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#Thread #Corona #Dentists #Precautions #Pune

There has been a lot of fear generated from the COVD-19 pandemic. Prominent among that has been the notion that "Dentists are at the highest risk of catching and spreading the virus."

This is a thread to discuss what we are doing
in our practice to address those risks and fears.

For starters, we were closed for the last 7 weeks. We were available via our clinic cell phone for emergencies. I don't know if people were just scared or their tolerance ramped up but we barely had to go in.
For starters, we have made 3 major infrastructural changes to our clinic. The first one was a fogger used in the OT of major hospitals. It blasts the disinfectants via micro droplets so there is no need for wiping/mopping. The disinfectant used is Quarternary Ammonium compounds,
proven to kill corona. It stays active on all surfaces and hence neutralizes the virus should the patient touch it. We use it at the end of the day as it is not advised to enter the operatory for 45 minutes after use.

The logic is that if it works for heart and brain surgeons,
it has to work for us dentists.

The other addition is a negative ion generator. This is basically for air purification. It was created and manufactured by the Science and Technology center, based in Pune University, set up by the Dept of Science and Technology USA.
From a dental procedural perspective, the biggest change has been the electric handpieces. We all know the sound of the drilling machine is dreaded by every patient. Given that they are typically air driven, they generate a lot of aerosols.
We have installed electric handpieces which are lighter, faster and more efficient as there is a torque involved. Running on an electric motor, there is a huge reduction in the amount of aerosols. Believe it or not, even the sound is reduced to a large extent.
When it comes to treating patients, for now we are only treating severe pain, swelling, fractured teeth etc.

We have a detailed telephonic consultation to first ensure the patient has not shown any signs and symptoms or actually contracted COVID-19.

We also ensure they have
followed the lockdown and not come in contact with anyone who has been positive. Travel history is also checked.

Once this is done, the tooth issue is discussed. We can diagnose the issue in most cases and are able to discuss potential treatment options over the phone,
including costs, duration, pros and cons etc. This helps us be efficient and render as much treatment as possible when the patient comes in, rather than have to bring them back for multiple visits.

For now, we are only seeing one patient at a time.A particular time slot is set.
We recommend the patient come alone, carry minimal items and wear a mask when they come in. On entering, they are handed hand sanitizer and temperature checked with a infra red thermometer.

They are seated and given a virucidal rinse like Hydrogen Peroxide or Povidone Iodine.
A major change is that we ask the patient not to spit into the spittoon as it generates aerosols. We hand them a 2nd cup and ask they use it to rinse, the contents of which we discard.

The treating dentist and chairside assistant are wearing complete PPE suits, which not only
cover the body but also have a head cover, seal the neck and foot covers. There is a N95 and a 3 ply mask with a face shield worn. Needless to say it is very hot and thank god we are able to use the AC since it is not central and we have the Iononizer to purify the air.
Treatment is carried out with the strictest protocol to ensure no contamination. Since this has always been the case in the practice, we have not had to worry about this.

We use something called as a Rubber Dam, which can be best described as a "Dental Drape".
Stock Image used for patient privacy. Also we are not taking any pictures during treatment.

This ensures a barrier between the air in the room and the patient's saliva so again minimizing the chances of aerosols containing the patient's saliva.
The image also shows a high speed suction we use to absorb the aerosols. Studies from Michigan USA are showing that these suctions virtually absorb 97% of the aerosols.

Currently we are not advising taking NSAIDS like Combiflam as the data is not clear on the ill effects.
Once the treatment is over, the patient leaves and the entire room is disinfected with either 1% Sodium Hypochlorite (Bleach) or 70% Ethanol for 10 mins. Everything is washed thoroughly with soap and water and sealed in single use pouches to be autoclaved.
The room is mopped and ventilated for sometime to allow for complete air change. We are asking patients to call us when they reach to minimize having more than one patient in the waiting room. So far it has not happened. If the patient needs to get someone along, only one person
is permitted and allowed to sit in the waiting room which is also disinfected once they leave.

Payments are only collected via digital platforms like UPI/NEFT to avoid cross contamination from cash/checks/credit cards.

Patients are followed up to ensure they don't develop
signs and symptoms of COVID-19.

I personally don't know how long we will have to follow all these protocols. The CDC is already saying the virus does not get spread from inanimate objects.

Some surgeons might feel we are over doing the PPE usage.We might feel the same soon.
But for now, we are doing what we feel virtually eliminates the chances of catching and spreading the virus.

Some things will remain constant for life. The fogger, air purifier, electric handpieces, Rubber Dam etc.

We hope we are able to practice based of a fixed schedule
the way we do right now but once everyone gets out on the streets, it might be tricky.

Right now we are only working one session. The suits are not at all comfortable. But it all boils down to my goal for 2020 which is SURVIVAL!

There is a huge cost associated with all these
upgrades and protective measures but we are not increasing our cost right now. But this is a good time to understand that dental treatment does cost. I am aware the numbers have gone up over the years but so has the technology. So has the cost of materials. I have an American
degree and practiced there for 10 years. I can assure you this is virtually the same things I would have added had I been back in New Jersey.

There was a fantastic line in the movie Jerry Maguire. He says "Help me help you".

I say the same line to my patients and all of you.
Regardless of who your dentist is, whether myself or someone else, help us help you.

Share any and all information. Keep your appointment as best as you can. If you are unable to make it, or are running late, call right away.

Discuss all treatment options with an open mind.
We are all here to take care of you. No one is trying to fleece you. We are all as concerned as you are.

Hence we are taking these additional measures. They might change as we understand better how to handle this terrible virus. Personally I believe in patient education.
I hope this thread will help all of you understand what we, in our practice, but also collectively as a profession are doing to take care of all of you.

The local Indian Dental Association has arranged a webinar where 3 of us will be speaking to all the members about this.
I received many querries from non dentists asking to let them attend so I put this thread together.

Feel free to reach out if you have any questions and querries.

This is a picture of me in February about to welcome my patient into the operatory. The gloves and masks used to
come on once the patient was seated. Now I am dressed almost like Neil Armstrong even to welcome them!

Till then stay safe, wash your hands and wear a mask PROPERLY!
Cc: @aparanjape @docbhooshan @DhongdeSupriya @ngkabra @godbole_shilpa @Girbane

A thread on what we are doing to take care of our patients and ourselves during this pandemic.

Cc: @c_aashish @GabbbarSingh both of you helped a lot by sharing the “Are dentists doctor” thread.
this one is extremely crucial to help put people at ease. Please share! And of course read.
Cc: @VaradhKrish please do take a look.
Missing some Tweet in this thread? You can try to force a refresh.

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