Protection Against Coronavirus

Practice establishes measures to ensure patient safety amid pandemic.

When the COVID-19 pandemic forced the temporary shutdown of his practice this year, Richard Leong Jr., DDS, P.A., gathered his staff together for a brief meeting at his Melbourne office.

“I told my staff that I could quit right then and there and go on to live a good retired life,” Dr. Leong reveals. “But I made it clear to them that I did not want to quit, because I really enjoy what I do and that for me, dentistry is a ministry.

“In my practice, I solve complex and difficult problems for people. I offer hope and solutions for patients who come in with 10 sets of dentures in their hands and aren’t satisfied because they have so many issues with their dentures.

“I consider those patients a challenge, and I appreciate taking care of their needs. I also appreciate helping older patients who have outstanding medical and dental problems and have no other place to turn.

“Many of my patients are people who have dental implant problems, need smile revisions or need help with something else because they’ve seen so many other dentists who could not help them and they have nowhere else to go.”

Many of Dr. Leong’s patients are referred to him by the postgraduate students he teaches at the Atlantic Coast Dental Research Clinic, where Dr. Leong has been instructing practicing dentists on implant dentistry for 30 years.

It is because of those patients’ needs that Dr. Leong chose to stay in his profession and keep his practice open even after the coronavirus outbreak. And he did so despite the fact that, like many of his patients, he is in the high-risk category for contracting COVID-19.

“I decided that if I’m going to stay open, I must protect myself and my patients and my staff as best I can from the virus,” Dr. Leong adds. “So, I went about researching all of the means necessary to do that. For several weeks while my practice was shut down, I spent eight hours a day researching the coronavirus and participating in webinars to learn how to set up the safest practice possible to protect me, my staff and my patients.

“As a result of that work, I have instituted a series of dramatic changes to our office and treatment protocols. I believe these changes make our dental office safer than even your own home. I believe that because these changes go far beyond the minimum safety guidelines recommended by the American Dental Association, the U.S. Centers for Disease Control and Prevention, and the Occupational Safety and Health Administration.

“I have taken these extra measures because of my increased potential for exposure to the coronavirus and to further protect my patients and everyone involved in my practice from exposure, and I’ve done so without sacrificing our level of care.

“When I take a patient in, that patient will still receive the best care I have to offer regardless of their ability to pay. They will still receive a full mouth x-ray, CT scan, full visual examination and full mouth photographs. They will still get an hour-long consultation with me that may last longer than that if their case requires. And they will all receive dictation of the consultation summary delineating their problems and their treatment plan options.

“I typically spend a lot of time with my patients because many of them have problems other than medical and dental, and if they need a kind ear, I will listen and even pray with them. That is part of the ministry. I am not a counselor or minister, but all of us in the Christian faith believe we are ministers in our chosen professions. That’s why, for 25 years, I visited Nicaragua as a dental missionary, teaching dental techniques and treating patients.

“I have always carried out that theme of ministry in my work, and it is with that same spirit that I continue practicing today and have taken the precautions to ensure staff and patient safety throughout my practice.”

Dr. Leong lists the following measures being taking by his practice:

Before Treatment

Patients will be notified of the office safeguards in advance of their appointments, which will begin with a meeting in the parking lot, where their temperatures will be taken and they will be asked to sign a consent form. The practice asks that if at all possible, patients come alone. If that is not possible, anyone accompanying the patient will need to go through the same pretreatment as the patient. Also, appointments are being scheduled so that no more than three patients are in the office at one time and no more than one patient is being treated by
Dr. Leong or the hygienist at a time. In addition, waiting room chairs have been spaced at least six feet apart in accordance with CDC social distancing guidelines.

Preventive Measures

Patients will be required to wash their hands upon arrival in the office. For this purpose, hand soap and drying towels will be provided. In addition, the office has long been equipped with automatic on/off water faucets and paper towel dispensers that help prevent cross-contamination of virus and bacteria. Also, for anyone needing to sign forms, a new pen will be provided that the patient can keep.

Cross-Contamination

Because a dentist and patient can infect each other, Dr. Leong and his staff are being tested frequently to ensure they do not have the coronavirus. Ideally, patients should be tested ahead of their appointment so as to avoid contaminating the office, staff and other patients. Because testing for every person is not feasible, first-line defenders such as dental personnel are being tested.

Personal Protective Equipment

PPE, or personal protective equipment, refers to outer garments and face equipment that dentists and staff members must wear to protect themselves from contamination.

Dr. Leong and his staff are using the same PPE used by hospital personnel when treating COVID-19. That includes disposable gowns covering the entire body with long sleeves; gloves that cover the hands and are pulled over the sleeves to prevent leakage of the virus onto the wrist and forearm; masks with ventilators that have higher filtration to stop viruses from traveling to a staff member or patient; eye protection in the form of glasses/goggles or face shields to keep aerosols out of the eyes of the dentist and staff; and surgical head shields that prevent aerosols from getting into the hair.

