Monday, May 25, 2020

Pelton & Crane to End Operations after Over a Century of Sales & Service

 


When I set up my first office location, my dream was to have Pelton & Crane equipment.  For years P&C was the creme de la creme of dental equipment.  Everyone who knew the dental industry knew that if you wanted the Ferrari or Lamborghini of dentistry, you worked with Pelton & Crane.  Their equipment was state of the art (as much as it could be back then) and built like a proverbial tank.  Their products were amazing and they just didn’t break down.  When I moved out of my original location, I was forced (long story) to leave behind a Pelton & Crane “Chairman” dental chair and I was less than happy about that.

Around 2005 I remember rumors at the Chicago MidWinter meeting that P&C was going to be purchased by Danaher and rolled into their dental division.  I remember at the time being impressed with the acquisition.  Danaher had made a splash with their move into dentistry and purchasing Pelton & Crane showed that not only did they have money to spend but that they were interested in making sure the industry understood their devotion to quality.  Purchasing a company with a reputation like P&C ensured that the industry understood.

Unfortunately, change isn’t always guaranteed to be a good thing.  Sometimes changes bring with it unfortunate circumstances… this is one of those times.  After over 100 years of dental excellence, Pelton & Crane will be closing for new business.

I suppose the “good news” if there can be any out of this circumstance, is that because of the backing of having Kavo-Kerr Group behind you, the company will continue to provide customer support for the duration of customer warranties.  So often businesses close and leave their existing customer base high and dry.  It looks at this point that P&C customers will not have to deal with that.

It’s still a tough loss for the industry though.  Pelton & Crane was one of the industry’s shining stars, as a guy that gets to walk on both sides of the looking glass in dentistry, it’s sad to see them go.

Here is the announcement they sent out to the industry:

Closing for Business, Here for Support

For over 100 years, Pelton & Crane has been a partner and dedicated resource committed to our customer’s dental journey and ongoing success. Because we’re not an equipment company—we’re a people company. And for the next century to come, Pelton remains focused on helping to support our customers.

Our more than a century of dedication and innovation started in 1900 but it is with a heavy heart we announce that we will no longer be taking any orders as of May 22, 2020.

Along with this announcement, sales of all Pelton & Crane dental operatory equipment will be discontinued in the US, Canada, and all international markets and for all customer segments.

This includes Pelton & Crane's Spirit Dental Chairs, Spirit or Alliance Delivery Units, Helios Dental Lights and Pelton & Crane Cabinetry.

We will continue to service our current Pelton & Crane customers by honoring our 5-year warranty period and maintain inventory of Pelton & Crane service parts where possible for up to 7 years. Warranty service questions and concerns may still be directed to CustomerService@pelton.net.

Over the coming weeks we will transition our website peltonandcrane.com to a support and resource center for existing Pelton & Crane customers. Here you will find information on service, use & care and installation support for Pelton & Crane equipment.

Thank you for being a valued Pelton & Crane customer and we appreciate you support throughout the years. 

Monday, May 18, 2020

Coronavirus (COVID-19) Update: FDA Informs Public About Possible Accuracy Concerns with Abbott ID NOW Point-of-Care Test

 



One of the few reliable (or so we thought) and easy Coved-19 tests available is the Abbott ID NOW.  Unfortunately now, well over 60 days into the pandemic here in the U..S., comes word from the FDA that the test might not be quite a reliable as first thought.  Here is the information staring from the FDA:

Today, the U.S. Food and Drug Administration is alerting the public to early data that suggest potential inaccurate results from using the Abbott ID NOW point-of-care test to diagnose COVID-19. Specifically, the test may return false negative results.

“We are still evaluating the information about inaccurate results and are in direct communications with Abbott about this important issue. We will continue to study the data available and are working with the company to create additional mechanisms for studying the test. This test can still be used and can correctly identify many positive cases in minutes. Negative results may need to be confirmed with a high-sensitivity authorized molecular test,” said Tim Stenzel, M.D., Ph.D., director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health.

The FDA is sharing early information available about potential inaccurate results in the spirit of transparency. The agency has been working with Abbott to analyze the information gathered to date and has worked with the company on a customer notification letter to alert users that any negative test results that are not consistent with a patient’s clinical signs and symptoms or necessary for patient management should be confirmed with another test.

