Covid-19: what has changed in the dental office?

COVID-19 has turned our lives upside down. It was no different with dental surgeons. Its main routes of transmission are by streakers, contact with mucosa and aerosol - everything we have a lot in dental care of our day to day.

I believe that it is possible to use this time of social isolation to rethink all the processes that exist in our offices. Until we have a vaccine for this disease so terrible that it attacks the entire global health system, a lot is going to change.

Will we retire the cloth coats for good? Which new E.P.Is will we have to buy and use? How will the patient flow? How will we do with the reception, since we will have to avoid agglomerations? Does the care room need a window? Exhaust for air renewal? How will health insurance plans look, which pass on little money and often require short consultations with many services? Will patients have money to spend with a dentist with this crisis?

Therefore, I went after reliable sources to clarify them for me and my professional colleagues.

Internet communication and the first studies that are coming out relating Dentistry and Covid-19 already show a way. However, we are still groping and adapting in some ways. The disease is new and unknown, has no cure or vaccine. Therefore, there is little care with biosafety and EVERYONE will have to readjust.

Today, according to health agencies, councils and other entities, in some states, dental care is restricted to urgencies and emergencies. However, when we return to normality, with the loosening of social isolation, I believe that the protocols listed below will continue to be used.

How will the pre-consultation interview work?

We will talk to the patient on the phone before he goes to the office. It is important to have in the head, colored and sautéed, what are the main symptoms of Covid-19:

- Fever above 37.8ºC for more than two days

- Muscle aches and weakness

- Headaches and throat

- Runny nose

- Total loss of taste and smell

- Diarrhea

- Dry cough

- Difficulty breathing, shortness of breath

Questions we should ask patients before referring them to the office for care:

- Have you had any flu-like illness in the last 14 days? Did you have any of the symptoms mentioned above?

- Do you live or had contact with someone with the flu in the last 14 days?

- Are you over 60?

-Do you have Diabetes, Hypertension, Lung Disease, Heart Disease, Obesity or any Autoimmune Disease?

Getting a YES answer to the first three questions, it is advisable to schedule it after 21 days, if it is not a very urgent procedure. In the affirmative case of the last question, the ideal would be to mark this patient in the deceleration phase of the COVID-19 outbreak.

How should the consultation and reception of patients be?

Always by appointment. The dentist should in no way shake hands with the patient. As the virus can be brought from the street by shoes, a solution would be to use a doormat just before the entrance door soaked in 1% sodium hypochlorite solution.

Upon entering the office, the patient must wear the propes that will be discarded at the exit. Before entering the care room, the suggestion is that the patient's temperature be checked with a non-contact infrared thermometer. If it is over 37ºC, it should be rescheduled after 21 days. Obviously, if it is not an emergency. However, common sense and study of each individual case is very important.

Ask the patient not to delay or change the appointment time

The dentist and his team must arrive before the scheduled time to prepare the care room. We must rethink the patient's flow from arrival to departure, minimizing touch on surfaces such as door handles and others. If possible, the patient should not bring companions and should be instructed to use a mask (take another spare mask and a paper bag to pack them) when leaving the house, even if it is made of cloth. The patient's mask will only be removed inside the care room.

Consultations should be as succinct and spaced out as possible. The suggested interval is 20 minutes between one patient and another and 2 hours if the dentist uses an aerosol - ultrasound, bicarbonate jet, high - speed pen or uses the two buttons of the triple syringe. Therefore, the procedure to be performed must be thought beforehand. Therefore, all material must be separated to avoid opening drawers and leaving the service room - which can contaminate other rooms.

Flow of patient care during the COVID-19 pandemic

The patient enters the room, sits on the chair and avoids touching any other surface. He receives a hat, goggles and a disposable bib. Soon after, the dentist requests that he rinse with a 1% hydrogen peroxide solution for 90 seconds. This solution can be manipulated with some flavor or made with 1 portion of 10v hydrogen peroxide to 2 portions of distilled water.

Best of all worlds: if possible and necessary, use absolute isolation. All handpieces must be cleaned with alcohol 70 and sterilized between one patient and another.

In addition, parts that have anti-reflux valves should be used. Remember to lubricate your pens and leave them running for about 20 seconds before and after the appointments. Use the plastic barriers such as PVC film or bags at the tips and in the triple syringe. Everything will be exchanged between one patient and another. It is also recommended to use a vacuum pump for more effective suction.

How will the consultation payment dynamics work?

Before entering the service room, request payment of fees. An indication here is to provide plastic patient gloves. He uses them to open his wallet and take the money or card. You can use a piece of PVC film to protect the card machine. Give preference to bank transfers made via cell phone. After payment, the patient discards the gloves, washes his hands and can enter the care room.

Cleaning the office and care room

The floor must be cleaned with a cloth with sodium hypochlorite or some ammonium quarternary. Inside the service room, it is possible to use ammonium quarternary spray and leave it in the air for 10 to 15 minutes without anyone inside the room.

How will your coat and team work?

Suggestion: when you get to the office, change the “street clothes” for surgical pajamas for exclusive use inside the office. Put all the E.P.Is on top of these pajamas and make your calls. At the end of the day, remove these pajamas, put them in a plastic bag for later washing, wash your hands and put on “street clothes” again to go.

Full coat

Gloves, mask, hat, personal protective glasses or glasses with magnifying glass, visor or face shield above everything, disposable lab coat minimum weight 40.

If you have an aerosol procedure, use the N95 PPF2 mask, preferably without a respirator.

TIPS:

- The N95 PPF2 mask can be used for up to 14 days if it does not get wet or dirty with patient fluids. It can be stored in a bowl with holes.

- Always prefer to work with assistants. They must wear 2 procedure gloves. The dentist focuses on touching the patient's mouth and assistants perform all instrumentation, avoiding touching the patient's mouth.

Hand washing moments, according to WHO, CDC and ANVISA:

- Moment 1: before contact with the patient;

- Moment 2: before performing the procedure;

- Moment 3: after risk of exposure to biological fluids;

- Moment 4: after contact with the patient;

- Moment 5: after contact with areas close to the patient, even if he has not touched the patient. Taking care directly or indirectly of the patient.

After each patient, everything should be discarded, except the N95 PPF2 mask as described above. The auxiliaries remove the second glove and with the lower glove disinfect the visor and its goggles, in addition to all critical surfaces and areas. The cleaning of the materials follows all the biosafety standards already in force.

Be very careful when removing E.P.Is

We know that often the contagion of the health professional happens at this stage. The mask will be removed last and preferably outside the care room, by the elastic bands, without touching the infected front.

Understand that all that has been described is the ideal

First of all, be very careful with the adaptations to the biosafety rules. There is no way to loosen care in this unique moment of the pandemic. Will it be more expensive? Go! Will I have to start charging consultation? Obviously yes! Remember that we are at the moment of reinventing the profession. The whole world had come out differently and I am sure that patients will increasingly pay attention to all of our processes.

Source: Todos pela Odontologia. Available at: http://todospelaodontologia.com.br/dentral-cremer-covid-19-o-que-mudou-no-consultorio/. Access on: 08/19/2020.
image: dolgachov, de envatoelements