For today’s blog post we want to talk about going back to the dentist during and after the COVID-19 pandemic. For many people, there are concerns about potentially being exposed to the virus during a dental visit. Because of this, we want to show that with the cleaning protocols we use daily, that it is indeed safe to get dental work done.
What is Clean?
First of all, how clean is clean? How do we know if something is clean? In the dental and medical field, we use several different levels of clean:
Sterile – This is the top level cleaning. Objects that are sterile will have absolutely no microorganisms (viral, bacterial, fungal). Devices that may enter normally sterile tissue or blood flows require this level of cleaning.
Disinfection – When we disinfect, we aim to eliminate many or all pathogenic microorganisms except bacterial spores. There are 3 levels of disinfection:
- High disinfection kills all vegetative microorganisms, mycobacteria, lipid and nonlipid viruses, fungal spores, and some bacterial spores
- Intermediate level disinfection kills mycobacteria, most viruses and bacteria, and is registered by the Environmental Protection Agency (EPA) as a “tuberculocide.”
- Low disinfection kills some bacteria and viruses
How and what gets sterilized
All non disposable instruments that go in the mouth are sterilized between uses. That means any non-disposable instrument that we use for you is guaranteed to have no microorganisms(that means COVID-19) before it is opened up for use. In order to sterilize instruments, dental offices typically use what is called an autoclave. An autoclave destroys all microorganisms by using high pressure steam heated to 270 degree F, this temperature is enough to kill all microorganisms. In contrast, COVID-19 viruses die when exposed to 132 degree F.
First, instruments are washed and rinsed by hand immediately after use. Next, they are soaked in ultrasonic enzymatic cleaners for 10-15 minutes to remove any other debris. Instruments are then placed in specialized pouches and loaded into the autoclave. Instruments are sterilized with 270 degree F steam for 30 minutes. These instruments remain in the sterile pouches until we open them for use.
How do we know if the instruments inside are actually sterile?
There are 3 conditions for determining the effectiveness of sterilization:
Each sterilization pouch contains an internal indicator. This indicator changes color only when certain conditions are met (a level of time, temperature and sterilant) inside the pouch. Therefore, this tells us that the physical and chemical conditions for sterilization have been met.
Biological Indicators are considered the gold standard of sterility assurance because they actually test the autoclave’s ability to kill specific types of highly resistant organisms. For instance, we use specific spore testing strips that substitute for dental pathogens(Geobacillus stearothermophilus). As a result, when we have met all 3 conditions regularly, we can be assured that any instrument that comes out of the autoclave is properly sterilized.
Everything else gets disinfected
On the other hand, all other parts of the patient area are disinfected. Therefore, an intermediate level of disinfection is used for countertops, non sterilizable equipment and fixtures. Caviwipes(or equivalent) are the industry standard for intermediate level disinfection of hard surfaces. Caviwipes are medical grade disinfectant wipes and sprays that can kill tuberculosis, hepatitis, other viruses, bacteria and fungi. Furthermore, they are effective approximately 3 minutes after application. According to the WHO, COVID-19 loses infectivity after exposure to common disinfectants.
What we are doing to protect patients and employees
What I have mentioned so far are standard protocols from the CDC[Centers for Disease Control] and OSHA [Occupational Safety and Health Administration] regarding dental office infection control. In addition to these standard protocols, we are also instituting new protocols specific to the pandemic in order to protect our patients and employees.
We have started:
- -Pre-screening telephone protocol to screen for potentially symptomatic COVID-19 patients
- – Forehead temperature screenings at appointment
- – No more than 2 patients/family members allowed in the waiting room at once, social distancing enforced.
- – Extending medical disinfectant cleaning to all equipment, front office counters, furniture, pens, card payment systems, and door knobs.
- – Appointing elderly patients either at the very beginning of the day or end of the day to avoid additional social contact
- – For our employees- mandated industrial strength face shields, eye protection and surgical masks in accordance with current CDC guidelines. High speed suction usage for all procedures that produce aerosols.
Is it safe to go back to the dentist with the pandemic going on?