“The era of Corona-Virus-Disease 19 (COVID-19) is an important historical period from various points of view, from the world health to the huge cascade of socio-economic implications. Everyday habits have been turned upside down and the way of life of people all over the globe, engaged in all activities, especially in the health sector, will be involved in this necessary change. Dentists, being in close contact with the patient’s droplets and aerosols generated, have to revise the operating protocols to protect the team and the patients from risk of infectious diseases.”1
When the pandemic started in March 2020, I wrote an article about what it felt like to be a dental hygienist in the middle of a global pandemic, and I shared my fears, thoughts, and expectations when we returned to work. Now, after seeing patients for about 18 months and getting feedback from fellow hygienists, I feel the need to share my thoughts again.
The dental hygiene world, along with the rest of the world, was turned upside down when the pandemic started. We didn’t know what to expect on a day-to-day basis. As dental professionals, we knew we were in for changes in the ways we worked, such as added personal protective equipment (PPE) and other precautions in the office.
“As we return to work and begin to grapple with the new policies, procedures and, yes, all that added PPE, dental hygienists and the entire dental team must learn to cope within new boundaries that COVID-19 has created for dentistry. To be successful, stay safe, and provide the optimum care for our patients, it is important that dental health-care workers (DHCW) reassess their current way of thinking.”2
Regardless of whether we’re working in a pandemic, there are the great offices, the mediocre ones, and the ones that no one understands how they’re still functioning. I’ve found that for the most part this plays a definitive role in whether the dentists follow CDC, OSHA, and ADA return-to-work guidelines. Some offices have gone above and beyond for their employees, buying air purifiers, extraoral suctioning, defoggers, and UV lights to sanitize the office. Some offices buy all the proper PPE for their employees to function properly and effectively. Then there are those that don’t give this pandemic a second thought and believe that their offices can function the same as before the pandemic.
“Many dental offices closed or offered only emergency care during the spring of 2020, owing to the risk of experiencing virus transmission. In the United States, all states (inclusive of the District of Columbia) restricted dental visits in some way, generally limiting services to only emergency care. In a survey conducted by the American Dental Association Health Policy Institute, 97% of responding dentists indicated that their offices were seeing emergency patients only or not seeing patients during the week as of April 6, 2020. By the week of September 7, 2020, about 90% of responding dentists reported being open, with 50% reporting lower patient volumes than usual. In addition, a nationally representative survey of adults conducted at the end of May 2020 reported that about 75% of US adults reported delaying dental treatment due to the pandemic.”3
In spring of 2020, the ADA, the American Dental Hygienists’ Association (ADHA), and the CDC came up with return-to-work guidance. “ADHA recommends that all dental hygienists follow the Standards for Clinical Dental Hygiene Practice, which state that dental hygienists follow the most current guidelines to reduce the risks of health-care-associated infections in patients and illnesses and injuries in health-care personnel.”4
Right now, my days consist of patient screenings to make sure it’s safe to see someone. This is a necessary protocol for me, the dental staff, and patients. We established added infection control procedures, such as longer appointments and longer time between patients for proper disinfection and sterilization of the operatories. We also wear more PPE, such as N95 or KN95 masks along with level 3 masks, or a respirator mask, a face shield, hair coverings, disposable gowns, and booties.
We also atomize the operatories after each patient, have increased HVE usage, and added air purifiers, extraoral suctions, and UV light sanitizers. Infection control procedures are extremely important whether we’re practicing in a pandemic or not. It is important to always have reduction of the bacterial load in a patient’s mouth to decrease bacterial airborne contamination in the office. That’s why we use an antimicrobial rinse as a preprocedural rinse.
“The dental team must adapt several precautions to avoid these infections; an adequate training and information of the personnel is mandatory in order to control infections in the dental office. The individual protection methods include a series of enforcement with the aim to reduce the risks of contamination, unfortunately without being able to eliminate them.”1
Another interesting thing about the pandemic are people’s thoughts on getting the vaccine. Being in the dental profession, I chose to get the vaccine when it became available to the health-care sector. But I do believe that getting the vaccine is a personal choice. “The future SARS-CoV-2 vaccine is considered by many countries as the last hope for protecting the population and economy against COVID -19. Successful vaccines rely on high vaccine uptake among populations. However, recent evidence predicts an unsatisfactory acceptance rate of a COVID-19 vaccine in the general population. A survey among the general population in the United States in June 2020 suggests that only 50% of Americans are willing to get vaccinated once the vaccine is available.”5
Dental hygienists are a wealth of knowledge and we should share what we know with our patients. “Infect your patients with what you know. Increase oral hygiene instruction. Consider home products that may help patients manage better at home during times when it may be necessary to quarantine. Stress to patients the very real connection between oral health and systemic health. Make patients aware of the importance of maintaining oral health to prevent diseases such as diabetes, heart disease, respiratory illnesses, and other conditions that may increase the risk for COVID-19. Infect your practice with your highly trained skills.”2
It is our responsibility to educate our patients on the information we have.
1. Bizzoca ME, Campisi G, Muzio LM. Covid-19 pandemic: What changes for dentists and oral medicine experts? A narrative review and novel approaches to infection containment.” Int J Env Res Pub Health. 2020;(17)5: 3793. Accessed June 26, 2021. doi:10.3390/ijerph17113793
2. Patenaude CL. Working safely in the dental office in the age of Covid 19." DentistryIQ, July 20, 2020. Accessed June 26, 2021 https://www.dentistryiq.com/covid-19/article/14180741/working-safely-in-the-dental-office-in-the-age-of-covid19
3. Kranz AM, Chen A, Gahlon G, Stein BD. 2020 trends in dental office visits during the COVID-19 pandemic. JADA. 2021;(152)7:535-541. doi: 10.1016/j.adaj.2021.02.016
4. ADHA Interim Guidance on Returning to Work. ADHA. Accessed June 26, 2021. https://www.adha.org/resources-docs/ADHA_TaskForceReport.pdf
5. Zigron A, Dror AA, Morozov NG, et al. COVID-19 vaccine acceptance among dental professionals based on employment status during the pandemic.” Front Med. 2021;8(2). Accessed June 28, 2021. doi:10.3389/fmed.2021.618403
Jennifer Morelli, MS, RDH, has more than 20 years of experience in general practice as well as 13 years in a prosthodontic office. For the past 14 years, Morelli has held adjunct professor positions in various hygiene programs. She is currently an adjunct professor at Middlesex County College in Edison, New Jersey. She enjoys being in private practice as well as teaching. Morelli takes continuing education classes every year to make sure that she is up-to-date on the latest trends so she can bring what she learns back to her students and private practice.