BOSTON — As Massachusetts prepares to slowly reopen its economy amid the coronavirus pandemic, many dental hygienists feel ill-prepared to return to work and keep themselves and their patients safe.
Several dental hygienists reached out to Boston 25 News, concerned about a lack of equipment and guidance about how to proceed when the state allows elective procedures to resume.
One hygienist, who spoke on the condition of anonymity so as not to jeopardize her job, told Boston 25 News Tuesday her and her peers’ primary concern is an inadequate supply of personal protective equipment including N95 respirator masks.
“There are not enough to wear them for every single patient and change them between every single patient,” she said. “There aren’t even enough to have a week’s worth maybe or a few days’ worth, depending on how many people you employ in a given office.”
She added that some procedures may not require an N95 mask. In some cases, a surgical mask may be appropriate. Just what protective gear is best given the supply available is currently unclear, she said.
Hygienists are also concerned about aerosols – or particles from blood, saliva or debris, propelled into the air by drills and other dentistry tools.
The Centers for Disease Control and Prevention (CDC) stresses the risk of spreading coronavirus through aerosols in its guidance for dental practices during the pandemic.
“The virus has been shown to survive in aerosols for hours and on some surfaces for days,” the CDC says on its website. “There are also indications that patients may be able to spread the virus while pre-symptomatic or asymptomatic.”
The Occupational Safety and Health Administration (OSHA) categorizes “performing aerosol-generating procedures on known or suspected COVID-19 patients” in the highest level of risk of exposure.
“In a place where there are reports that aerosols can hang in the air for hours at a time, as a patient, I would be extremely concerned about going to an office and lying there with my mouth open in a place where someone else had just previously been,” the hygienist told Boston 25 News.
To mitigate aerosols, many dentists have instructed hygienists to discontinue use of aerosol-generating tools and instead do procedures by hand. But that work presents another set of problems, she said.
“The equipment is good for patients,” she said of the ultrasonic scalers and other high-speed instruments. “But it’s also made huge strides in allowing hygienists to be hygienists for their entire careers, versus having musculoskeletal problems and disorders after just a couple of years and needing to quit the job.”
To be able to continue using the equipment but reduce the aerosols, she wants her boss to buy her and other hygienists the high-volume suction devices that many dentists use during their own procedures.
She also hopes her office will invest in improvements to air filtration.
Following guidance from the CDC, OSHA and the American Dental Association, dental practices will reopen with many changes for the patient, including screening for symptoms before appointments, taking temperatures, eliminating use of waiting rooms, alternating procedure rooms between patients, requiring patients to wear masks before and after being seen and requiring a mouth rinse for each patient with a 1% hydrogen peroxide solution before the procedure to kill microbes.
Boston 25 News has learned many dental offices are gearing up to resume elective procedures, like cleanings, on May 18 – the date of the beginning of Gov. Charlie Baker’s four-phase approach to reopening non-essential businesses.
But that date does not apply to the public health sector. The Department of Public Health’s order banning elective procedures remains in place until further notice.
Baker’s office confirmed Tuesday no date has yet been set for non-emergency procedures to resume.
The hygienist Boston 25 News spoke with hopes dental offices like her own will hold off until more equipment and more guidance have been provided.
“We want our offices to thrive,” she said. “But we also don’t want to die for our offices.”
Dr. Janis Moriarty, president of the Massachusetts Dental Society, told Boston 25 News in a statement Tuesday the organization has been working on a set of guidelines to help the dental community safely return to work.
“As experts in infection control, we know that the practice of dentistry has been changed forever,” Moriarty said. “While we have not received definitive guidance from the Baker Administration on when dentists in the Commonwealth will be able to open their doors, we have been working behind the scenes for the last 9 weeks to develop new and extensive guidelines, incorporating information from CDC and OSHA, for reopening in a way that will ensure patients and staff alike return to a safe environment for furthering good oral health.”
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RESOURCES:
- Massachusetts Coronavirus Information
- Boston Coronavirus Information
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