A visit to your dentist is both an essential service and an essential piece of the puzzle in terms of your overall health. As most dental procedures are Aerosol Generating Medical Procedues (AGMPs), it is our opinion, as well as the opinion of the Public Health Authorities, that during the COVID-19 pandemic, unless proper precautions and adjustments to how dentists approach the way they practice have been made, a visit may not be safe or recommended.
In March 2020, immediately after review of most recent guidance, Care Dental suspended physical operations, and moved to providing care via tele-dentistry and referral. During this time, we reviewed guidance, and research, and deployed dentists, surgeons, medical doctors and engineers to assist us in formulating a plan that would allow us to address virus transmission concerns safely and responsibly resume in-practice operations. We are pleased to announce that these changes have been made, and we are re-open to provide Emergency & Urgent Care effective May 7, 2020.
The BCDA is maintaining a listing of dentists that are open for emergency and urgent care, and yes, beginning May 7, we will be listed as a provider here as well. It is important to note that no formal emergency network exists. The listing on the BCDA website is simply a list of dentists and dental surgeons that have chosen to open for emergency and urgent care. It does not demarcate that dentists listed there have met any sort of formal standard or have undergone any additional oversight, scrutiny or inspection.
In re-opening, we are 3 weeks “behind” them, but this because we have taken the time to have our building re-engineered to provide CSA-Z8000-18 HVAC compliant Negative Pressure Aireborne Infection Isolation Room (AIIR) standard in ALL aread of the practice. i.e. Not just in our clinical spaces, our entire practice has been renovated to this standard. If a dentist has not taken this step, more specifically, the step of having a mechanical engineer design, certify, test, balance and oversee the installation of a negative pressure system, they are not meeting the standard outlined by the Canadian Standards Agency.
Care Dental has taken steps to provide easy and direct access to emergency and urgent care to the community. We are open 7-days per week, and our dentists and clinicians are putting in all this extra time so that no one needs to suffer unduly, and also, so that we can take pressure off the hospital system.
Although we accept referrals from other health care providers, a referral to Care Dental is not required.
Saving our patient’s time and money is important to us. Even during this pandemic situation, and the significant investments that we have made in order to provide access to care, we do not levy a referral or any specialists fees for care, and have not increased our pricing. At all times, Care Dental follows the most recent BCDA fee guide.
The College of Dental Surgeons of BC’s (CDSBC) primary role is to protect the public, and as can be expected, they are intently focused on this pandemic as it applies to dentistry.
The pandemic situation, however, is without precedent and the nature of it, as well as what happens next, is new to everyone, the College included.
The CDSBC is following the advice of BC Public Health officials and has instructed dentists in the province to suspend all non-essential care, and to manage these concerns remotely via tele-dentistry wherever possible. They are permitting only energency and urgent care to be completed in BC dental practices. This is similar to the steps taken by most regulatory bodies in North America.
As dentists are highly trained and skilled professionals, the dentist themself is responsible to ensure that emergency and urgent care is delivered in the most responsible and safe manner possible. Care Dental is no different, and the steps that we have taken are to meet or exceed this threshold at all times.
This point has been a primary concern at Care Dental from the very moment the pandemic began, and we have considered it in all of our planning and preparedness throughout. Being nervous is a manifestation of the fear emotion, and this emotion is built into how humans are wired, as a way to keep us free from injury, harm or loss. Some fears are rational, and some are not. In many cases, fear is a by-product of lack of knowledge, training or procedures. The “unknown” often triggers a fear response.
In the case of COVID-19, there are many unknowns, however what is well understood is how pathogens, not just COVID-19, are transmitted. By focusing on and addressing the ADC‘s (Aerosol, Droplet and Contact) of transmission, we can reduce the risks presented by COVID-19 to within an acceptable risk profile.
Just as medical doctors, nurses, first responders, and workers in the supply chain that are keeping the country healthy and moving, we are proud to be doing our part during this time of great suffering, tragedy and change.
