before an appointment, and upon arrival to our office. Even though I am confident in our new and improved airflow and protective gear, if you answer yes to any of these questions, we will most likely reschedule your appointment. 

Any team member in our office as well, will be asked to stay home to quarantine for 14 days AND provide two negative tests to return to work if they have any signs or symptoms of COVID or if they (or a family member) have come into contact with a COVID positive person when they are not wearing a mask. 

Thank you for understanding our caution. I am not interested in taking any risks when it comes to this very unknown virus. I am choosing to celebrate the fact that thorns have roses and not bemoan the fact that roses have thorns.

unnamed.jpg
 

5/25/2020

Dental offices are permitted to open for routine care May 29th. Thank you for your patience as we finish getting everything in place to reopen, specifically finishing measures above and beyond what the American Dental Association and the Center for Disease Control recommend. We will reach out to you when we are ready to open with more details of what your appointment will look like. 

Here are some of the additions we are finishing to protect you and to protect our team:

  • Surgically clean air purification units in each room that will completely turn the air over every 4 minutes or 15 ACH (air changes per hour)

  • Extra-oral suction units in each room that further mitigate aerosols four times more than any other unit on the market

  • Improvements to the overall HVAC system including UV-C, electrostatic filtration and HEPA filtration

  • A new whole office dry pump to accommodate additional chair side high volume suction systems to further minimize aerosols

  • UV-C sterilization to clean hard to wipe areas

  • Fogging devices to use in rooms before and after each patient visit with HOCl

  • Fluid resistant level 3 gowns that are washable to minimize landfill burdens that will be changed for each patient

  • A supply of surgical masks available for you to wear if you do not have your own

  • A molecular iodine rinse (it tastes like apple!) for you to use before every appointment

  • A proper supply and a choice available to each team member of properly fit-tested masks or respirators that will not be reused from patient to patient.

  • Touchless and virtual checkin and checkout systems 

  • Virtual reality headsets available to wear instead of staring at our new masks, face shields, gowns and head covers so you can relax and tour the world during your appointment

Again, we will reach out to you to let you know when we will open, we are getting closer. Stay tuned! Stay safe. Thank you for trusting us.


4/24/2020

Stay home and stay safe has been extended to May 15. Please keep checking back for updates. Even though we CAN open, our ability to open will depend on our access to proper PPE. We are still here for you on the phone, via text, email and video teleconferencing. 


4/16/2020

Like most of my colleagues, business owners and employees forced to stay home from their place of employment all over the world, I'd like to go back to work. But first, I am carefully analyzing the DATA in my area to help me anticipate and determine the best date to reopen to ensure the safety of everyone involved. 

This data analysis includes local hospital admissions for pulmonary issues, local health department information and deaths, and the availability of proper personal protective equipment (PPE) and other infection control materials. DATA NOT DATES, are what I use as my guide. I am using this time wisely to revise our infection control procedures so they exceed the American Dental Association’s and the CDC’s guidelines.

The following are three areas of DATA I will review to decide when to reopen: (Vital Strategies has a fact sheet that provides helpful draft guidance on these.)


Status of the pandemic
We should see a sustained reduction of COVID-19 attributed deaths in the last 14 days in our local hospital, Veterans Affairs (VA) hospital, or regional hospital.  I like COVID-view from the U.S. Centers for Disease Control and Prevention (CDC) because it looks at pulmonary admissions data from hospitals, etc. I wish it were real-time, but you can see what happened last week.


Availability of infection control supplies 
When the local hospitals have adequate PPE on hand and they return to elective surgeries, then it will be time for us to properly equip our office for reopening. 


Green light from health authorities
Such authorities include the CDC, the ADA, our state dental board, and our state and local health departments.

I am not pinning my ability to reopen on dates, I am researching data specific to our region. In the meantime, the best thing to hope for are both antibody and antigen COVID-19 tests that are readily available in our community which will show in real-time what our community epidemic will be. 

Special thanks to Margaret Scarlett, DMD, an infectious and chronic disease prevention specialist and dentist in Atlanta for some of this content. For 30 years, Dr. Scarlett has provided expert guidance on infectious diseases and infection control as a consultant to the Centers for Disease Control and Prevention, the World Health Organization, the Pan American Health Organization, the United States Agency for International Development, the American Red Cross, and many consumer health companies.


4/6/2020

Our office is still currently closed. The “stay safe stay home” order is in effect through the end of April. If you have an appointment during this time, please consider your appointment cancelled and we will call you to reschedule closer to when we know we can reopen.  Rest assured we are working nonstop researching and implementing new infection control protocols for airborne pathogens. An entirely new world class medical-grade air purification system that exceeds the guidelines for surgically clean air quality is scheduled to be installed in each room in the building May1st.  We may not be seeing patients, but we are here for you. If you have a dental emergency or if you would like to speak to Dr. Lisa, please feel free to leave a message on her cell phone at 317-258-8222.  Stay safe. Stay home. We will see you soon.


3/23/2020

As you know, as of Monday March 23, 2020 at midnight, Governor Whitmer has issued an Executive "Stay Home, Stay Safe” Executive Order for Michigan. We will follow the Governor’s lead and stay closed as well until at least April 14, 2020. 

Dentists are EXCELLENT at protecting against blood borne pathogens and if COVID-19 was blood borne only, I wouldn’t change a thing with respect to our infection control. Unfortunately, there are respiratory considerations specific to COVID-19 that demand respiratory specific protocols, namely the N-95 masks and PPE that will help prevent transmission of the virus. These precautions would be appropriate for a dental emergency visit considering the likelihood of aerosolized respiratory droplets involved in active dental care whether a patient has COVID-19 symptoms or not. 

