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. Sice then we no longer use capes or OR caps.
Here’s a patient in the chair, summer 2020. She is wearing a hairdresser’s cape, a cloth Operating Room hat, and disposable nitrile gloves.These have since have been superceded by white washable cloth gloves. My assistant sewed the hats from cotton cloth. The capes and gloves were inexpensive from Amazon. My assistant in this photo 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, that makes quite a bundle on the bike!
Before entering the clinic, of course we screen patients with the usual questions, and we ask patients 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 wanted to avoid alcohol-based sanitizer to avoid odors and scents in our small airspace. 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 virus family. It also meets 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 office.
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 has no environmental hazard. This 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!.
So we substituted a washable paper towel . This was 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- is much more effective than any HVE 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. A stainless steel mesh is fitted in the mouth of this funnel to prevent small objects such as temporary crowns being trimmed, from disappearing down its mouth if inadvertently dropped..
You can see the naked tube hanging by a magnet from the light-post when not in use, left photo above. 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. Also to capture mercury vapors released in the removal of amalgam restorations. We consider this large volume aspirator essential for the respiratory health of the team in daily 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, and stain-free margins based on fresh-cut enamel rod-ends see Enamel axioms on this website.
What is new is using it control aerosols.
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.
- We have installed a new autoclave which operates in the new best practices recommendations of dry-to-dry cycles, reducing sterilizer exhaust air concerns.
In summary, Covid became a way to work better, more safely, and in some ways more cheaply. It took hundreds of hours and months to get smooth.
If only society could embrace other problems as fully as this challenge required, we might find our way through a real, permanent, deeply embedded and far more catastrophic crisis:- our presently un-managed climate crisis. It will have become larger and more unstoppable once our single-minded focus on a 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.