The FDA looks at a variety of sources to identify and understand potential patterns or significant issues with the use of the Abbott test. No diagnostic test will be 100% accurate due to performance characteristics, specimen handling, or user error, which is why it is important to study patterns and identify the cause of suspected false results so any significant issues can be addressed quickly.
The agency is aware of some scientific studies that have identified accuracy issues with Abbott ID NOW and is investigating whether it could be due to the types of swabs used or the type of viral transport media (material used to transport the patient’s specimen). While there is important information to gather from these studies, it should be noted these studies have limitations, including small sample size, potential design biases, or tests that may not have been executed according to the manufacturer’s instructions for use, an important part of scientific research. This is why external scientific studies are one part of the FDA’s overall evaluation of a diagnostic performance.

The FDA has received 15 adverse event reports about the Abbott ID NOW device that suggest some users are receiving inaccurate negative results. The agency is reviewing these reports. It’s important to note that the adverse event reports the FDA receives from manufacturers, health care providers, health care facilities, and patients can be incomplete, inaccurate, or unverified, so agency staff must meticulously comb through the reports to identify crucial data to support any signals or patterns about device use.
Moving forward, Abbott has agreed to conduct post-market studies for the ID NOW device that each will include at least 150 COVID-19 positive patients in a variety of clinical settings. The FDA will continue to review interim data on an ongoing basis. The information gathered from the post-market studies can further help the agency understand the cause or patterns of any accuracy issues and inform any additional actions the company or the FDA should take.

The FDA will keep working with Abbott to further evaluate these accuracy issues and will publicly communicate any updates.

Thursday, May 14, 2020

CAO Group Announces PPE Product Line Aegis PPE product line available now for Dental Offices

 


The day that seemed like it would never get here has finally arrived.  Most dental offices will re-open on May 18th… at least here in the Midwest.  I know that Utah has been back to work for at least a couple of weeks while other states, like New Jersey, are still under quarantine guidelines.

However, whether you are ready to open or at starting to gear up, things in the dental industry have changed… drastically.  Offices across the country and now working hard to find the proper PPE (Personal Protective Equipment) to keep staff and patients safe from the continued threat of Covid-19.

This is a strange time in the profession.  As the supply chain struggles with shortages and counterfeits of trusted products, suddenly every office is ordering the same product as every other office and the supply chain is groaning under the stress.  Dentists need *reliable* PPE and it seems that even things like face shields are shoddily made and in short supply.  Wouldn’t it be great if a *trusted* name in dentistry could help with the supply problem?

Well help is here.  CAO Group, a company that has been making dental products for years has now announced the Aegis PPE line.  This is a new venture for CAO Group, but one I commend them for.  They’ve made a lot of great dental products over the years and when they saw the problems with PPE that dentists were battling, they were quick to jump in and help.  Here is the info on this new company:

The CAO Group, Inc. (CAO) announces both the launch and availability of their AegisTM brand Personal
Protective Equipment (PPE) product line to help dental practices come back to operation under COVID-19
pandemic conditions.

The Aegis PPE line consists of, but not limited to, the following items: Aerosol VacStation, Infrared
Thermometer, Coverall Suits, Protective KN95 Masks, Surgical Masks, Protective Goggles, and Face Shields.
Each product has unique features to protect staff in dental practices. Aegis VaStation features a three stage6
filtration and UV light with a flow rate of three cubic meter per minutes and low noise. The three-stage
filtration includes a moisture filter, a HEPA H13 filter for particles as small as 2.5um, an active carbon filter for
solvent and active particles. The UV light is 275nm wavelength of light intensity. Aegis infrared thermometer
are FDA cleared class II medical device and measure body temperature with no contact less than 1 sec. Please
visit www.caogroup.com and amdlasers.com for details of products.

“Protecting office staff shall be the number one priority for dental practices” said, Densen Cao, PhD, Founder
and CEO of CAO. “Protections in dental practices must be advanced to a new standard under COVID-19
pandemic. Our recommendations for additional procedures for protecting dental staff are as follows: 1. Check
patient temperature as part of check in; 2. Use coverall suit, goggles, KN95 or surgical masks, and face shield to
protect staff during the procedures; 3. Use aerosol vacuum station to suck away aerosol during the procedures;
4. Disinfect routinely between patients.”

