The current pandemic of Covid-19 has significantly changed the daily practice of dental offices around the world. We have spoken to Dr. Jurate Zekoniene, President of Lithuanian Society of Periodontology who runs her own dental clinic in Vilnius, to find out how they responded to new regulations, how they equipped their clinic and what their new approach with their patients is.
How has the global pandemic affected your dental clinic?
We needed to synchronise the working plan for the office with the National Public Health Centre under the Ministry of Health, and get their permission to re-open. Of course, there are some rules we need to follow, based on the epidemiological changes of Covid-19.
For example – if there were to be an increase in the numbers of infected, we would need to decrease our number of patients seen by 50%. At the moment we treat 80% of the number of patients we used to treat, due to the obligatory rules to have breaks in between each patient (10–15 min) for disinfection and ventilations.
We have to do long questionnaires by phone so as to make the triage a day before the patient’s visit, which takes more time and effort for reception. Also we measure the temperature of each patient entering the clinic.
In the reception area we have made a protective organic glass wall. The patients do not meet each other in the waiting room. They come in protective masks and there are no toys or any info materials in the waiting hall, and also nothing on the surfaces/outside the draws in the operating rooms. The staff also aren’t communicating as they usually would, taking no coffee breaks together for example.
What about the financial aspect of the clinic? Have you already experienced the influence of the crisis?
Due to the quarantine, the dental clinic was closed for two months. The financial support from the Government is partial and low, covering only parts of salaries. Some other measures are being promised in the future. Since the re-opening, the patients have been quite willingly coming, but the waiting times for treatment are longer now. We are not planning any summer vacation.
Also, all materials we are buying now are very expensive, so the costs and expenses for the dental offices are huge and are several times higher than they were in January for example.
Are there any new tools and equipment that you started to use on a greater scale during the pandemic?
Of course. There is new personal protective equipment that we need to use for every patient and every procedure, the so-called III level of security: the waterproof gown, the cap, the mask with shield or the respirator FFP2 or FFP3 with shield and the gloves. Before we used only surgical masks and gloves. Shields were used often, but not at every procedure.
The biggest potential danger for dental professionals is aerosol treatments. Are there any new rules or tools recommended for this kind of treatment?
For aerosol control, high volume aspirators are advised. We used to use the one included in the dental chair and it is very effective. We just checked and did some corrections in the office to be safer and more effective.
The usual HVE used in dentistry has a large opening – usually 8 millimeters or greater and is attached to an evacuation system that will remove a large volume of air (up to 100 cubic feet of air per minute). But now there is advice to use new aerosol suction machines with bigger suction power. Also germicidal lamps for further disinfection are used more.
There are also strict recommendations to pre-procedure rinse with peroxide. In our dental clinic we use Peroxide and Chlorhexidine. We always work with a dental assistant. We use High Volume Evacuation (HVE), air ventilation, we also open windows for 15 minutes after each patient, disinfect all surfaces and we keep all instruments and handpieces sterile.
Methods of reducing exposure to dental aerosol, according to research
- Water flowing from unit handpieces should meet the conditions for potable water.
- The correct maintenance of handpieces should follow the principle: “Do not disinfect when sterilisation is possible”.
- 20-30 second rinsing helps to reduce the risk of retraction of the oral cavity fluids and is aimed at the elimination of potential cross-infection. Chlorhexidine gluconate has been found to be more effective than other solutions in reducing bacterial aerosols. Some studies show that two 30-second rinses decreased more bacteria for a longer period of time than a single 30-second rinse.
- Dental teams should use personal protection measures (clothes, gloves, masks, protective goggles, visor shields).
- A high-performance sucking device, maneuvered in the oral cavity and correctly positioned near a handpiece, is an effective method for aerosol reduction. The use of a high-volume evacuator (HVE) has been shown to reduce the contamination arising from the operative site by more than 90%.
- The position of a patient during dental treatment is also significant. A patient should be treated in the supine position which makes it possible for a doctor to avoid working directly in front of a patient’s breath direction. From a practical point of view, it is easiest to remove as much airborne contamination as possible before it escapes the immediate treatment site.
Sources:
Harrel SK: Airborne spread of disease – implication for dentistry. J Calif Dent Assoc 2004, 32, 901-906.
Timmerman MF, Menso L, Steinfort J, van Winkelhoff AJ, van der Weijden GA: Atmospheric contamination during ultrasonic scaling. J Clin Periodontol 2004, 31, 458–462.
Micik RE, Miller RL, Mazzarella MA, Ryge G: Studies on dental aerobiology. I. Bacterial aerosols generated during dental procedures. J Dent Res 1969; 48 (1): 49–56.
Miller CH, Palenik DJ. Aseptic techniques [Chapter 10]. In: Miller CH, Palenik DJ, eds. Infection control and management of hazardous materials for the dental team. 2nd ed. St. Louis, MO: Mosby, 1998.
