The Department of Labor recently used data from the Occupational Information Network to rank the occupations most at risk for becoming infected with COVID-19. Occupations within dentistry were ranked highest with dental hygienists topping the list closely followed by dental assistants, general dentists and oral surgeons. This news comes at a time when many dental practices in America have re-opened or are working towards re-opening in the safest way possible. So, why are those working in dentistry most at risk for COVID-19, and what can dentists do to protect themselves and their team?
According to Dr. Margaret Scarlett in The Role of Active Air Disinfection in Mitigating the Effects of Aerosol Generating Dental Procedures Aerosol Generating Dental Procedures, or AGDPs, present the most danger to dentists’ health. She writes that AGDPs “like bronchoscopy and intubation, ultrasonic scalers, high speed handpieces, or air-water syringes, increase risks for transmission [of infection] to healthcare practitioners.” AGDPs produce particles and droplets that have the potential to transmit infections and diseases, including COVID-19. She explains that the “SARS-CoV-2 virus is transmitted via droplets through the nose, mouth, and eyes. Droplets emitted when speaking, singing, coughing, breathing, and sneezing are known to travel distances anywhere from 6 to 27 feet. Although the precise dose that causes infection is still unknown, aerosols pose a significant risk.”
These risks are intensified by the lack of accessible and affordable personal protective equipment, or PPE, in the United States. Dr. Scarlett writes “The shortage of N95 masks is exacerbated by the fact that over 75% of KN95 masks were recently recalled by the FDA. Access to proper PPE for all healthcare personnel during AGPs remains a challenge. Inventory for PPE remains low in dentistry.” A majority of the nearly 100,000 healthcare workers who are estimated to have caught COVID-19 are thought to have been “infected by patients due to inadequate use or contamination of PPE.”
These risks can be mitigated by the implementation of Respiratory Protection Programs. These programs include “training on proper use of PPE, standard fit tests and references to user fit checks for face filtering respirators (FFRs) for each use. A face shield and surgical mask or N95 and goggles is recommended; N95 or better FFRs will filter particles down to 1 micron.” Because the dose required to transmit COVID-19 is still unknown since SARS-CoV-2 is so small many dental practices are choosing an even higher level of protection, “namely N99 or N100, or even powered air purifying respirators.”
It’s clear that AGDPs present the biggest threat to the health of those working in dentistry and are the reason occupations in dentistry are most at risk for catching COVID-19. In order for dental practices to effectively protect their staff from becoming infected they must implement “infection prevention programs and protocols, particularly wherever AGPs are being produced.” To learn more about the risks posed by AGDPs and how to alleviate them read Dr. Margaret Scarlett’s full paper here.