Gearing Up When the Economy Restarts

[setdoc7]

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After 5 weeks of sheltering in place, I am ready to go back to my private practice in NYC. I have been steadily accumulating PPE, and feel I have enough to begin once 5/15 rolls around. My question to practicing dentists, is how have you dealt with adequate eye protection? I know that the ED and ICU staff have been wearing goggles and face shields. The face shield is not an issue, but have any of you come to a reasonable conclusion on how to wear loops and goggles with the headlight? I have disbanded my attached loupe headlight and opted for the old surgical light that sits on top of your head in order to wear the googles, but it is no where near as comfortable. Any thoughts would be appreciated. Since we are in one of the most difficult professions when it comes to COVID 19, I feel that eye protection in the face of such close contact, patients consistently breathing in our face, and the plume we cause with the high speed necessitates proper eye covering. The face shield is not enough as it does not form a sealed barrier.
On another note, has anyone thought about medical grade ventilation in the operatories to diffuse the cloud of droplets we cause when working. I recently purchased a medical grade air sanitizer with HEPA and UV. 300CFM. Negative pressure was out of the question as I am on the ground floor and it would vent to the sidewalk outside my building.

 

[P7898]

After 5 weeks of sheltering in place, I am ready to go back to my private practice in NYC. I have been steadily accumulating PPE, and feel I have enough to begin once 5/15 rolls around. My question to practicing dentists, is how have you dealt with adequate eye protection? I know that the ED and ICU staff have been wearing goggles and face shields. The face shield is not an issue, but have any of you come to a reasonable conclusion on how to wear loops and goggles with the headlight? I have disbanded my attached loupe headlight and opted for the old surgical light that sits on top of your head in order to wear the googles, but it is no where near as comfortable. Any thoughts would be appreciated. Since we are in one of the most difficult professions when it comes to COVID 19, I feel that eye protection in the face of such close contact, patients consistently breathing in our face, and the plume we cause with the high speed necessitates proper eye covering. The face shield is not enough as it does not form a sealed barrier.
On another note, has anyone thought about medical grade ventilation in the operatories to diffuse the cloud of droplets we cause when working. I recently purchased a medical grade air sanitizer with HEPA and UV. 300CFM. Negative pressure was out of the question as I am on the ground floor and it would vent to the sidewalk outside my building.

0.05% mortality rate in NYC projected. You probably only need the ADA recommendations.....

 

[TanMan]

After 5 weeks of sheltering in place, I am ready to go back to my private practice in NYC. I have been steadily accumulating PPE, and feel I have enough to begin once 5/15 rolls around. My question to practicing dentists, is how have you dealt with adequate eye protection? I know that the ED and ICU staff have been wearing goggles and face shields. The face shield is not an issue, but have any of you come to a reasonable conclusion on how to wear loops and goggles with the headlight? I have disbanded my attached loupe headlight and opted for the old surgical light that sits on top of your head in order to wear the googles, but it is no where near as comfortable. Any thoughts would be appreciated. Since we are in one of the most difficult professions when it comes to COVID 19, I feel that eye protection in the face of such close contact, patients consistently breathing in our face, and the plume we cause with the high speed necessitates proper eye covering. The face shield is not enough as it does not form a sealed barrier.
On another note, has anyone thought about medical grade ventilation in the operatories to diffuse the cloud of droplets we cause when working. I recently purchased a medical grade air sanitizer with HEPA and UV. 300CFM. Negative pressure was out of the question as I am on the ground floor and it would vent to the sidewalk outside my building.

Go use a respirator hood with a coverall or a respirator hood with a built in p100 respirator.

 

[setdoc7]

Go use a respirator hood with a coverall or a respirator hood with a built in p100 respirator.

Ok. Not available here in NYC

 

[setdoc7]

0.05% mortality rate in NYC projected. You probably only need the ADA recommendations.....

Probably will not cut it.

 

[charlestweed]

Being bored at home, my wife learned how to make the faceshields herself. She also learned how to make fabric masks that fit over the N95 masks so we can re-use the N95 masks.

She also learned how to cut hair at home. Sorry, I can't show the pic of what she did to my hair😱.

