Protecting our Patients and Team from COVID-19 by Land, Sea, and Air

Many of the changes that we have made to protect those in our care are now becoming standard throughout orthodontics and dentistry in general. Screening questions are asked immediately before appointments. Temperatures are taken before patients are escorted to the treatment area. All patients are being asked to wear their own masks until their removal is needed. The number of people in the office at any one time is limited. Paperwork is being done digitally as much as possible. Sneeze guards have been installed along the full length of our reception desk.

However, there are also many changes we have made that are not so obvious and are above and beyond what is currently required. We like to consider this as offering protection to our patients and employees by Land, Sea, and Air.

Protection by Air:

The CDC now believes that COVID-19 is transmitted mostly by aerosol. As transmission is known to take place before a patient is symptomatic and coughing, that means that transmission is taking place through the droplets let out while breathing and especially during speech. Without intervention, HVAC systems have the potential to spread these viral and bacterial particles throughout an office. Hospitals are becoming very sensitive to this issue and are addressing it in their HVAC systems.

As a result, we have installed needle-point bi-polar ionizers in the main trunks of all three of the HVAC systems in our office. This is a cutting edge technology which kills viruses, bacteria, and mold that goes through the HVAC system. It produces no ozone and has no degradation or maintenance concerns, as other systems do. We invite you to read and watch a short video about the system that we have installed at http://www.iwaveair.com/.

This is a change in our office that you will not see. However, I personally would not have felt safe working in our office without this protection. Now that it is installed, I feel much more comfortable working there and I hope that you will feel comfortable there as well.

Protection by Sea:

In this case “Sea” represents the water droplets or aerosols that are put into the air by some dental procedures. Whenever a dentist or orthodontist uses a dental handpiece (drill), ultra-sonic tooth cleaner, or even an air/water syringe dental aerosols are put into the air. These aerosols can contain virus and bacterial particles. While most of these particles fall quickly to the floor, the smaller ones remain airborne for some period of time. While the infectivity of these dentally produced aerosols is currently not known, reducing and protecting against these has been a strong emphasis from the CDC, ADA, and AAO.

In the past, the use of high volume suction (the larger suction tube at nearly every dental office) or even extra-oral suctions has been relied upon to reduce these aerosols. High volume suction, when properly done, is known to remove approximately 90% of dentally generated aerosols. The current problem with this method is twofold. The first is that the roughly 10% of aerosol that is not evacuated instead goes into the air. The second is that this technique is not always ideally applied.

We believe that our solution to this problem is unique and most ideal. Our solution to this problem was inspired by the work of Dr. Kazmierski’s wife, in a hospital laboratory. In these laboratories, infectious materials are handled under a negative pressure hood. Air flow from the room into the hooded area keeps the air in the room safe. Dr. Kazmierski has designed an all Plexiglas hood that creates a negative pressure environment to remove these aerosols and prevent their entry into the room air.

Our Dental Aerosol Safety Hood (D.A.S.H.) is tilted over the patient after they are seated. The patient is comfortable because it is far from their face and the inside of the D.A.S.H. hood is also quite large. It is transparent, so that the patient can see about them in all directions. These are installed over all chairs in which dental aerosols are produced. For those in the health professions, our D.A.S.H. hood is very similar to the Intubation Boxes now being used by anesthesiologists. Even more similarly, to create a localized negative pressure area they are now starting to attach vacuum hoses to those boxes as well.

I personally feel much safer knowing that the aerosols produced during dental procedures in our office are removed with our D.A.S.H. units. I currently would not want to practice without them. I believe that patients will also feel more secure knowing that all patients treated in our office will be protected by this system.

If you would like to see videos of D.A.S.H. in use and testimonials about the D.A.S.H., please visit our YouTube channel playlist on D.A.S.H. by clicking here.

As a side note, in addition to doing virtual consultations with our patients, I spent most of our mandatory shutdown period working on this system with a national manufacturer. If it does make you feel safer, the technology will soon be available to your dentist and other dentists and orthodontists around the country. Whether or not this is a national success, I am quite proud that our patients will be protected with this system.

Protection by Land:

Protection by land represents protection against potentially contaminated surfaces. I placed this protection last as it is very close to the “Universal Precautions” already practiced. Nearly every dental office in the United States already has a black belt in this form of protection. We have been doing it since day one. As a result, any changes here are more subtle.

For surface disinfection, our office is transitioning to exclusively using Activated Hydrogen Peroxide in all patient treatment areas. This is a much newer disinfectant and has several advantages. While prior surface disinfectants were effective, Activated Hydrogen Peroxide is less caustic to those around it and those using it. It has a virus kill time of 1 minute, which is as good as it gets. Also, it will not destroy plastics such as our keyboards and mice or our new “Aerosol Removal Hood”.

To protect our employees in the staff room, we are unable to use the same chemicals around food that we are able to use in patient treatment areas. As a result, for the staff room we are using the new hydrogen hypochlorite maker from Force of Nature. While this cleaner takes 10 minutes to inactivate viruses, it is much safer to use in these areas. The technology is very interesting. A simple mixture of salt and water is electrolyzed to form hydrogen hypochlorite. As the material is only stable for 14 days, the solution must be made at home or in the office. The system we purchased is EPA registered. Having used it in our home for 2 weeks now, I can highly recommend it for home use as well. The link to their web site is https://www.forceofnatureclean.com/natural-cleaner-and-disinfectant/.

Thank you for taking the time to read through all of this. Considerable thought and effort has gone into each and every change that we have made. It is too easy right now to do things that are both costly and useless for protecting our patients. I have tried to do absolutely everything that I could to make me believe that our office is one of the safest places that our patients, our team, and I can possibly be.

Lastly, thank you for entrusting me with your orthodontic care. For the past 30 years, it has been a great joy to be able to earn my living by providing patients with the healthiest and most beautiful smile that I am able. I hope to continue to earn your trust.

Sincerely,

Dr. Kaz

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