as safe and protected as we can make them. In 2020 the office of the governor and theNewYork StateDepartment of Health (NYSDOH) issued “Interim COVID-19 Guidance for Dentistry” for starting up our practices after the shutdown. We were handed mandates that included checklists and very specific documentation. Included among them was a written pre-appointment screening form, the daily documenting of the temperature of staff upon arrival and departure, and the documentation of the patient’s temperature immediately prior to their appointment, as well as another in-office screening form. Those mandates were rescinded in 2021 and replacedwith a second set of mandates, these being issued by theNewYork StateDepartment of Labor under the HEROES Act. The HEROES Act has also been rescinded and there are presently no mandates whatsoever. None. Simply recommendations from the Centers for Disease Control and Prevention (CDC), which are also referenced by the NYSDOH. So, our autonomy has been restored but many look for something more concrete than recommendations. Some would feel most comfortable (understandably) with a new checklist that spells out our obligations. As this list of best practices does not exist, we are faced with answering: “What might we be doing to best ensure that our office is not a locus from which COVID transmission is facilitated?” (Keep in mind that this is the author “thinking” out loud; pick and choose if you think a practice makes sense.) Let’s consider some of what we had been doing. Screening the patients on the phone when confirming their appointments. Asking if they have been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID19 or who has or had symptoms of COVID-19 or if they have tested positive for COVID-19 in the past 14 days, and/or have experienced any symptoms of COVID-19 in the past 14 days. It does not hurt to ask. One can tailor the time frame to what they feel is reasonable. Have the patients fill out a questionnaire regarding the above when they arrive for their appointment and keep that record in their chart. In my opinion, while the answers to the questions are important, putting it on a separate piece of paper is simply a waste of paper. Keep a log of the temperature of all staff when they arrive and when they leave, as well as documenting the temperature of patients when they present for their appointment. Theater. While it is possible that some office in this country actually did have a patient present with an elevated temperature that proved to be related to a COVID infection, it seems that the odds of winning Lotto twice are better. Wait at least fifteen (15) minutes after completion of the dental visit or procedure to allow potential contagious droplets to sufficiently fall from the air before beginning cleaning and disinfection of surfaces in the dental operatory. Seemed reasonable when it was proposed. However, when the theoretical was actually studied, it turned out that the air in our operatories was not a cesspool of pathogens and the CDC rescinded this recommendation. The highest concentrations of pathogen containing aerosols turned out to be extremely close to the mouth of the patient, not the other side of the room, and the main component of the aerosol was the handpiece irrigant, not saliva. We know that dentists are the medical professionals that are probably the best versed in barrier technique and source control to prevent infection. We should do what we do best —mitigate transmission by creating barriers. Consider requiring that masks be worn by patients in the waiting area. If you choose to do so and a patient objects and states that they cannot breathe when they wear a mask, educate them in the kindest and most polite way possible that that is a load of nonsense. Dentists, worldwide, are proof that proper mask wearing minimizes or prevents the spread of airborne/ respiratory pathogens. There is no death certificate anywhere that records the cause of death as “a well-fitted surgical mask.” Should a patient object on the grounds that there is no such governmental mandate or you are violating their personal rights, depending upon your comfort level, you may show them the door—your office, your rules. You are legally within your rights as the proprietor of your business to establish reasonable rules and expectations. Consider the continued use of HEPA filters or another formof air cleaning system in each operatory and in the waiting and administrative areas. Consider adopting a pre- procedural mouth rinse with an agent that has been shown to reduce the oral viral load of SARSCOVID 19. Consider fogging with 500 ppm hypochlorous acid. Now available in Staten Island 6 SDDS BULLETIN November/December 2022 — VOLUME 39 ◊ NUMBER 6
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