I BELIEVE THAT IT IS UNETHICAL AT THIS TIME OF CRISIS TO ATTEMPT TO OBTAIN ANY OF THIS PPE THAT COULD BE DIRECTED TO FRONT LINE HEALTH CARE PROVIDERS INSTEAD. USING ANY PROTECTION THAT IS LESS THAN IDEAL COULD ALSO LEAD TO UNNECESSARY TRANSMISSION AND FURTHER ADDING TO THE BURDEN OF OUR HOSPITAL CARE PROVIDERS.

To keep you out of the ER should have a dental emergency, there are one or two offices that ARE properly protected and prepared should a dental emergency arise so that we may streamline and use as little of this PPE as possible while still being able to take care of you. Please call me so I can direct you to the correct location should an emergency arise. 

That said, if there were ever a time to step up your oral hygiene, this is it. Maintaining a good oral hygiene regimen now can save you a lot of stress and time and money later. Even though this crisis is stressful, please remember to continue brushing your teeth and flossing at least twice a day to prevent future dental concerns. Your mouth is the portal to the rest of your body, keep it clean! 

In addition to brushing and flossing, a common reaction to stress is teeth grinding and it can have damaging effects on your teeth. No one needs a cracked tooth ever, but especially right now. Remind yourself throughout the day to not clench. I suggest finding something you do once an hour like looking at the clock or checking your email or a checking a certain app to associate with reminding yourself to see where your teeth are. If they aren’t relaxed and slightly separated, stop and unclench your jaw and stretch your face muscles. Wiggle your jaw around to relieve tension. If you notice symptoms like worn teeth, facial pain, or regular headaches, you may want to see if you can get an over the counter guard that you can custom fit at home for the short term. If you don’t want to go to the store, I am happy to mail you a guard. I am also happy to mail you any additional dental supplies you may need. 

Please don’t hesitate to email me at drlisamusgrave@icloud.com or text or call my cell phone at 317-258-8222 if I can help with anything, dental related or not! One bright side of this crisis is that I have enjoyed personally calling and rescheduling appointments via the phone or text and I have never been more grateful to have a small, relationship based dental practice. 

Much love, 
Lisa Musgrave, DDS


3/15/2020

I have started to make an update about our office several times this weekend, and deleted each because the information coming changes rapidly or is completely different depending on the source. As of Friday, March 13, 2020, the American Dental Association stated that the only changes we need to make in the dental office are to have patients rinse with 1% hydrogen peroxide, have their temperatures taken and be screened for COVID-19 symptoms and travel history.

While the ADA (American Dental Association), the CDC (Center for Disease Control) and the MDA (Michigan Dental Association) are all important sources of information for guidelines and recommendations, I have found that they have been a week behind in putting into place measures to support the latest research emerging from sources like the Journal of Dental Research and the actions put into place by the state dental schools.  In slowing the spread of this virus, a week is critical time. 

The Governor has also issued an executive order as of Saturday, March 14, 2020, that stated, “Beginning on March 14, 2020 at 9:00 am, and continuing through April 5, 2020 at 5:00 pm, all health care facilities, residential care facilities, congregate care facilities, and juvenile justice facilities must prohibit from entering their facilities any visitors that are not necessary for the provision of medical care or the support of activities of daily living, or that are not visiting under exigent circumstances, such as grave illness or imminent death of a family member under care in the facility.” There has been a lot of controversy amongst dental professionals as to whether or not “health care facilities” includes dental offices and the Governor has not yet responded to my inquiry. 

I have been relying on many evidence based resources for the latest information to keep my patients, my team and our community safe. The Journal of Dental Research stated, on Thursday, March 12, 2020 that, “Due to the unique characteristics of dental procedures where a large number of droplets and aerosols could be generated, the standard protective measures in daily clinical work are not effective enough to prevent the spread of COVID-19, especially when patients are in the incubation period, are unaware they are infected, or choose to conceal their infection.”

“The use of personal protective equipment, including masks, gloves, gowns, and goggles or face shields, is recommended to protect skin and mucosa from (potentially) infected blood or secretion. As respiratory droplets are the main route of transmission, particulate respirators (e.g., N-95 masks authenticated by the National Institute for Occupational Safety and Health or FFP2-standard masks set by the European Union) are recommended for routine dental practice.”  N-95 masks and gowns are all backordered and unavailable at this time.  

So, for now, some of you may think I am being overreactive, but based on the science and current evidence that our historical universal precautions are not a safe guarantee against COVID-19, I am choosing to close our office until Monday, April 6, 2020. As of today, Sunday March 15, 2020 the MDA and the regional district dental society and other dental offices have not yet made the same decision.  

I am always available by telephone 317-258-8222 or email drlisamusgrave@icloud.com if you have questions or concerns or are seeking dental advice that I can give remotely.  I have networked with other dentists in our state to try to make a list of offices that may have these more protective measures in place (N-95 masks, etc.) for true dental emergencies. 

As a patient, you have the right to a safe environment and I would much rather be safe and proactive than reactive. Politics aside, it is evident that social distancing is the number one preventative method for slowing the spread of this virus so that we do not overwhelm our hospitals. Dentistry has ALWAYS been at the forefront of preventative measures. I’d like it to stay that way.