Source: https://www.onenews.ph/strictly-by-appointment-dentists-face-covid-19-risks-to-treat-patients

“Please always believe in your hearts that the world needs dentists to keep the world smiling,” the president of the Philippine Dental Association said.

Your next visit to the dentist will never be the same amid the coronavirus disease 2019 pandemic.

In a dental clinic in Sampaloc, Manila, the reception booth has been covered with plastic. The dentist – Dr. King Solomon – and his staff are wearing personal protective equipment (PPE).

In another clinic in Antipolo City, the dentist and her staff change their PPE after treating every patient. They wear three layers of PPE if the patient is unknown to them, to ensure protection.

Disinfection procedures have become more stringent, with even the use of ultraviolet light while procedures are going on.

Patients cannot just walk into a dental clinic even under the general community quarantine. For safety, dentists prefer to interview patients first before treatment. Securing an appointment is a major adjustment in the dental industry, according to Dr. Stephen Almonte, president of the Philippine Dental Association (PDA).

Patients must wear face masks, disinfect their hands and shoes, and have their temperature checked upon entering the clinic. Having companions is also discouraged.

During the enhanced community quarantine imposed over Luzon and other areas since mid-March to prevent the spread of COVID-19, some dental clinics had to limit or stop operations due to the lack of PPE.

Based on guidelines released by the PDA on April 26, dentists – as responsible health workers – must not ignore patients needing urgent management. But in general, they should limit treatment to non-aerosol-generating procedures while adhering to strict infection control protocols.

The PDA, which has over 15,000 members, said dentists have a moral obligation to serve their communities, but should not place anyone’s life in danger through the lack of preparation in treating patients.

Under the guidelines, dentists and all members of their staff must wear the prescribed PPE including protective eyewear, surgical mask, disposable caps and disposable gloves. Dentists must observe a “high level of precaution” when handling patients amid the COVID-19 pandemic.

“All patients should be treated as potentially infective COVID-19 carriers. As such, high level of precaution should be exercised. If an individual exhibiting symptoms of possible COVID-19 arrives in your dental practice, patient must be immediately referred to seek medical treatment,” the PDA explained in its COVID-19 guidelines.

High-risk profession

Solomon told The Philippine STAR that in their profession, there is a high risk of transmission of aerosols and droplets. This requires stringent screening of patients for symptoms of infection.

According to the PDA guidelines, the coronavirus is transmitted through droplets entering exposed mucous membranes such as the eyes, nasal cavity and mouth.

“Dental professionals are at high risk for being infected and transmitting the virus though aerosol-generating procedures (AGP) such as ultrasonic scaling, use of high-speed handpiece (a precision device for removal of tooth tissue), (three)-way syringe and high or low volume saliva evacuation,” the PDA said.

“These risks are unique to dental interventions, where aerosol generation, handling of sharps, and proximity of the provider to the patient’s oropharyngeal (part of the throat) region is unavoidable,” it added.

The Centers for Disease Control and Prevention or CDC defines aerosol as a suspension of tiny particles or droplets in the air, such as dust, mist or fumes. These particles may be inhaled or absorbed by the skin, and can sometimes cause adverse health effects.

Solomon admitted that it is hard to know if a patient is infected with COVID-19 especially if the person is asymptomatic. This is why the PDA is requiring patients to answer a questionnaire before undergoing any dental procedure, to ensure that they do not have symptoms of COVID-19.

The dentists can only hope that no patient will lie about being infected.

“Please be honest” and “reveal everything” to the dentist, Almonte stressed.

Solomon said his clinic’s new set-up was based on the advice of the PDA. Plastic sheets for distancing in reception areas have become common. Solomon said dentists also implement their own disinfection protocols in their respective offices.

Every morning, Solomon’s clinic undergoes fumigation. The clinic has air purifiers for infection control.

Before the pandemic, Solomon said they could accommodate around 15 to 20 patients a day. But now, only seven to eight patients per day can set an appointment.

He explained that they stopped accepting walk-in patients to ensure physical distancing and prevent crowding in the clinic, as required under quarantine rules.

“Before ’yung COVID-19, ginagawa namin ’yung basic to advance procedures. Usually itong reception area is napupuno kasi nag-i-schedule kami ng patients on a daily basis, pero nag-a-accept pa rin kami ng walk-ins,” Solomon said. “Strictly by appointment (for now) para lang ma-make sure na konti lang muna ’yung tao dito sa clinic, sa loob ng clinic, sa reception, as well as dun sa operatory.”

For those who have orthodontic braces, dental cleaning will not be performed in the meantime due to the high risk of aerosol production.

Source: https://www.onenews.ph/strictly-by-appointment-dentists-face-covid-19-risks-to-treat-patients

“Please always believe in your hearts that the world needs dentists to keep the world smiling,” the president of the Philippine Dental Association said.

Your next visit to the dentist will never be the same amid the coronavirus disease 2019 pandemic.

In a dental clinic in Sampaloc, Manila, the reception booth has been covered with plastic. The dentist – Dr. King Solomon – and his staff are wearing personal protective equipment (PPE).

In another clinic in Antipolo City, the dentist and her staff change their PPE after treating every patient. They wear three layers of PPE if the patient is unknown to them, to ensure protection.

Disinfection procedures have become more stringent, with even the use of ultraviolet light while procedures are going on.

Patients cannot just walk into a dental clinic even under the general community quarantine. For safety, dentists prefer to interview patients first before treatment. Securing an appointment is a major adjustment in the dental industry, according to Dr. Stephen Almonte, president of the Philippine Dental Association (PDA).

Patients must wear face masks, disinfect their hands and shoes, and have their temperature checked upon entering the clinic. Having companions is also discouraged.

