Dentists and their staffs take precaution before heading back to work

The era of COVID-19 is unprecedented, from office closures to reopenings, and protection from the virus.

The COVID-19 outbreak and its

impact on our daily lives is rapidly evolving. As dentists and their staff entertain going back to work after states reopen, they have been identified as a high-risk job for potentially contracting the novel coronavirus. In that realm, the American Dental Association (ADA) has provided mask and face shield guidelines and a return to work toolkit that are meant to help practices take measures before, during and after patient appointments to protect dentists, patients and staff. In a statement, the ADA said it believes dentists should exercise professional judgement and carefully consider the availability of appropriate personal protective equipment (PPE) to minimize risk of coronavirus transmission.

According to OSHA, dentistry work tasks associated with exposure risk levels include: > Lower (caution) > Performing administrative duties in non-public areas of dentistry facilities, away from other staff members. > Medium > Providing urgent or emergency dental care, not involving aerosol-generating procedures, to well patients (i.e., to members of the general public who are not known or suspected COVID-19 patients). > Working at busy staff work areas within a dentistry facility. > High > Entering a known or suspected

COVID-19 patient’s room or care area. > Providing emergency dental care, not involving aerosol-generating procedures, to a known or suspected COVID-19 patient. > Performing aerosol-generating procedures on well patients. > Very High > Performing aerosol-generating procedures on known or suspected COVID-19 patients. > Collecting or handling specimens from known or suspected COVID-19 patients. The ADA has provided interim mask and face shield guidelines that align with existing CDC recommendations for patients without signs or symptoms of COVID-19, including: > It should be assumed that all patients can transmit disease. > Use the highest level of PPE available when treating patients to reduce risk. > N95 masks – Level of risk: Low > N95 equivalent masks, KN/

KP95, PFF2, P2, DS/DL2, Korean

Special 1st – Level of risk: Low > Surgical mask – Level of risk: Moderate > If masks with either googles or face shields are not available, please understand there is a higher risk for infection. > Use your professional judgement related to the treatment provided and the patient’s risk factors.

Meanwhile, for those dentists reopening their doors, the ADA’s Advisory Task Force on Dental Practice Recovery has developed the free “Return to Work Interim Guidance Toolkit.” It includes: > Welcome back reassurance sample letter to patients > Guidance on pre-appointment screening > In-office patient registration procedures > Reception area preparation strategies > Chairside checklist

> Staff protection strategies > Supplies shopping list

The ADA’s Advisory Task Force on Dental Practice Recovery began meeting in April with the overall goal of helping dentists get back to serving their communities while protecting patients, office staff and themselves. It is comprised of practicing dentists with support from ADA experts in science, practice, law, regulation and other key areas. Drs. Rudy Liddell, chair of the ADA Council on Dental Practice, and Kirk Norbo, 16th District trustee, are the co-chairs for the advisory task force.

To further help dentists reenter their offices, the Organization for Safety, Asepsis, and Prevention (OSAP) has provided an on-demand webinar on respiratory protection in the era of COVID-19. The webinar discusses: > Steps to introduce the use of

N95 and other respirators in dental settings > Practical tips for developing the

OSHA respiratory protection program, including fit-testing, medical evaluation and training > Different levels of surgical masks and how they compare to

N95 respirators > Proper steps for donning and doffing of all PPE

Video highlights also include: > How to put on and take off PPE > Droplet and airborne transmission precautions for the dental team > Using respirators and surgical masks in dental setting during COVID-19

> Understanding FDA and OSHA requirements for using respirators for confirmed or suspected

COVID-19 patients > How to optimize PPE > OSAP experts answering dental community questions about PPE

The impact of COVID-19 is unprecedented. Given the rapid spread to date, DSOs should consider a set of actions: protect and provide purpose to employees, stress-test financials, stabilize critical functions, engage with patients and leverage online training.

Aspen Dental

New York-based Aspen Dental is taking proactive steps so that patients, care teams and communities have a safe, clean care environment for their dental needs. They are committed to the highest safety standards and now, deep cleaning has taken on a whole new meaning. All care team members must wear PPE such as masks when working with patients, whether they are at the front desk or in a treatment room. Equipment is sterilized and dental chairs and all surfaces are cleaned between each patient. Surfaces in waiting rooms and common areas are cleaned hourly to keep high touch surfaces clean. Hand sanitizer is available throughout the office.

Patients are being asked to arrive on time, not early, to minimize time spent in the office. Patients are quickly moved into their treatment room upon arrival. If a wait is required, patients are asked to wear a mask and wait outside the office, preferably in the car, before an appointment. They are texted when they are ready to be seen. Also, family and friends of the patients are asked to wait outside the office unless the patient requires personal assistance during their visit. If so, their companions are checked for symptoms, given a mask, and wait outside during the appointment.

Team members are checked daily for signs or symptoms of illness, including mandatory temperature checks. Care team members who show any signs or symptoms of a cold, seasonal flu or COVID-19 must stay home until they have been cleared by their healthcare provider. All patients are screened before starting care to assess their COVID-19 risk, including temperature check and symptom screening.

