This just came from the Pennsylvania Dental Association.

[PCIntern]

Last edited Mon May 25, 2020, 08:58 AM - Edit history (1)

But first, word from me: Other than the obvious risks of being a dentist with respect to communicable disease, this pandemic is presenting new challenges to our safety and health, as well as the safety and health of patients. As most of you know much of what we do causes aerosolized particles which without question contain virus. The problem for us is that the two major things which we perform, drilling teeth and cleaning teeth in many cases cause this to be a continuous risk factor. Many offices now use ultrasonic scalers to clean the patients which use water to cool the tip of the instrument. Now, when I was trained the ultrasonic scaler was only used in cases of large amounts of tartar and debris which was very tenacious. However, with the advent of the need to maximize profit in the healthcare environment, many officers routinely ultrasonic or patients for maximum speed and efficiency. Many hygienists are not trained to quickly hand scale their patients routinely and quickly and are in a professional quandary.

Now as far as dentists go, Nearly all tooth reduction is performed utilizing An ultra speed handpiece which as we Unfortunately all know, spray water to cool the bur head which essentially bathes the dentist and the assistant Thoroughly with fluid which contains viral particles. No masking will prevent those viral particles from entering the respiratory system of dental personnel. In addition the room is covered with the mist and the particles and cannot be wholly cleaned in between patients, I don’t care what “they” say.

Now, I personally am working, this is my fifth week back beginning tomorrow, Tuesday, and I’m willing obviously to take the risk and the chance to serve my patients who were in desperate need of care in many cases. The Commonwealth of Pennsylvania has not yet allowed dental hygienists to return to work as of today, because cleanings are Not considered essential services. And in general, this is true.

I received the following email from the Pennsylvania dental Association yesterday and thought I would share it with everyone. There are private dental personnel websites on FB and other sites which have been on fire since Day One of the shutdown. If you think DU has moments of extreme contention although in theory we are all bonded by some principles, you should see what’s going on in these sites. It’s like WW III. Anyway, this came yesterday and you can get a flavor for what’s going on. (Oh and of course it’s poorly written: these people in organized dentistry were lucky to get through English 101 in college. Adequate knowledge of Literature and ability to perform decent expository writing are not required to be a healthcare professional. )




​Memo to All Pennsylvania Dental Professionals


The Covid-19 pandemic has pushed dentistry into a new era, and now more than ever dentists and hygienists need to be working together. Just remember that in the patient’s eyes there are no “sides,” and this virus, like every other virus, doesn’t discriminate. So, before we rip apart our practices any more than what circumstances have already done, let’s stitch things back together.

There is NO WAR between Dental Hygienists and Dentists!
The WAR is the virus… or all new viruses to come.
DO NOT LISTEN to (or encourage) the rogue Facebook and fear mongers!
DO reference directly official guidance/guidelines, etc. from authoritative sources rather than relying on what you “heard” was in them or was claimed in someone’s social media post.

Registered dental hygienists in clinical practice have always given and want partnership, trust, and responsibility from the dentists they work for. The relationship between the hygienist and the dentist is one of trust, respect and mutual support. The dentist is the team leader and as the doctor uses professional acumen to determine the needs and care of the patient. It is the responsibility of dentists, particularly those who are practice owners, to organize their offices and supply all appropriate and mandated equipment to allow a safe, proper environment to keep hygienists, assistants, receptionists, doctors and the patients as safe as “humanly” possible. As health care providers, this is an essential facet of our unique and vital obligation to the shared responsibility for keeping our communities safe as a whole.

What occurs in the dental hygiene chair between the patient and the hygienist, is not under direct supervision from the dentist. The dentist trusts the hygienist to be his/her eyes and ears and to fill the role of educator and, in some cases, confidant with their patients. The role of the hygienist is greater than just “cleaning” teeth and providing services. Hygienists are instrumental in facilitating optimal oral and overall health of our patients. The relationship between patient and hygienist is distinct, and hygienists have earned that measure of autonomy – and the responsibilities that go along with it – through their training, education, experience and licensure.

It is also the hygienist’s responsibility to adhere to standards of care, engage in continuing their education, and follow infection control protocols and standard precautions to promote the utmost safe environment. The dentist needs to review with the hygienist both what is expected and the policy in each clinical situation as they collaboratively provide care to the patient.

Unfortunately, no one can guarantee a 100% safe environment especially when dealing with an imperceptible and not totally understood virus. There is no way to guarantee 100% safety to anyone, anywhere, in any situation! We are experts in infection control procedures and have the knowledge, equipment and policies to diminish risks and to be able to provide care in the safest environment possible.