 

[allDAT]

After 5 weeks of sheltering in place, I am ready to go back to my private practice in NYC. I have been steadily accumulating PPE, and feel I have enough to begin once 5/15 rolls around. My question to practicing dentists, is how have you dealt with adequate eye protection? I know that the ED and ICU staff have been wearing goggles and face shields. The face shield is not an issue, but have any of you come to a reasonable conclusion on how to wear loops and goggles with the headlight? I have disbanded my attached loupe headlight and opted for the old surgical light that sits on top of your head in order to wear the googles, but it is no where near as comfortable. Any thoughts would be appreciated. Since we are in one of the most difficult professions when it comes to COVID 19, I feel that eye protection in the face of such close contact, patients consistently breathing in our face, and the plume we cause with the high speed necessitates proper eye covering. The face shield is not enough as it does not form a sealed barrier.
On another note, has anyone thought about medical grade ventilation in the operatories to diffuse the cloud of droplets we cause when working. I recently purchased a medical grade air sanitizer with HEPA and UV. 300CFM. Negative pressure was out of the question as I am on the ground floor and it would vent to the sidewalk outside my building.

I would just wait for official guidance before making any significant investment in your time or money.
If you must wear goggles and a face shield, then drop the loupes. Nobody will care if your crown preps are wiggly right now - this is more about just getting by than perfection.

I'm wearing loupes and a face shield during endo right now, and I am wearing goggles and a face shield while performing extractions. Aerosols are everywhere where we work, you can't escape it. If we do end up having to go with negative pressure ops, seeing one patient at a time, and practicing airborne precautions, we may be better off just getting rolled up into the hospital system so save as much cash as you can right now.

Surgical air scrubbers may be a thing worth looking into because your patients can see them. It's more of a marketing expense rather than a true means of infection control, but if I were in NYC right now, I'd probably buy some to ease staff and patient tensions regardless of their validity.

 

[setdoc7]

I would just wait for official guidance before making any significant investment in your time or money.
If you must wear goggles and a face shield, then drop the loupes. Nobody will care if your crown preps are wiggly right now - this is more about just getting by than perfection.

I'm wearing loupes and a face shield during endo right now, and I am wearing goggles and a face shield while performing extractions. Aerosols are everywhere where we work, you can't escape it. If we do end up having to go with negative pressure ops, seeing one patient at a time, and practicing airborne precautions, we may be better off just getting rolled up into the hospital system so save as much cash as you can right now.

Surgical air scrubbers may be a thing worth looking into because your patients can see them. It's more of a marketing expense rather than a true means of infection control, but if I were in NYC right now, I'd probably buy some to ease staff and patient tensions regardless of their validity.

Sorry. Loupes are not negotiable. I have secured a good set of goggles which go over my loops. My UV-C air purifiers came today, so I am open as of Thursday once I run through with my staff tomorrow and Wednesday. Any questions about PPE, I would look at the Academy of Infectious Disease white paper statement regarding the use of PPE and minimum standards. Since this is their world, I trust them.

 

[Life of Pablo]

Sorry. Loupes are not negotiable. I have secured a good set of goggles which go over my loops. My UV-C air purifiers came today, so I am open as of Thursday once I run through with my staff tomorrow and Wednesday. Any questions about PPE, I would look at the Academy of Infectious Disease white paper statement regarding the use of PPE and minimum standards. Since this is their world, I trust them.

Is your hygienist returning? Word on the street is that's a big issue.

 

[allDAT]

Is your hygienist returning? Word on the street is that's a big issue.

CA has not given us the green light yet. We're still waiting for guidance. I'm only seeing ERs right now. I don't expect hygiene to be using ultrasonic instrumentation when they get back. Hygiene will probably just hand scaling through the summer.

With the new PPE, hygiene may end up losing money if costs cannot be passed on to the patient so if managing hygienists become a problem they may not be employable at their current compensation. We'll worry about that when we get there.

 

[allDAT]

Sorry. Loupes are not negotiable. I have secured a good set of goggles which go over my loops. My UV-C air purifiers came today, so I am open as of Thursday once I run through with my staff tomorrow and Wednesday. Any questions about PPE, I would look at the Academy of Infectious Disease white paper statement regarding the use of PPE and minimum standards. Since this is their world, I trust them.