Aegis PPE products are available on caogroup.com, amdlasers.com, and certain dental distributors.

About CAO Group, Inc.

Monday, May 11, 2020

Counterfeit N-95 Masks Begin to Enter Market - Buyer Beware

 


On Friday of last week, the New York Times published an article about the sudden influx of counterfeit N-95 masks entering the U.S. supply chain from our friends in China.

For those of you not well versed in mask terminology, at true U.S. certified respirator (even though it *looks* like a mask) has a snug fit and is referred to as an N-95.  Other countries have similar standards, but their names for the devices vary, adding to the confusion.  The China equivalent of the U.S. N-95 is called a KN-95.

Due to the global pandemic and the shortage of PPE (Personal Protective Equipment) that it created, the U.S. relaxed testing standards and was allowing KN-95 masks to enter the U.S. supply chain without testing.

About 3 weeks ago, some tests were performed and massive amounts of failures were noted.  This lead to the U.S. banning 65 of the previously approved 80 Chinese manufacturers.  Unfortunately because, for some unknown reason, the failures were not reported for about 3 weeks, that meant that these inadequate masks entered the U.S. supply chain and were put into circulation for healthcare workers on the front lines.  Basically that means that doctors & nurses were gearing up in these masks to go into rooms with patients known to have Covid-19, thinking they were wearing the best PPE they could get.

Why it took 3 weeks for the U.S. government to take action remains a mystery.

Thursday, May 7, 2020

Hawkeye Key Logger Comes Amid Pandemic Concerns

 


Not everything that you receive electronically dealing with Corona Virus fears is being sent to you out of concerns for your safety.  A recent spate of emails, in fact, is being sent in hopes of capitalizing on fears of safety.

It seems that recently emails are being sent that “appear” to be from the WHO’s Dr. Tedros Adhanom Ghebreyesus.  This email reports to be offering “drug advice” to unsuspecting users.  In reality what is being delivered is the Hawkeye Key Logger program. 

Key Loggers are named because they truly have the ability to record every key stoke entered into a computer and can then send this information back to whoever sent the malware in the first place.  It basically allows an unknown person to see everything that happens on the infected computer.  In addition to stealing keystrokes and sending them along, Hawkeye can also capable of stealing credentials such as user names and passwords from email accounts and web browsers installed on the computer

The secret to avoiding these types of programs and situations are the ones I’ve discussed before.  “Think before you click” is the best advice I can give.  If you do not open files attached to emails, you won’t have many problems to deal with… so don’t open files sent to you unless you can verify the person who sent them to you.

It’s bad enough that we have to deal with the Covid-19 outbreak without having to worry about scams associated with it.  Unfortunately, that’s the world we live in...

Tuesday, May 5, 2020

ITC Judge’s Initial Determination Rejects Align Technology Claims against the 3Shape TRIOS scanner

 
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There have been rumblings lately about the lawsuit between Align and Trios.  It seems that Align had sued Trios for violating patents, among other things.

Today comes word that, at this point in time, 3Shape seems to be in the clear.  Here is the info:

3Shape today announced that the company has received a favorable Notice of Initial Determination regarding the 3Shape TRIOS scanner. The Notice of Initial Determination was issued by Administrative Law Judge MaryJoan McNamara of the U.S. International Trade Commission (ITC) following the ITC’s investigation of the complaint, filed by Align Technology, Inc. against 3Shape in December 2018, which is the third ITC case filed by Align against 3Shape

On April 30, 2020 Judge McNamara found that 3Shape did not commit any unfair acts in connection with the 3Shape TRIOS scanner as asserted by Align, ruling that there was no violation of the patents asserted against the TRIOS scanner. Thus, 3Shape will continue to sell, supply and service 3Shape TRIOS scanners in the USA.