Negative pressure is created when more air is exhausted out of, than is drawn into an enclosed space. This creates active air movement, which contains and removes aerosolized particles. Kind of like how we create a breeze when we crack a few windows in the house to “air it out”. The term “negative pressure” is a misnomer however, as engineers utilise both positive and negative pressure within each area to create containment zones or “bubbles”. Negative Pressure Airborne Infection Isolation Rooms (AIIR) are used by advanced hospitals to contain and remove airborne pathogens within a specific area. In Canada, the agency that provides guidance to the engineers and architects that design these rooms, and the hospitals themselves is the CSA, specifically under specification CSA-Z8000-18.
In April 2020, Care Dental made significant investment and renovated facilities, retaining the same engineers that are involved with hospital construction, and re-engineered our HVAC to meet CSA Z-8000-18 and other HVAC specification Negative Pressure Airborne Isolation Rooms ( AIIR). We used this technology to create isolation zones in each of our operatories. We didn’t stop there though, and extended the system to provide protection to all other areas, protecting all of our teams and patients, regardless of where they are within the practice. For example, each of our operatories has a containment “bubble” engineered around it. Air is forced down from the roof, using positive pressure, forming the outer walls of the containment “bubble”. This contains the airborne pathogens created in the operatory from floating away, as well as keeping airborne pathogens created outside of the bubble from floating into the operatory. Then, positioned over each patient, approximately 7 feet from the floor, is a 12ACH negative pressure intake, which draws air in, removing quickly any airborne pathogens, protecting team and patient alike. This air is then HEPA-filtered and safely exhausted on the roof. It runs 24/7.
Clean Air, we Care!
Many facilities purport to provide negative pressure to their patients or customers, and this will only increase as awareness of the issue becomes more prevalent in community discussion, however if the system that they have installed has not been engineered, installed, balanced, and tested to CSA guidelines, it may not be providing you with the actual protections that proper systems, like ours, are designed to provide.
Here’s a great article from the Toronto Star that explains how Negative Pressure can help battle COVID-19 Pandemic.
Infection Control basics demand that Health Care Workers consider the “ADC” of pathogen transmission; Aerosol, Droplet and Contact, in all areas of facility design and operating procedures. Current guidance indicates that the primary mode of transmission of COVID-19 is droplet and contact transmission. As however many dental procedures can be classified as aerosol generating medical procedures (AGMP), aerosol risk must be considered in a dental practice setting as well.
Aerosol – very small particles of water, suspended or floating in the air, carrying pathogens with them. This is often described as “airborne” transmission. Aerosolized pathogens can stay in the air for 30-minutes or more, and move around from place to place. You can become infected when you breathe them in as you walk through the “cloud”.
Droplet – a cough or a sneeze, or someone talking “moistly” (sorry Mr. Prime Minister, couldn’t resist). Droplets are ejected from one person’s respiratory system, into another person’s respiratory system.
Contact – When droplets or aerosolised particles land on a surface, a table, or door handle, and are touched by someone else and picked up. Transmission occurs when this person touches their face, or eyes.
No. Aerosols have been present in dental practices, and considered by dentists for many years. Dentists are highly skilled infection control experts, and are trained to take steps to protect themselves, their patients and the public from this risk. In Canada, dentists have very robust infection control and sterilization protocols running all of the time, not just during COVID-19 Pandemic, and the College of Dental Surgeons of BC (CDSBC), provides training, guidance and oversight, holding dentists accountable to these standards of practice.
COVID-19 provides however for additional aerosol risk beyond the everyday, due to both the community transmission factors (we assume that everyone we treat is “COVID-Positive”) and the significant mortality rates that the disease delivers, particularly to vulnerable populations. Hand tools, suction, irrigation, and most dental procedures are classified as Aerosol Generating Medical Procedures (AGMP).
In response to the additional aerosol risk brought by COVID-19, Care Dental suspended physical operations, and retained engineers and consultants to retrofit, renovate and re-engineer our facility to meet CSA-Z8000-18 HVAC Negative Pressure Airborne Infection Insolation Room (AIIR) Standards to contain and control aerosolised pathogens. This, plus rewrites and major changes to our patient handling and infection control protocols allows us to re-open effective May 7, 2020 to most safely provide emergency and urgent care during this and any future pandemic. A visit to Care Dental during the pandemic wont feel as “spa-like” as a visit to Care Dental when not a pandemic situation, however our ability to pivot to a more “hospital-like” operating setting and protocol, and commitment of team to provide this emergency and urgent care ,we feel remains in-line with our Vision, Mission, and Core Values.