During the enhanced community quarantine imposed over Luzon and other areas since mid-March to prevent the spread of COVID-19, some dental clinics had to limit or stop operations due to the lack of PPE.

Based on guidelines released by the PDA on April 26, dentists – as responsible health workers – must not ignore patients needing urgent management. But in general, they should limit treatment to non-aerosol-generating procedures while adhering to strict infection control protocols.

The PDA, which has over 15,000 members, said dentists have a moral obligation to serve their communities, but should not place anyone’s life in danger through the lack of preparation in treating patients.

Under the guidelines, dentists and all members of their staff must wear the prescribed PPE including protective eyewear, surgical mask, disposable caps and disposable gloves. Dentists must observe a “high level of precaution” when handling patients amid the COVID-19 pandemic.

“All patients should be treated as potentially infective COVID-19 carriers. As such, high level of precaution should be exercised. If an individual exhibiting symptoms of possible COVID-19 arrives in your dental practice, patient must be immediately referred to seek medical treatment,” the PDA explained in its COVID-19 guidelines.

High-risk profession

Solomon told The Philippine STAR that in their profession, there is a high risk of transmission of aerosols and droplets. This requires stringent screening of patients for symptoms of infection.

According to the PDA guidelines, the coronavirus is transmitted through droplets entering exposed mucous membranes such as the eyes, nasal cavity and mouth.

“Dental professionals are at high risk for being infected and transmitting the virus though aerosol-generating procedures (AGP) such as ultrasonic scaling, use of high-speed handpiece (a precision device for removal of tooth tissue), (three)-way syringe and high or low volume saliva evacuation,” the PDA said.

“These risks are unique to dental interventions, where aerosol generation, handling of sharps, and proximity of the provider to the patient’s oropharyngeal (part of the throat) region is unavoidable,” it added.

The Centers for Disease Control and Prevention or CDC defines aerosol as a suspension of tiny particles or droplets in the air, such as dust, mist or fumes. These particles may be inhaled or absorbed by the skin, and can sometimes cause adverse health effects.

Solomon admitted that it is hard to know if a patient is infected with COVID-19 especially if the person is asymptomatic. This is why the PDA is requiring patients to answer a questionnaire before undergoing any dental procedure, to ensure that they do not have symptoms of COVID-19.

The dentists can only hope that no patient will lie about being infected.

“Please be honest” and “reveal everything” to the dentist, Almonte stressed.

Solomon said his clinic’s new set-up was based on the advice of the PDA. Plastic sheets for distancing in reception areas have become common. Solomon said dentists also implement their own disinfection protocols in their respective offices.

Every morning, Solomon’s clinic undergoes fumigation. The clinic has air purifiers for infection control.

Before the pandemic, Solomon said they could accommodate around 15 to 20 patients a day. But now, only seven to eight patients per day can set an appointment.

He explained that they stopped accepting walk-in patients to ensure physical distancing and prevent crowding in the clinic, as required under quarantine rules.

“Before ’yung COVID-19, ginagawa namin ’yung basic to advance procedures. Usually itong reception area is napupuno kasi nag-i-schedule kami ng patients on a daily basis, pero nag-a-accept pa rin kami ng walk-ins,” Solomon said. “Strictly by appointment (for now) para lang ma-make sure na konti lang muna ’yung tao dito sa clinic, sa loob ng clinic, sa reception, as well as dun sa operatory.”

For those who have orthodontic braces, dental cleaning will not be performed in the meantime due to the high risk of aerosol production.

The “new normal” has raised the cost of dental services because of the spike in prices of medical supplies especially masks and gloves. This is apart from the cost of the PPE and many other materials for infection control.

“Isang example na dun ’yung price ng face mask. Before, nabibili namin siya ng parang P100 lang per box, but ngayon ang price niya is P700, P900,” he lamented.

Solomon said some patients are scared to visit dentists due to the risk of contracting COVID-19. He stressed the importance of building trust between patients and their dentists.

Industry badly hit

On the PDA website, Almonte said committees were formed to raise funds and procure PPE for donation and distribution to health workers in need.

He said a scientific committee was working double-time to coordinate with international health and educational institutions on research and practical clinical protocols pertinent to their practice.

Funds were also allotted to help members affected by the public health crisis caused by COVID-19.

In a discussion on the new normal for dentists with The STAR’s Career Guide, streamed live on Facebook on May 27, Almonte emphasized the value of dentists as she noted that many of them in the Philippines have struggled financially due to the lack of work during the ECQ.

He commended the resilience of Filipino dentists, but pointed out that retrofitting of clinics to ensure proper ventilation, among other recommendations from abroad, would need funds. There are also those who are renting spaces for their clinics.

For some, Almonte says it is like starting all over again, while others are quipping that it is time for them to look for another profession.

He sees the operations of dental clinics going full blast by the first or second week of this month, but says they “cannot go back to business as usual.”

Almonte said they had been doing webinars to help their members cope, and most of them are confident that they can get back on their feet.

The increase in professional fees, he noted, would be inevitable.

“Stay strong,” he told the dentists, expressing optimism that their profession would have a resurgence.

As a first line of defense, Almonte says dentists will practice telemedicine.

If the procedure can wait, then the patient can consult the dentist on the phone or online. “If we can delay treatment, why not?” Almonte said.

“Take it slow,” he said as he advised dentists to do a test run, and retrain themselves and their staff.

Almonte observed that the health sector, especially oral health, has been neglected in the country, and the pandemic should prompt the government and everyone to make health a priority.

While waiting for the dentists to be fully ready to resume operations, Almonte reminded everyone to “brush your teeth” – and mouthwash will help – to avoid the need to see them during the pandemic.

Source: https://www.onenews.ph/strictly-by-appointment-dentists-face-covid-19-risks-to-treat-patients