“We are pleased that Judge McNamara rejects Align’s claim that the TRIOS scanner infringes any valid Align patents, like Judge Lord and Judge Cheney did in the two previous ITC cases launched by Align. Further, Judge McNamara found that one of the patents asserted by Align against TRIOS application software was invalid. This is a victory for innovation and the many dental professionals who every day apply innovative dental solutions to provide better dental care for their patients. We are confident that the ITC will follow Judge McNamara’s Initial Determination regarding the TRIOS scanner and its application software at issue,” says Tais Clausen, Co-CEO and Co-founder of 3Shape.

In her ruling, Judge McNamara reached an Initial Determination that certain claims of two other patents asserted against certain 3D model alignment methods when comparing a scan to a Virtual Ortho setup, as well as certain specific methods to align two 3D models in 3Shape’s Compare Model Sets ortho software module were infringed. 3Shape will seek the ITC’s review of this holding.

Innovation is the driving force behind 3Shape. 3Shape has always had the utmost respect for patents and intellectual property. We continue to create groundbreaking technology to advance dental care. That ability has made 3Shape a leader, which is supported by our more than 80 patent families and numerous industry awards.

3Shape will continue to do what we have always done: Work with companies (including competitors) to create exciting and innovative solutions that benefit labs and dentists and improve patient care.

Monday, May 4, 2020

U.S. Department of Labor Issues Additional Respirator N-95 Reuse Guidance

 


Here is the latest info on decontaminating high filtration masks for re-use.  This is through OSHA which is part of the Department of Labor.

WASHINGTON, DC - The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued interim enforcement guidance on reusing disposable N95 filtering face piece respirators (N95 FFRs) that have been decontaminated. The action marks the Department’s latest step to ensure the availability of respirators, and follows President Donald J. Trump’s Memorandum on Making General Use Respirators Available.
The guidance applies to workplaces where workers need respirators to protect against exposure to infectious agents that could be inhaled into the respiratory system, including during care of patients with suspected or confirmed coronavirus and other activities that could result in respiratory exposure to SARS-CoV-2, the virus that causes the coronavirus.
If respiratory protection must be used, and acceptable alternatives are not available for use in accordance with OSHA’s previous coronavirus related enforcement memoranda, the National Institute for Occupational Safety and Health has identified available research that suggests the following methods offer the most promise for decontaminating FFRs:
Vaporous hydrogen peroxide;
Ultraviolet germicidal irradiation; and/or
Moist heat (i.e., using an oven).
If the methods above are not available, microwave-generated steam or liquid hydrogen peroxide could also be suitable.
The following methods are not considered acceptable unless objective data that sufficiently demonstrate the safety and effectiveness of such methods become available:
Autoclaving;
Dry heat;
Isopropyl alcohol;
Soap;
Dry microwave irradiation;
Chlorine bleach;
Disinfectant wipes, regardless of impregnation (i.e., chemical saturation); and/or
Ethylene oxide.
Employers should investigate the effectiveness of any particular decontamination method used for the specific filtering facepiece respirator model to be decontaminated. Employers should be able to demonstrate the effectiveness of any decontamination method used against the likely contaminant(s) (i.e., pathogens) of concern, and that the decontamination method used does not produce additional safety hazards.
This interim guidance will take effect immediately and remain in effect until further notice; however, this guidance is time-limited to the current public health crisis. Visit OSHA’s Coronavirus webpage regularly for updates.
For further information about the coronavirus, please visit the Centers for Disease Control and Prevention.
Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit www.osha.gov.
The mission of the Department of Labor is to foster, promote, and develop the welfare of the wage earners, job seekers, and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.
Agency
 Occupational Safety & Health Administration
Date
 April 24, 2020
Release Number
 20-759-NAT
Contact: Department of Labor National Contact Center
Email
 DOL-Info@dol.gov

Wednesday, April 22, 2020

Want to Learn about Digital Caries Diagnosis?

 




In these crazy global pandemic times, a lot of folks in dentistry are spending the downtime taking online CE courses.  

In case you are one of those folks and are looking for info on Digital Caries Diagnosis, I’d like to suggest you check out a webinar I did for Weave recently on that very subject.

A couple of weeks ago I settled down in front of my computer and recorded about 45 minutes of information on how I am now examining and monitoring caries in my patients.

I cover a couple of the diagnostic types of devices available as well as some clinical examples of what both devices cover.  It's not an inclusive list, but I feel this will give you a nice overview of the subject that you can incorporate into your practice once we are cleared for elective treatment.

