We have received a great deal of interest on how we avoided a landslide of plastics while coping with the pandemic. From within the profession, we heard from dentists burdened by the cost of purchasing barriers and then disposing of them. Some also felt pain from losing ground on the critical single-use plastic file that was just gaining traction when the virus arrived. Some dentists did not want to impose the Covid-19 protective surcharge on their patients, adding to the already high cost of dental treatment.
Other interest came from patients and environmental groups, all appreciative that we were doing something different. So here’s a little photo rundown on how we proceeded. These photos are dated from summer 2020, and need updating.
In response to recent inquiries i am putting this post up, but unfortunately we have been closed for holidays over the winter 2020-2021 and have no photos to show upgrades that developed since them, Stay tuned for the third week in March when we will re-open, shoot and post new photos of our latest routines.
Here’s a patient in the chair. She is wearing a hairdresser’s cape, a cloth Opertaing Room hat, and disposable nitrile gloves. which since have been superseded by white washable cloth gloves. My assistant sewed the hats from cotton cloth. The capes and gloves were inexpensive from Amazon. She is wearing a more stylish version of the OR hat, as do I when operating. She also has a face shield and mask, the shield also being an Amazon item, which came with 10 screens for around $35. I also wear one.
The patient garb is discarded into a bin in our waiting room, (in which no-one waits any more). They are all laundered and dried at the end of each day, sometimes on an outdoor clothesline in our rural clean-air environment. When I cycle-commute home from Denman Island, it makes quite a bundle on the bike!
Before entering the clinic, of course we screen patients with the usual questions, and we ask the patient to remain masked until seated. The patients sanitize their hands, like most premises, before donning the cloth gloves. We provide wipes saturated with sanitizer initially outside at the doorway, now inside the entry to the bus.
We avoided alcohol-based sanitizer. Instead we used Optim 33-TB, a commercial product based on “accelerated peroxide” for dental/medical/veterinary use. It was developed for the last coronavirus, SARS, and is demonstrated very effective against this family but also again TB and polio challenge tests, eliminating 10 to the sixth power in one minute. It also is easy on the hands and lungs, an important consideration for our small volume airspace.
After sanitizing ,patients dry their hands on a standard white cotton facecloth; dry hands are more comfortable. You see a pile of OR hats behind them.
We had used this product for years in our clinic, its only drawback being occasional surface corrosion on some aluminum surfaces. Being free of phenols, and having no skull and crossbones on it, it is free of environmental hazard, which cannot be said of many intermediate-level surface disinfectants in common use in dentistry. Safety was confirmed by NAVID OMIDBAKHSH ET AL, Am J Infect Cont June 2006,VOL 34,ISSUE 5,PG 251-2547,See http://HTTP://WWW.AJICJOURNAL.ORG/ARTICLE/S0196-6553%2805%2900575-4/ABSTRACT
Here’s where we made a surprise finding! Optim 33 TB is routinely sold in tubs loaded with a roll of wipes, which, did you see this coming, is a woven plastic fabric!.
Not good.
So we substituted a washable paper towel we purchased from Lee Valley Tools. Its claim was 300 washes and a final destiny as a compostable product. We are at about 100 washes so far and most are still good. They initially were too large and used too much solution,so we cut them in half, making them even more affordable.
After we began using these to disinfect our counters and surfaces, we installed a drop-chute in our countertop, under which resides a mesh laundry bag. At day-end, this is zipped closed and run through our laundry cycle. This keeps the wipes separate from the rest of the load, reducing sorting time for the various items.
in light of the science behind the pandemic, we began using Optim 33TB in a spray bottle, as well as in wipes, getting better surface contact on irregular surfaces. Our reasoning: we are battling an aerosol/droplet-borne pathogen, and thus an aerosol spray faces off in the same frontier in which we know the virus is spread.
Finally, we now employ a very-high volume air evacuator which is connected to our central vac system, (which exhausts outside the bus) , ensuring rapid air changeover when generating aerosols. When flushing with an air/water syringe, or preparing teeth with an air-driven handpiece,research has shown very high capture- over 90%, with two 1/2″ diameter dental high-vacuums. We use one, and this oversize evacuator in tandem.
It stands to reason that a 2 inch diameter tube moving 125 cubic feet of air a minute- over two cubic feet a second-a minute is even more effective than a second half-inch tube.. When using water-spray to keep teeth cool and happy, we can even see the droplet stream turn 90 and go down the mouth of this king-size evacuator.
A funnel keeps the tube from aspirating the patient’s cape, or the bib, or any small objects that might get close to it, or their face!
The tube was stocked from a hardware store, the canning funnel from a retail canning supply outlet. . In the mouth of this funnel is a stainless steel mesh which originally was part of a gasoline funnel, to separate out water droplets and debris in fuel. It keeps small objects from disappearing down its mouth.
You can see the naked tube hanging by a magnet from the light-post when not in use. In the right photo, the funnel is in place and attached to a second magnet located behind it chairside There we use it to capture acrylic dust during temporary crown trimming or denture adjustments. We consider it an essential for our respiratory health in the practice of dentistry.
This has been our routine for years to control abrasive powder when sandblasting teeth or prostheses prior to bonding,and it is a cornerstone of our adhesive-oriented practice, ensuring longevity, maximum adhesion, stain-free margins based on fresh-cut enamel rod-ends see Enamel axioms on this website.
What is new is using it control aerosols.
OTHER CHANGES:
Some final and more generally followed Covid changes: an acrylic screen was placed between patient and receptionist at the front desk. We changed our booking sequence so that no two patients would be in the waiting room at the same time. We evolved to longer appointments to reduce patient turnover/interaction; we reviewed all our surfaces to minimize opportunities for cross-contamination, reorganizing all operating areas. Once onto the plastics-free front, we were able to change a number of autoclave-loading systems to eliminate single-use wrap and instead used re-usable stainless steel cassettes.
In summary, Covid became a way to work better, more safely, and more cheaply. It took about a hundred hours and several months to get smooth.
If only we could embrace other social problems as fully as this challenge required , we might find our way through the real, permanent, deeply embedded and far more catastrophic crisis:- our presently un-managed climate change. It will be larger and more unstoppable once this temporary issue of a single virus passes. We are losing precious years during this distressing Covid period – time we urgently need to get on top of a burning and progressively less livable planet.
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