In the Air Tonight
14 Sep 2020 Paul Feuerstein, DMD
Grounded. For about 20 years, I have spent time at least once a month sitting at Boston Logan International Airport or Manchester-Boston Regional Airport in New Hampshire waiting to get on an airplane and go off to a dental conference. Armed with a battery of meetings to see the latest and greatest new dental technologies or teach groups about making intelligent purchase decisions related to my findings, I spent my non-clinical time following this passion. Along the way, I got to meet the who’s who in dentistry, pick their brains, and make friends around the world. Since March, I, along with most of you, became an expert in Zoom and tried to carry on my quest in this virtual world. I have had a difficult time getting information on new products due to manufacturer shutdowns and layoffs; things are in limbo. In fact, in March, there were a few new projects that were announced, and to date, I have no idea what happened. Of course, as I said, a lot of my information comes from face-to-face meetings and demonstrations, which are currently not happening.
This is not to say that nothing is new. First of all, there has been a surge of online patient communication tools emerging under the category of “teledentistry.” As explained in my previous column, this is not just an advanced use of Zoom, Skype, and FaceTime. There are HIPAA-compliant portals that handle these patient and dentist-to-dentist communications. As we are now open, there are still clever uses of these services for marketing, consultations, patient screenings, and secure collaborations. It will be interesting to see how many of us continue using these platforms.
We have all increased our disinfection and sterilization protocols. At chairside, we are using wipes, sprays, fogging, UV-C lights, air purifiers, external suction, and more. As I tell my patients, although we are creating a safe environment for them (and likely the safest place they have been all day), a lot of this is for our own safety. If we are confident in the environment, they should be too. In July and August, many of our patients stated that the dental office was the first excursion they had made from their houses except for going to supermarkets.
This has led to a proliferation of equipment sales online from such “reputable” sources as eBay. Figuring out what to use requires a bit of scientific study. It is unlikely that a $200 air purifier from Amazon is as effective as one costing 10 times more, such as the Surgically Clean Air Jade room unit (scadental.com). In fact, just the UV-C bulb plus the filters retail for a total of over $200, so who knows what is in these inexpensive units, not to mention the amount of air exchanged per hour, which is often rated by the companies without the filters inside their products. There’s a lot to think about here.
One area to look at is disinfection. I am not an expert on pathogens, but during my downtime, I found a few people who are. One is Leslie Fang, MD, who practices and sees COVID-19 patients at Massachusetts General Hospital in Boston and is on the faculty at Harvard Medical School. You might also recognize him as author of The Ultimate Cheat Sheets: The Practical Guide for Dentists as well as a faculty member of DOCS Education. The other is John Burd, PhD, who, along with his work with diabetes and having been awarded the American Association for Clinical Chemistry’s Edwin F. Ullman Award for Technology Innovation, is the founder of Wonder Spray (thewonderspray.com). Both have been teaching the use of hypochlorous acid as a solution that can be fogged in a room to safely disinfect every surface before and after seeing each patient. It can actually be used to fog your staff members and you, as well as clothing and covers, between appointments. Plus, in a dilution to 50 ppm, it can be used directly on surgical sites and in water bottles for handpieces and ultrasonics to create a partially disinfected spray. Do some research on this product and process.
Keyboards and mice are another area that has been scrutinized during this time. Offices spend a lot of time and create environmental waste covering these with plastic barriers. I came across Man & Machine, which makes totally sealed keyboards and mice, both wired and wireless. They can be wiped, sprayed with all disinfectants, and even washed in a sink. Some of the keyboards also come with a “skin” that can be removed and autoclaved (just the skin, not the keyboard). There is an extensive selection on the company’s website, man-machine.com.
This time might also be a chance to reassess the idea of digital impressions as well as one-visit dentistry. Certainly, the disinfection of impressions and trays can be eliminated, as well as the “hazards” of shipping and handling. And if you think it through, keeping the entire crown production in your own facility keeps external pathogens under your control.
If you take extraoral photographs, how do you cover or disinfect a camera? I suppose an underwater setup from Nikon or Canon would be a possibility but fairly bulky and expensive. To the best of my knowledge, there is only one disinfectible camera that is used in dental offices, and that is the Shofu EyeSpecial, now in its fourth version (C-IV) (shofu.com/en).
Each of us has our own comfort level, and some dentists have said that it is not really necessary to do all of these things. If you have invested in any of these or other products or processes, it is essential that you show these off to your patients. You can even call it a marketing expense, as I have found that patients are quite impressed as well as reassured that you are doing everything possible for their safety. No matter what you are doing, please stay safe and use common sense.