Loupes are not required to perform dentistry. Endo is the only procedure where magnification may be argued is part of the standard of care - the rest do not require it. So if it comes down to it, you don't have to wear them, that's all I'm saying (I wear 4.5x so I get the importance of good lighting and magnification, but it's not the standard of care).

Academy of Infectious Disease is not a regulatory body. Neither is the ADA or your state dental association, or the CDC for that matter. IC mandates will come from OSHA and the dental boards because OSHA can fine us, and the dental boards can revoke our licenses. Employ lawsuits will likely be based on OSHA's recommendations. [EDIT - we may also get requirements from our county or state's department of public health].

 

[setdoc7]

IMHO the standard of care in endo is microscopy, but I am sure I will receive flack about that too. Whether or not loupes can be determined as the standard of care, if one has been using them for over a decade and all of a sudden cannot, it is a problem, as is the lack of discussion on any site about proper and appropriate eye protection in the face of the aerosol we produce. No amount of suction is going to cure that, and there is no scientific data to back up any extraoral suction will provide adequate protection for you or your staff.
No professional organization is regulatory. I agree. So far the US DOL nor OSHA have published any hard and fast regulatory guidelines. In the face of uncertainty, I am inclined to believe the opinions of scientists and doctors whose entire world revolves around infectious disease, as they are in the face of this pandemic, the experts. The Chinese data backs them up. Clinicians who wear the N95 mask have a far lesser risk of COVID 19 infection than those who do not.
Covered up is the way to go.
Surgical Hood
N95 with level 3 mask over it
Goggles
Face shield
Isolation gown
double gloves over sleeves of gown
Shoe booties
Office are purification (HEPA + UV-C)
Anti Viral wipe down of Op between patients, and all high touch area (Virex, Monarch, etc.)

Very expensive. I know. So what?

 

[OMSDoc]

It’s all about overhead.

Always do what you think is best for the patient.

But what if all of this best care costs 85 or 95 percent of what you charge the patient? Are you willing to take home 5 percent of what you charge?

Moreover, in case you didn’t know, you will never be paid by Medicaid what it costs you to take care of the patient.

NEVER.

Will you see those patients and fund HALF of their care and NEVER get paid yourself?

Such largesse is only sustainable if you can charge (and collect from) the non-Medicaid patients. This is the only way you can pay your home mortgage.

What if every medical entity in the USA goes to single payer? What procedure will you recommend for an infected first molar when the bureaucrats pay you $40 for an extraction and $55-60 for a molar root canal?

 

[endodonia]

I agree with setdoc 7 for Ppe. The face shield w/o goggles has always been a conundrum for me (aren’t their gaping holes to the bottom and to the left and right?). Goggles seem prudent under a face shield if you are truly concerned with your safety regarding aerosols. Sure people talk about direct splatter/viral load. It’s all just a crapshoot. However, I’ve always been an advocate for doing what you want so long as you don’t hurt the patient.

Standard of care is a legal term. Arguing the topic will take you down a rabbit hole which leads to a swamp where lawyers live and eat. Treating patients for me has always come down to, as OMS puts it “Always do what you think is best for the patient.”
- I haven’t been perfect. If I did that I wouldn’t pick up a hand-piece. There’s always someone better than me. I just do my best.

Guys, OMSDoc is cooking the books. I get paid $100 for an extraction and $200 for a molar Endo.... (these are 100% real world numbers in a Medicaid system. It’s very generous for molar Endo to be compensated above $0)

 

[OMSDoc]

Guys, OMSDoc is cooking the books. I get paid $100 for an extraction and $200 for a molar Endo.... (these are 100% real world numbers in a Medicaid system. It’s very generous for molar Endo to be compensated above $0)

The only thing I ever cook is kids’s breakfasts.

My numbers are hypothetical of a single-payer system in which the federal government controls all of health care, and the money to pay you is being pulled away by other non-medical projects and is subject to bureaucratic control.

I actually got these numbers from my father (an OMS), who sat next to a dentist from Europe (maybe the UK) at an implant meeting. This is the story he got from him. So, granted, it is third-hand hearsay.

But, rest assured, when we go to single-payer, previous fee schedules will be out the window.