DocumentIn the early days of the Covid-19 pandemic, when almost all U.S. dentists had temporarily closed their doors, Ravina Kullar’s mother shut down her dental practice for good. At 70 years old, she was ready to stop practicing — but as it became clear that both her age and profession placed her at particularly high risk, the pandemic “kind of pushed her into retirement,” says Kullar, PharmD, a Los Angeles, California-based infectious disease specialist, epidemiologist, and Infectious Diseases Society of America spokesperson.
To date, no cases of Covid-19 have been attributed to any dental practices in the U.S., according to Kullar and the American Dental Association (ADA). But the practice of modern dentistry places oral health care practitioners and their patients in a uniquely dangerous position — and as practices reopen, people are facing decisions about whether and when to see a dentist.
Here’s what you need to know if you’re one of them.
When used in the mouth, all of these instruments create sprays of tiny droplets and aerosols containing not only water but saliva, blood, and microorganisms.
Why dental practices are uniquely high-risk
The novel coronavirus spreads when virus-contaminated saliva droplets from a symptomatic or asymptomatic person find their way into another person’s nose, mouth, or eyes, conveyed there either by inhaling droplet-filled air or by second-hand contact with a surface (as when a person wipes their nose with their hand after touching a contaminated doorknob).
The issue is that dentist’s offices create huge amounts of saliva droplets. “Look at some of the instruments that they use, such as the drills, the scalers, the air-water syringes,” says Kullar.
When used in the mouth, all of these instruments create sprays of tiny droplets and aerosols containing not only water but saliva — which contains high levels of virus, blood, and microorganisms. The smallest of these particles can stay in the air for hours, while larger ones can land on surfaces like doorknobs and dental chairs.
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Together, these characteristics make aerosolized oral secretions powerful potential vectors of Covid-19 in dental practices.
Because dental practices are such high-risk environments, the U.S. Centers for Disease Control and Prevention (CDC) recommended against providing all but emergency dental services in March. And indeed, during the first few months of the pandemic, fewer than 5% of U.S. dentists were open for non-emergent visits, according to a member survey conducted by the American Dental Association.
As the pandemic has evolved, however, more dental practices have reopened for business: As of mid-July, about 42% of practices nationwide were conducting business as usual, according to the survey.
What practices are (or should) be doing differently
Many of the CDC’s recommendations — like those related to surface cleaning and the personal protective equipment worn by the hygienists, dentists, and other professionals who actually poke around in mouths — were already part of many dental professionals’ practices pre-Covid-19, says Kullar. But other infection control practices might be new to some, among them the CDC’s recommendation to consider using HEPA filters