Practice Closures, Redundancies, Layoffs, Threats, Bullying, Salary Cuts

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We live exceptional times. We all live exceptional times, not just us dental professionals. But it might feel like we are alone in this, when the measures we must take are drastic and have huge impact on us.

At times like these, I would hope to see solidarity, compassion and charity amongst people more than ever before. The rich giving help to the poor. The healthy giving help to the sick. This is already happening to some extent.

I am happy to notice that the healthy are helping the sick – offering to do food shopping for them etc. But when it comes to finances, it seems to be so, that only the poor is giving help to the poor, giving out form the little they have even though they are also struggling. Is this how it should be?

Now would be the time for the rich to spend money, keep the small businesses running, help out the single parent families. A small deed might mean a world to someone.

How about in dentistry?

I recently asked dental professional tell me how the coronavirus have affected their practice. I also did some research on internet forums and facebook groups. It’s quite fragmented when it comes to the policies and procedures the dental practices have taken.

Most likely the trade unions are to blame. They have not provided adequate and prompt advice to their members. Matters around coronavirus have developed faster than the responses from professional bodies in different countries (BDA, ADA etc.)

This has forced the dentists to take the matters in their own hands. Some dentists have decided to close their practices for couple of weeks. Some have concentrated on seeing patients that need urgent treatment. Some have not done any changes.

Behind these decisions are many difficult questions. How about the supportive staff? Can they be allowed to work? What should be done, so that they are protected from the virus? Surgical or N95 masks? Full face visor or safety glasses? Are they taking their holiday leave if the practice closes. Or are they laid off with less money or no money at all?

And even more serious questions. How long will this epidemic last? Will my practice survive this? The bills keep on coming despite the circumstances.

These questions do not necessary have a right answer. Maybe that is why there has been both overreactions and underreactions.

Ugly side of our profession

I have written about dental practice’s hierarchy in my previous posts (part I, PartII, Part III) and how between different professions in dentistry there is not always equality. This whole business with coronavirus has raised again that questionable side of our profession where the dentists are deciding for the nurses in the matters of health.

There’s been downright threatening about nurses loosing their jobs if they didn’t comply with the dentists’ decisions to keep the practice open. There’s been bullying in a form of shouting (there should be no shouting at any workplace). Some dentist let the nurse take a time off but without any salary. The dentists themselves carry on working.

What I am afraid of is that our profession is not using this downfall to strengthen the teams they work in, but to increase the division between different dental professions. Now would be the time for solidarity, compassion and understanding. From everyone. But it cannot be one-sided.

Single-Use Masks

Some practices have found creative ways to guarantee that they won’t run out of face masks. Some have told they autoclave used masks that do not look soiled. Some have told they use the same mask all day long. Some think that surgical mask will protect you. Or wearing a surgical mask on top of the other will provide extra protection.

Thankfully all the above are just isolated cases and majority of the practices follow the standard of care we are supposed to. But just to remind everyone – single-use means single-use. The mask should be changed after each patient and disposed carefully. Used mask should not be autoclaved under any circumstances.

Some facts. Even though the surgical mask filters the airborne viruses, there is leakage from the sides of the mask when person wearing the mask inhales. So airborne viruses will enter through the sides. Therefore N95 masks are the only ones that provide close to 100% protection from the airborne viruses and all the dental staff should wear N95 masks when they perform treatments that produce aerosols (remember that even air-water syringe does that). Even if you are treating only seemingly healthy patients, you will never know if the patient has contracted the virus and not showing the symptoms yet. He is nevertheless spreading the virus already. That is why dental staff should wear at least N95 masks, full face visors, protective disposable coat and a hat for all procedures that produce aerosols.

Have look at this link, where the difference between the surgical mask and N95 mask is explained in detail.

We are in this together

It’s thankfully not all that gloomy. There are stories about practices pulling together. Doing the right thing. Everyone in consensus. That’s how it should be. If it isn’t, somebody is not listening. Somebody is using one’s power in nonconstructive way.

Money is important to everyone. To the dentists, the hygienist and the nurses. Money is probably the reason why different views collide. We all are worried about financial effect of the situation. Everyone should be prepared to downsize in life style to get over this difficult period. Owners of the practices will need to make difficult decisions over salaries. Hopefully these decision are made with solidarity and respect. I know stories of restaurants where they have started to provide take away food with delivery and all the revenue they make, goes towards the employee’s emergency fund.

If the owner or a dental practice has been wise and farsighted, he has put some money on side for emergencies. Hopefully this money covers the bills and if there’s any leftover, it is used to help the employees. By doing that, practice owners make sure their employees stay loyal to the practice and highly motivated towards the work after this difficult period has passed. Motivated and loyal staff is a great asset to the practice and the patients will notice the good vibe and spread the word. So by taking care of the employees financially, you are actually putting money into marketing. That if anything is a win-win situation.

Coronavirus in Dentistry and How to Protect Yourself

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Like doctors and nurses in hospital, the dental professionals are more at risk of contracting viruses. Dental offices can also be a place where the viruses, such as corona can spread if the cross infection control is not up to the standards.

I have gathered the most important things here for dental professionals to check to make sure you are protecting yourself, the staff and the patients. I have not gone into things like instrument disinfection because that should be organised regardless the coronavirus. If in doubt, read this

Use Soap

Something we should remember when using hand sanitiser is that it does not kill all the viruses like norovirus (the one causing the winter womiting disease). Therefore it is advisable (also advised by the World Health Organization, WHO) for all of us to wash hands 20 seconds with soap even though it is pain in the backside to wait for the hands to dry so that you can pull on the examination gloves. Remember to use disposable hand towels to dry your hands and close the tap either with your elbow or with the hand towel to prevent re-contamination of your hands from the tap.

Cover Up

In the normal situation where we treat healthy patients, a lower fluid resistance and filtration efficiency are acceptable (personally I use either ASTM Level 2 or Level 3 masks). But when we are at greater risk of treating a patient who might carry airborne diseases like coronavirus, TB and influenza, we should use masks that have the maximum filtration. These face masks you recognise from the markings FFP2. 

It is even better if the face mask has a visor attached to the mask. But even if it has the visor, use also safety glasses/your normal glasses under the visor. If the face mask doesn’t have a visor, use safety glasses or separate visor – also on top of your normal glasses. 

Now, I would use also disposable hats like they do when performing oral surgery because people (me too) have these mannerisms of touching our head, scratching our head etc. for example on a lunch break. And do we always notice we do that? If we don’t, then how do we know to wash our hands straight after before we take another bite from the sandwich.  

Check Your Surface Disinfection Liquid

Today is the day to look deeper into the small print of your practice’s disinfection liquid. I did some research some time ago because I wanted to find out if the liquid we were using was killing everything it was meant to. I found out that not all of them kill for example norovirus. And if they don’t kill norovirus, I doubt that they kill coronavirus. 

I cannot tell you which one to use, but the bottle should have all the information needed. If not, contact the supplier or the manufacturer. One thing I noticed when I did my research that the disinfection wipes and liquids for sensitive surfaces are the ones that do not kill viruses.

Wipe Wider

It is good idea to wipe the door and chair handles (the unit’s of course but also the regular chairs) with disinfection wipes. Also it is good idea to go through the other handles of the practice many times a day – even the ones outdoor. 

Provide Hand Sanitiser for Patients

Place a bottle of hand sanitiser in the waiting room. I saw my physiotherapist yesterday and first thing I did was to wash my hands.  Common people do not realise to do this so could you perhaps ask your patients to wash their hands (for 20 seconds) when they arrive to the surgery?

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