"Health officials know COVID-19 is transmitted through close contact with an infected individual. Individuals can prevent the spread of viruses by practicing good hand hygiene (hand washing, hand sanitizer use), avoiding touching the face with unwashed hands, avoiding close contact with sick individuals and staying away from other individuals while sick.”1—The California Dental Association
As I sit here writing this article, I never thought that I would be a dental hygienist in the middle of a global pandemic. I have been in the dental world for 25 years, 19 as a dental hygienist and 13 as an educator, and this idea never even crossed my mind. To say it’s quite scary is an understatement. It’s the fear of the unknown that has me scared and anxious. The future of dentistry and dental hygiene is unclear. Will I have a job to go back to? Will I have to look for a new job along with an influx of other very qualified dental professionals? Will there be a change in infection control procedures? Should I make a career change? These questions have been going through my mind for quite a few weeks.
“Dental patients and professionals can be exposed to pathogenic microorganisms, including viruses and bacteria that infect the oral cavity and respiratory tract. Dental care settings invariably carry the risk of 2019-nCoV infection due to the specificity of its procedures, which involves face-to-face communication with patients, and frequent exposure to saliva, blood, and other body fluids, and the handling of sharp instruments.”2 I have heard some horror stories lately about how hygienists have been treated. It amazes me, but I am not surprised. There are some dentists who seemingly don’t care about their staff’s health or their patients’ health and wanted their staff to come into the office to treat patients, even though their states recommended that elective treatment be postponed. This did not change for some dental professionals until it was mandated by state officials and the president. I just hope those hygienists remember how they were treated and decide whether their offices really value them when it’s time to return to work. There are some employees lucky enough to work in offices that have the resources to pay them for their time off, but others aren’t so lucky and have to collect unemployment temporarily.
I live in New York and practice in the states of New York and New Jersey. Currently, Governor Cuomo’s most recent executive order changes the recommendation that dental offices only respond to emergency services to a NYS mandate. This is still true, only emergency treatment can be seen, any elective treatment needs to wait. At the beginning no one knew how bad this was and state mandated stay at home orders were put into effect. “This executive order is in effect through April 19, 2020. This is subject to change based on further direction from governmental agencies."3 This order changed several times over the last few weeks. First the order was changed to stay in effect until April 30 and now it has changed again until May 15 and I am sure it will change several more times as our governor starts opening up the state in phases. “The overarching obligation of the New Jersey State Board of Dentistry is to protect the public’s health, safety and welfare. That includes everyone: the people who live and work here, those who pass through and of course the dentists, their patients and their staff."4
According to the New Jersey Consumer affairs website, “Dentists should cancel or postpone any elective procedure or routine service until at least April 20, 2020, to limit exposure to and transmission of the virus and help preserve and extend the supply of personal protective equipment.4 On Sunday March 22, Governor Phil Murphy signed an Executive Order suspending ALL elective surgeries and invasive procedures for adults - both medical and dental effective 5:00pm on March 27. This was also changed to April 30, and now is indefinitely until the state of New Jersey starts to open. There is no set date when dental offices can resume business again.
What am I doing during this unexpected time off? Like most everyone, I am listening to the news reports from the mayor, governor, and president and trying not to let my anxiety get the best of me. Since I normally work four to six days a week between clinical dental hygiene and education, I am trying to be productive with my time off. I am spring cleaning, organizing, and catching up with friends with whom I normally don’t have the time to chat on the phone or via FaceTime or video chat. I am also using my time wisely by taking a few webinars for continuing education classes. There are a lot of these being offered, and some are free. This is a good time to take advantage of classes that are being offered through the American Dental Hygienists’ Association, dental companies, and many other outlets.
What does the future hold?
When things get back into a routine and we are back in our offices, we will need to regroup as a dental team. Now is a great time to have office meetings to discuss new office protocols and for an infection control review. Anything that needs to be changed should be changed, and new protocols established.