According to health experts, there may not be a vaccine for some time. Should you not provide dentistry or dental hygiene until we get one? What happens when the next virus appears, and we have to scramble again? The same health experts warn that this kind of pandemic will happen again. The only sensible response is to continue to provide the essential health care that only dental professionals can provide while availing ourselves of the best available information and equipment to protect both care providers and patients.

This is the new world of emergent health hazards and dentistry. It is not what anyone signed up for. For some in dentistry, it may be the time to re-evaluate their role as a health professional, and perhaps seek a new profession. Like it or not, this is the new norm that we in dentistry will just have to deal with it. We have to be prepared to adapt and adjust as changes occur. Guidelines and recommendations will change as we learn more about the virus. We need to use our critical thinking and work together to apply guidelines to our policies and procedures in a unified way.

Dentists, need hygienists as a crucial member of their oral health care team; hygienists need dentists for their employment and to provide a safe, properly equipped facility in which to provide that oral health care. Patients need all of us. We are a meshed team! Now more than ever the dentist-hygienist team needs to work together with respect for each other to deliver dental healthcare that their patients desperately need while maintaining an environment that is as safe as ”humanly” possible.

[GusBob]

1. Who sent that email?

Did he or she actually tell “some in dentistry”
its time to quit?

I find that very strange

[PCIntern]

3. I don't belong and haven't for decades

But these dental associations are often populated by morons.

[GusBob]

5. Oh ours is too!

I quit our association decades ago as well. Self righteous bullies who claim to love the profession but despise their colleagues

This person WANTS people to quit more money for them
What are they gonna do? Sell real estate? Stupid

I work for the IHS and share a clinic area with dental. It has been hard no doubt but I have not noticed any conflict between the dentists and hygienists.

[hlthe2b]

2. There is no single good solution right now, but in future, I believe high risk settings as this

will increasingly have to retrofit their clinics to include the same kind of in-ceiling UV-c disinfection systems that hospitals have used for years for their maximum isolation rooms (esp. for drug-resistant TB), operating rooms, and some ERs to fight nosocomial infection including MRSA and C. difficile. Obviously retrofitting as negative pressure rooms would the ultimate, along with high-efficiency filtration systems, but I don't see that being a practical consideration, given the very high cost of the latter, but in-ceiling UV-c might well be a more practical part of the solution. (and no, I have no financial interest in UV-c or any other such system) but here is one example.

https://www.e-co.uk.com/uvcor/

How they will pay for it is a big question, but given they can accommodate both continuous disinfection and rapid 30-minute decontamination necessary to make such a setting overwhelmingly safer for both patients and staff., it may well be a potential, if partial solution.

While this coronavirus has thus far spared humans from being at risk of infection transmitted from common companion animal species and thus veterinarians have been at risk from pet owners, rather than the pets themselves, the next one to emerge may confer more animal-human direct risk. And pneumonic plague has long been a rare but similar risk for respiratory transmission to veterinarians and staff in the Southwest, so they too may need to be looking at such future retrofits to protect against emerging highly infectious respiratory
pathogens--at least in the larger veterinary emergency clinics.

[PCIntern]

4. You are absolute correct and

In no way is it going to happen.

[GusBob]

6. Oooh I like that!

[milestogo]

7. National Health Care needs to include dentistry.

If people don't think its safe to go to the dentist, they will avoid going until they are miserable.

[Ms. Toad]

8. I've always refused to permit my hygienist to use an ultrasonic scaler.

I am apparently one of the rare individuals who find it extraordinarily painful. I'm surprised to hear that hygienists are frequently not trained well enough in hand descaling. There is not a lot of turnover, but of the three I can recall in the last 20 or so years, even the one I helped get fired (for disease-spreading practices) were competent in hand-scaling.

[PCIntern]

9. In the old days, when dentists cared a lot,

Ultrasonic scalers were not used precisely because they would decimate the sealed margins of restorations, particularly gold and silicate its composite (tooth colored fillings). When I mention that now, people just stare at me like I have three heads.

They also replace the restorations every five years instead of 35. Yeah.

[Ms. Toad]

10. Makes perfect sense.

I had my first filling at age 13. I'm pretty sure that aside from one disaster of a dentist, the only filing I've had replaced was this year (I'm in my 60s). I've got composites in my two front teeth that date to somewhere between 1974 and 1978. I can't imagine replacing fillings every 5 years. Aside from the cost, every time a filling is replaced I lose more of the tooth. Yikes!

I did have 2 of the three fillings done by the disaster of a dentist replaced within 5 years, plus I was treated to an immediate root canal at least partly because she was so rough with her work on an adjacent tooth - and one of the two fillings that had to be replaced nearly turned into a root canal because she didn't clean it out properly before filling it. She was brutal as well as incompetent (bruises every time I visited her) She is also where I had my one and only ultrasonic cleaning, so she may have done me a favor in that respect).