The world changed overnight, and dentistry will need to change too, forever. As a general public, we are looking at everything through a new lens. Considering what we touch and how close we get to other people has become the new norm. Hand sanitizer, sterile-wipes and masks are a coveted commodity. We are now more aware of the “droplets” we create in simply speaking. We stand 6 feet away, donning masks in public. We have heard the safe distance could be up to 13 feet! But what happens when you go to your dentist?
Dentists and dental hygienists create aerosols for a living. We use ultrasonic cleaners to remove tarter creating plumes of tiny oral droplets. We use drills that spin at 500,000-800,000 rpm blowing air and water into your mouth that flies back out at us, around the room, into the hallway, and up the HVAC. The “droplets” blow out into the reception area where unknowing patients sit and wait for their cleaning appointment, or into a neighboring operatory. These aerosols travel more than 6 or even 13 feet! How do we go back to our dentist for even a routine cleaning without considering oral droplets?
So, as a dentist trained in the ’80s, we learned what it was like to treat all patients as though they had an infectious disease, although, at the time, the virus was HIV. Dentists went from barehanded, “wet-fingered” dentistry to using “Universal Barrier Precautions”. This meant we were all required to wear gloves, masks, eyewear, and gowns. Some dentists retired at that point, “I cannot work with those gloves on my hands…I cannot feel the small crowns and inlays with gloves” they complained. But this was the new “Standard of Care” in dentistry. It was 1987 and I was at the University of North Carolina School of Dentistry in Chapel Hill NC.
Fast forward to 2020 and we have a new, but much more contagious infectious disease to contend within the dental field. How do we handle a virus so easy to catch that lives in our salivary droplets? We aerosolize these droplets in our everyday work! So, in response to COVID19, with safety in mind, we decided to custom design engineer the first “Cleanroom Dental Experience”.
In the semi-conductor industry, or pharmaceutical industry, it is common to operate in a “Cleanroom”. This is a space where the particulates in the air are nearly eliminated by filtration and airflow. The air in a cleanroom will turn over more than 13x per minute keeping dust, bacteria, particulates, and virus out of the air. My husband happens to work in this industry for over 30 years and is a safety expert. He wanted to help me stay safe and keep our staff and patients from airborne infection.
Dental offices were asked to close in early March in Oregon in an “effort to conserve PPE”. But the reason should have been twofold. The most important reason to close our offices should be to prevent the aerosolizing of COVID19 in patients or asymptomatic carriers.
Biological Safety Cabinet
Because we do not know who has COVID19, we continue to treat everyone the same. We must be prepared to treat every patient as though they could be infected with COVID 19. In response, we have created the first isolation treatment rooms with HEPA filters in the ceiling creating laminar airflow to the floor. While treatment is performed a second “extra-oral HEPA vacuum” from overhead extracts the aerosols, filters, and neutralizes the infected droplets. The entire HVAC system has a secondary HEPA unit to purify the whole office environment. Each dental treatment room is an isolated mini Cleanroom with return ducts on the floor to turn the air in the room over 13x per minute. The instrument sterilization area has a Biosafety Cabinet with its own HEPA filter to process the contaminated items from the treatment rooms.
This is the future of dentistry. It is time again now to change the way we operate in the dental office. For the safety of our staff, our patients and providers, we need to take the necessary measures. It is our responsibility.
Find out more about our total office re-design with our new “Cleanroom Dental Experience” in Portland, Oregon.