Dr. Raghunath Puttaiah is an expert on dental infection control, epidemiology, and OSHA protocols. He addresses questions and concerns regarding how Covid-19 will affect our practices.
Dr. Raghunath Puttaiah is a specialist in infection control, OSHA compliance trainer and epidemiologist. Do you recommend closing or only seeing emergencies? As trained dental professionals need to use common sense and use what we know. Use screening procedures and continue seeing emergencies with caution. Try not to do high splash procedures and post the protocol in your office and on social media. Use a skeleton crew, wash hands upon entering, and don’t touch things if possible, especially with dirty gloves. For an N95 to work properly, the seal has to be tight with a respirator attached. A regular mask keeps someone from coughing on you or vice versa. Masks are good for droplets, but aspirate gets through. Wearing a respirator mask for even a short time will make it difficult to breathe unless it is a negative pressure mask.
What precautions should we be taking and what procedures qualify as an emergency? What about the hygiene department who can’t work? Reduce procedures that include splashing, don’t polish or use a cavitron without a direct suction tip and preferably hand scale. If the patient is in pain, do a dry look first. If it needs antibiotics then do it, if it is a surgical extraction you need to wait because it uses a handpiece. If the tooth is bombed out and needs a root canal do it. To crown, you’ll still need to prep with a rubber dam, high suction, and 4 handed dentistry. Just avoid things with aerosols. UV suction air filters such as Surgically Clean air which is a centralized or portable system that reduces up to 95% of aerosols.
Is it true that hydrogen peroxide reduces the virus load? Do a preprocedural mouth rinse such as Listerine or Chlorhexidine. Life will move on, so be cautious but don’t freak out.
What do we do about lockdown areas if we have patients with temp crowns? Clean out by hand and reseal. To adjust anything, use chlorhexidine as an irrigant or a bur without coolant if done slowly. Can they use a cavitron with Peridex? Yes, but it is expensive and you will need to do assisted hygiene for suction.
Should facial hair be shaved? If you don’t, wash several times per day. You also can’t wear a respirator with one. In surgery, you should already use a beard net.
Is an isolite okay to use? Yes if it’s two-handed, but it’s also noisy.
Do you dilute the peridex or will it clog up the lines? Don’t dilute more than 0.12%, but either way, it doesn’t clog the lines.
Chlorhexidine stays for a longer period of time, but Listerine is sufficient or a short time. If you are using the painter’s mask don’t use it longer than half a day. The biggest thing is that no matter the mask you use that you have a good fit.
When do you think things will get back to normal? The term novel means that we just don’t know. It could be several months. We should be used to infection control because of our jobs. Don’t expect the ADA to make sanctions on this.
What can we do to ease employee fears? You are the leaders in your office. You need to educate them without getting angry.
We are healthcare professionals. Our job is to continue to serve patients as best we can.