Specific protocols are being followed to prevent contamination. For example, once an appointment has been completed, staff members are required to follow guidelines for removing PPE. This includes hand-washing before removing each article and donning a new gown, head piece and mask. In addition, each patient will be met by dental staffers with new PPE so the coronavirus is not cross-contaminated from one patient to the other.

Proper Hand-washing

For staff members, the universal method of hand-washing for at least 20 seconds while covering all surfaces, including the wrists and under the fingernails, has long been in practice. Dr. Leong and all assistants are required to wash their hands before, during and after each procedure to prevent cross-contamination and are now required to wash their hands four to five times when donning and doffing PPE.

Preparation of Each Operatory

Research has shown that aerosols from the use of a dental drill can spread as far as 30 feet from where the patient is seated. Therefore, decontamination of each operatory will be done between each appointment using alcohol and Lysol spray. These agents have proven to be the most effective in killing the coronavirus and are being used on counters, surfaces and in the air where the aerosol droplets remain. In addition, all handles on lights, cabinets or doors are covered ahead of or sterilized after each appointment.

Sterilization of Working Instruments

Dr. Leong’s practice has replaced all dental instruments that cannot be autoclaved with instruments that can, so all instruments can be sterilized thoroughly after each use. This includes the three-way syringe used to squirt water and air into the patient’s mouth as well as the high-volume evacuator (HVE), or suction instrument.

“I made the decision to buy new instruments, because I thought about what I would want in my mouth if I were sitting in that chair,” Dr. Leong explains. “I would want the best sterilization possible so that I have the least chance of having coronavirus passed to me by an asymptomatic patient. Therefore, I purchased these new instrumentations because no bacteria or virus will be passed on between patients when using three-way syringes, HVE suction handles and saliva ejectors that can be and are sterilized.”

Air Filtration to Remove Aerosols

Aerosols linger in the air for more than three hours. If they are not mechanically removed, filtration devices must be utilized to maintain proper patient flow. The practice has equipped each operatory with Blueair Pro L air purifiers. This air purifier has been rated the best on the market by Clinicians Report, a publication of the CR Foundation, which conducts independent dental product testing.

Dental Hygiene Visits

To further prevent the spread of aerosols during dental hygiene visits, the hygienist is limiting the use of the ultrasonic high-speed cleanser and prophy jet polisher, both of which spread large amounts of aerosols into the air during use.

High-Volume Evacuation

In an effort to reduce aerosols that may contain the virus, Dr. Leong is using a high-volume suction instrument during all procedures involving a drill as well as cleanings. This instrument, called the Isolite, uses high-speed suction, and covers and protects the throat and tongue at the same time. When used with the standard saliva ejector tube that hangs out of the corner of the patient’s mouth, the amount of aerosol is reduced by 95 percent.

HVE is the first line of defense for removing aerosols in the patient’s mouth. Other aerosols are removed by the air-purification units. Very few dental offices have both HVEs in the mouth at the same time and few, if any, have air-purification units working in conjunction with HVEs to essentially remove up to 100 percent of aerosols in the air.

Rubber Dam Treatment

A rubber dam is a thin rubber mask that covers the throat and tongue and does not allow saliva and contents from the mouth to be exposed while drilling is going on. It is clamped onto the teeth adjacent to where the work is being done, which helps prevent aerosols from entering the dental environment. This type of mask is used most extensively when doing root canal treatments or fillings. It was an often-used protocol method even before coronavirus was a problem but is now being used more frequently.

Avoid Touching Objects

Inadvertent actions such as straightening glasses, and touching computer keyboards or drawer handles can break the chain of prevention that has been set up to prevent cross-contamination. At Dr. Leong’s practice, several steps have been taken throughout the office to ensure that chain is not broken, including covering all keyboards and handles with plastic wrap between each patient visit.

Housekeeping After Hours

Each night, our maintenance staff spends approximately four hours cleaning and sanitizing the floors and walls of each operatory. Like the members of our dental staff, our maintenance team members have been trained extensively regarding the use of PPE as well as hand-washing and cross-contamination techniques.

Overnight Ozone Sterilization

Ozone is a highly effective sterilization oxidant that can kill a wide range of pathogens and microorganisms. Ozone is a more powerful disinfectant than chlorine or chlorine dioxide. Dr. Leong’s office has ozone generators that flood the airspace so that there is virtually no virus or bacteria left in the office after the nightly administration. The amount of ozone in the air is minimal but effective enough to sterilize the entire office. The ozone is only in the office at night for eight hours and dissipates in 15 minutes, so when the staff and patients arrive, the ozone has done its job and no ozone, virus or bacteria is left in the air.

Restroom Use

The practice respectfully requests that anyone utilizing a restroom while on the premises notify the staff so it can be sterilized following each use.

Internal Building Architecture

Operatories with open doors allow for the escape and free flow of aerosols that can result in cross-contamination of the virus. Though the open-door concept does have many advantages, all operatory doors at Dr. Leong’s practice will be closed during procedures for privacy and to prevent any possible escape of the virus.

Internal Staff Communication

To further reduce the potential for cross-contamination, the staff is using hands-free voice-actuated communication devices that eliminate the need to touch intercoms or telephones.

Print This Article