Dentistry and COVID Infection – How at Risk are VA Dental Professionals?
In March 2020, The New York Times listed dentistry as one of the professions at highest risk of COVID-19 infection based on data from O*NET, a database maintained by the U.S. Department of Labor. It has been presumed that virus transmission could occur because of the close proximity between dental professionals and patients, and because many dental procedures generate aerosols that may contain viral particles from infected individuals.
In October 2020, the American Dental Association published data from a survey of dentists. The study showed that as of June 2020, fewer than 1% of dentists tested positive for the coronavirus. The results were published in the American Dental Association’s: "Estimating COVID-19 Prevalence and Infection Control Practices Among US Dentists,.” The ADA says, “This was the first large-scale collection and publication of U.S. dentists’ infection rates and infection control practices related to COVID-19. Of the 2,195 dentists who responded to the survey, 20 had a confirmed or probable COVID-19 infection. Respondents included dentists from every state and Puerto Rico. When the results were weighted according to age and location to approximate all U.S. dentists, 0.9% were estimated to have a confirmed or probable COVID-19 infection, with a margin of error of 0.5%.”
Interim guidance from both the ADA and CDC called for dental professionals to use the highest level of personal protective equipment available, including masks, goggles and face shields. To minimize aerosols, the ADA guidance also recommends dental professionals use rubber dams and high-velocity suction whenever possible and hand scaling instead of ultrasonic scaling when cleaning teeth.
Dentistry has seen it’s share of highly communicable, transmissible infectious diseases. Coronavirus is one more on the list which includes such notables as HIV, Hepatitis B&C, Tuberculosis, and Syphilis. VA Dentistry has a long history of upholding the most stringent infection control practices in the profession. Infection Control Standards in VA Dentistry date back to 1987 with an initial publication of a standard set of guidelines that all VA Dental clinics and VA Dental Personnel were expected to follow. Over the years this document had been revised and updated incorporating guidelines from other sources such as the American Dental Association and the Centers for Disease Control and Prevention, as well as VA Directives and Regulations such as those pertaining to Reusable Medical Equipment which requires that all dental personnel be trained, with documentation of initial training, proficiency and annual competency. A basic tenet of VA Dental Infection Control is that, other factors being equal, single patient-use, disposable products are preferable to reusable medical equipment. This continues to apply in the face of the coronavirus pandemic.
VA Dental professionals as a group (dentists, hygienists, assistants) wholeheartedly embraced new ideas and technologies to ensure the safety of their patients as well as themselves. Clinics with open door designs have implemented plastic barriers to contain aerosols in the operatory. Face Shields and N95 masks, hair covers and shoe covers are used routinely in aerosol generating procedures (AGP’s). VISN’s have purchased extraoral suction devices to help eliminate scatter aerosol when handpieces and ultrasonics are used. Some VA’s have issued PAPR’s to their dental personnel. All dental personnel are actively screening their patients upon entry to the clinic including taking temperatures (even if they were already screened to gain entry to the buildings) and then following up with the patient after the procedure to make sure the patient did not subsequently test positive or have symptoms consistent with coronavirus. All of this is very good news for our patients. VA Dental patients tend to be extremely sick, with multiple co-morbidities, they tend to be frail, and immunocompromised. And, they tend to have more rampant dental disease than the average private practice patient population. VA dentists understand the link between oral health and systemic health. For the overall health of the patients, VA Dentists mitigate the risk of infection, as much as possible, given the current state of knowledge, in order to provide dental work the patients need. The measures taken by VA Dentistry, including heightened infection control practices seems to be working. The study appears to support that.
“The fact that dentistry was named one of the most at-risk professions for infection, but has a far lower prevalence of infection compared to other health professions, is not a coincidence," said Marko Vujicic, Ph.D., chief economist and vice president of the ADA Health Policy Institute. "The profession has taken this issue extremely seriously, and it shows.”
VA Dentistry and the infection control practices undertaken by the profession as a whole will continue to evolve as additional science emerges. As VA Dentistry flexibly adapts to emerging scientific evidence, we will continue to ensure a very low risk of infection among VA Dental Professionals.