Appointment times are staggered to limit the number of people arriving to the office at any given time. Where possible, high-risk patients will be scheduled earlier in the day, when the office is less busy, to minimize unnecessary contact. Aspen Dental encourages patients to complete their paperwork online in advance of their appointment to minimize paper in the office. And, they have eliminated paper sign in at the front desk.

Achieving practice growth through the use of digital treatment options

One clinician’s treatment journey with the Invisalign system : ALLISON WALKER

Digital technology and workflows bring a new level of efficiency and

ease to a growing number of dental practices. Dr. Shorouq Sahawneh, lead dentist with Smile Brands Inc. (SBI), and Clinical Director and Professional Corporation (PC) President of all southern California offices, knows this well.

Dr. Sahawneh and her team

Throughout her 12-year career, Dr. Sahawneh has been fascinated with technology. Embracing new digital innovations has allowed her to save time, enhance patient communication, and see Smile Brands, Inc. continue to expand. “We have almost 72 offices in southern California and we’re growing,” she says. “It’s been an amazing journey and I’m very grateful.”

When Align Technology introduced the Invisalign Go system to Smile Brands and their general dentists in 2017, Dr. Sahawneh was given the opportunity to practice in orthodontics, an area of longtime interest. “I loved that Invisalign treatment helped me offer more comprehensive care. It helped me take advantage of a new area of untapped potential to help my patients.”

Dr. Sahawneh prescribed everything from restorative dentistry, extractions, and implants to her patients but had to refer all of her orthodontic cases to a specialist. “With Invisalign Go, I was able to provide my patients with orthodontic treatment. Achieving a straighter smile was a helpful first step in planning future restorative work more effectively and achieving better overall results for my patients,” she explains.

Dr. Sahawneh points out that incorporating Invisalign treatment into the practice workflow is a team effort. The training and support provided by Align Technology are critical to getting up to speed and mastering the different components of the Invisalign Go System – from the Invisalign Photo Uploader through the intuitive ClinCheck treatment planning software. “Align Technology’s Invisalign Pro course, featuring one-on-one tutoring, was a tremendous opportunity to learn from an expert orthodontist while going at my own pace. It helped me become who I am and built so much confidence in my ability.”

Today, an orthodontic assessment is part of every patient’s evaluation and oral examination at Dr. Sahawneh’s practice. “I’m connecting the position of the patient’s teeth, their occlusion and misalignment, to the conditions that they complain about,” Dr. Sahawneh explains. “We are educating patients during periodic appointments that filling a chip or recession with composite is just a temporary fix and we need to treat the cause or the root of the problem—the malocclusion.”

Dr. Sahawneh started her Invisalign journey through utilizing the Case Assessment tool in the Invisalign Go system, which gave her a sense of assurance and confidence to assist her in determining if the patient was a candidate for the Invisalign Go treatment. After about a year, though, Dr. Sahawneh felt confident enough to do her own case assessments. “By this point, my practice was the top office in the whole company based on our number of Invisalign Go cases. But I felt limited and that there where situations where I could provide a more ideal outcome for my patients,” she recalls.

Dr. Sahawneh had been relying on standard impressions to start her Invisalign Go cases. She believed that starting the digital journey with a digital scan would further streamline the process for her team and for her patients. “Smile Brands’ leadership team was supportive, so we added an iTero intraoral scanner to my office,” she says.

Combining her advanced knowledge of Invisalign treatment options while utilizing the enhanced visualization tools, such as the Outcome Simulator available on the iTero scanner, gave her more confidence in case selection and efficient treatment planning. “Now we have more knowledge and can see the bigger picture of what to expect at the end of the case,” she explained.

The iTero scanner helped Dr. Sahawneh tap into something even more important than cost savings and efficiency. The Outcome Simulation feature helped her connect with her patients on a real and cases. “No more impressions!” she exclaims. “It has reduced my percentage of crown and bridge re-dos. In addition, don’t forget that at the end of the day, it enhances patient experience.”

powerful emotional level. “Patients know from looking in the mirror that they have crowding or malocclusion,” she noted. “But looking at a 3D image on a screen tells a completely different story. It opens up their eyes. They often say they didn’t know it was that bad. Even just looking at their scans before getting to the simulation step is really helpful for them,” she explains. “One great thing is the iTero allows us to email them the simulation we created so they can look at it again and show it to their family. That is really awesome! It gives patients more confidence in their decision making and usually leads to a better outcome for case acceptance.”

Dr. Sahawneh uses the iTero scanner for 100% of her restorative

The Invisalign Outcome Simulator and the Invisalign Go Case Assessment tool.

In fact, Dr. Sahawneh and her team have been discussing the need for a second iTero scanner. “We’re using it on every single patient—restorative, prosthetic, Invisalign treatment, all new patients, and for progress assessment in recurring patients.”

Dr. Sahawneh finds these digital technologies reinvigorating. She admits that in the past, she had gotten to a point where she felt “capped out” with regard to both dental procedures and production. “However, adding the Invisalign system and the iTero scanner to my practice created so many opportunities and took my office to the next level. It’s been amazing.”

In her opinion, connecting the iTero scanner to Invisalign treatments has added an additional line of business to her practice. “It took my revenue and production through the roof,” she says. “We’re literally hitting our goals every single month and offering Invisalign treatment to our patients is a big part of that success.”