When I return to the world of dental hygiene, I will be doing most of the same things as usual but taking extra precautions. A study by Peng et al. stated:
“Based on the possibility of the spread of 2019-nCov infection, three-level protective measures of the dental professionals are recommended for specific situations. (1) Primary protection (standard protection for staff in clinical settings). Wearing disposable working cap, disposable surgical mask, and working clothes (white coat), using protective goggles or face shield, and disposable latex gloves or nitrile gloves if necessary. (2) Secondary protection (advanced protection for dental professionals). Wearing disposable doctor cap, disposable surgical mask, protective goggles, face shield, and working clothes (white coat) with disposable isolation clothing or surgical clothes outside, and disposable latex gloves. (3) Tertiary protection (strengthened protection when contact [with] patient with suspected or confirmed 2019-nCoV infection). Although a patient with 2019-nCov infection is not expected to be treated in the dental clinic, in the unlikely event that this does occur, and the dental professional cannot avoid close contact, special protective out[er]wear is needed. If protective out[er]wear is not available, working clothes (white coat) with extra disposable protective clothing outside should be worn. In addition, disposable doctor cap, protective goggles, face shield, disposable surgical mask, disposable latex gloves, and impermeable shoe cover[s] should be worn.”2
I believe there will be mandated changes in infection control protocol. These may include N95 masks, hair protection, and use of a face shield. We have been taught to practice standard precautions. I already change in and out of my uniform at my office, use the proper personal protective equipment (PPE), and use proper sterilization and disinfection techniques—we probably all do, but nobody is perfect.
According to the CDC, “Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients. Standard precautions include:
1. Hand hygiene
2. Use of personal protective equipment (i.e., gloves, masks, eyewear)
3. Respiratory hygiene/cough etiquette
4. Sharps safety (engineering and work practice controls)
5. Safe injection practices (i.e., aseptic technique for parenteral medications)
6. Sterile instruments and devices
7. Clean and disinfected environmental surfaces.”6
Hope for the future
I am hopeful for the future of dentistry and dental hygiene. There will probably be a greater need postpandemic. Initially, dentistry and dental hygiene may be slow, but things will improve greatly. “Our profession has its variety of challenges and occupational hazards, this COVID-19 is just the newest. Be vigilant, intentional, and follow the CDC and ADA recommendations until we have a better understanding of this disease and, ultimately hopefully, a vaccine.”7
I hope that dental hygienists don’t give up on the profession but reevaluate it. It will take time, but with new guidelines, different PPE, and a vaccine, my hope is that things will all get figured out. “At present, there is no specific guideline for the protection of dental professionals from 219-nCoV infection in dental clinics and hospitals.”2
This current situation reminds me of what people who worked in the AIDS epidemic went through. There were a lot of unknowns, but dental professionals worked afterwards and changed up infection control procedures and PPE. I am optimistic that things will get back to normal sooner rather than later. Things may change, but our work is not considered “elective” all the time—only during a pandemic. We will have jobs again; at least, that’s what I keep telling myself every night!
Editor's note: The content of this article is the opinion of the author. For clinical recommendations, please consult the CDC, ADHA, or ADA.
References
1. Coronavirus and patient screening: Recommended actions for dentists. CDA. Updated March 4, 2020. https://www.cda.org/Home/News-and-Events/Newsroom/Article-Details/coronavirus-and-patient-screening-recommended-actions-for-dentists#
2. Peng X, Xu X, Li Y, et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12:9. https://www.nature.com/articles/s41368-020-0075-9.pdf
3. Novel coronavirus (COVID-19). New York State Dental Association. Last updated Apr. 19, 2020. https://www.nysdental.org/news-publications/novel-coronavirus-(covid-19)
4. COVID-19 Advisory for New Jersey Dental Professionals. New Jersey Office of the Attorney General. March 21, 2020. https://www.njconsumeraffairs.gov/den/Documents/COVID-19-ADVISORY-FOR-NEW-JERSEY-DENTAL-PROFESSIONALS.pdf
5. Executive Order No. 109. nj.gov website. https://nj.gov/infobank/eo/056murphy/pdf/EO-109.pdf
6. Standard Precautions. Centers for Disease Control and Prevention. Page last reviewed June 18, 2018. https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html
7. Kiser K. Coronavirus: What dental professionals need to know about COVID-19. Today’s RDH. March 7, 2020. https://www.todaysrdh.com/coronavirus-what-dental-professionals-need-to-know-about-covid-19/
Jennifer Morelli, MS, RDH, is a licensed dental hygienist with over 19 years of experience in a general practice as well as 12 years in a prosthodontic office. For the past 13 years, Jennifer has held adjunct professor teaching positions in various dental hygiene programs with first-year and second-year dental hygiene students. She is currently an adjunct professor at Middlesex County College in Edison, New Jersey. She enjoys being in private practice as well as teaching students. Jennifer takes continuing education classes every year to make sure that she is up-to-date on the latest trends and education so she can bring what she learns back to her students and to private practice.