The good folks at Weave have been nice enough to provide quite a few online CE webinars that they are providing free of charge

Tuesday, April 21, 2020

Ultradent Offers 40% Discount on Emergency Products

 



You’ve got to love Ultradent.  In all my years of working with companies I’ve never seen one that is SO committed to doing the right thing.  These are people with a true heart of gold and a love for the profession of dentistry and a desire to help patients by “improving oral health globally”

The company continues to display this commitment during the time of the global pandemic by offering a 40% discount on”emergency essential products”.  Here is the latest:

With many dental offices only able to perform emergency procedures during this time, we want to make sure that you have everything you need to take care of the patients you see. We are offering emergency essential products at a discount with the hope that this can help you keep treating patients for as long as possible. We also have a resource library with suggestions on how to keep your businesses going strong through this unprecedented time

Monday, April 20, 2020

ADA Advises Dentists to Follow Science-Backed Guidance Regarding SARS-CoV-2 Testing and Avoid "Gray Market" Products

 


Last week I posted regarding the amount of SARS-CoV-2 spam I’ve been receiving and the efforts by less than honest people to profit from the ongoing crisis

It seems I may have been just a bit ahead of the curve on that as I recently received similar information from the ADA regarding the fact that the market is now seeing a rapid influx of companies promising reliable SARS-CoV-2 tests that are anything BUT reliable.  The global pandemic has let a lot of cockroaches crawl out of the woodwork and they are attempting to prey on those who are trying desperately to do the right thing.

Here’s what the ADA has to say:

The ADA is urging dentists to be cautious about using novel coronavirus diagnostic tests before they have been properly evaluated and made available for dentists.

“The testing market is becoming a bit of the Wild West for companies right now,” ADA Executive Director Kathy O’Loughlin said in an interview. “There is very little scientific evidence that the tests being marketed to dentists are reliable, so be careful when you see an offer that seems ‘too good to be true.’”

The ADA Science & Research Institute is evaluating the evidence regarding tests and the level of specificity and sensitivity and is talking directly to manufacturers and distributors.

“All dentists need a fast point-of-care test that accurately predicts the presence or absence of COVID-19 virus in real time,” Dr. O’Loughlin said. “Unfortunately, very few tests have met a high standard for specificity and sensitivity, which means a potential for high rates of false negatives and false positives.“

In a letter dated April 17, ADA President Chad Gehani and Dr. O’Loughlin asked the Department of Health and Human Services to use its discretionary authority during public health emergencies to extend targeted liability protections for dentists who administer those COVID-19 diagnostic tests, similar to the protections offered to pharmacists on April 8.

In the meantime, the ADA is advising dentists to steer clear of so-called “gray market” point-of-care tests for COVID-19, recommending they follow the direction issued by the FDA regarding testing procedures in their practices. Dentists should also be aware that manufacturers and distributors are prioritizing the distribution of the available kits to facilities with high-level needs.

Dr. O’Loughlin noted that there is one test, ID Covid Now, that is being sold through Henry Schein to the medical community, but not to dentists. It is a fast point-of-care test manufactured by Abbott Labs, and they are reported to be only able to produce 50,000 tests per day.

Because of the medical demand, Henry Schein has informed the ADA that they are not planning on selling this point-of-care test to dentists in the very near future.

Some community health centers have also received tests because HHS is distributing the tests to Indian Health Service and Health Resources and Services Administration sites, Dr. O’Loughlin added.

The Association does not consider COVID-19 testing to be a scope of practice issue, in that dentists are expected to routinely screen for high blood pressure, smoking habits and in some offices blood sugar and A1c levels. The test is not diagnostic in a dental office, since dentists are not treating COVID-19 illness.

“Some community health centers may even have dentists doing the tests on behalf of the medical staff,” Dr. O’Loughlin noted.

“An accurate test for the presence of COVID is the most predictable way for dentists, dental teams and patients to be safely treated in traditional elective dental care,” Dr. O’Loughlin noted.

Licensed dentists are eligible to administer COVID-19 diagnostic tests within their scope of practice, provided they obtain (or already have) a Certificate of Waiver from the Centers for Medicare & Medicaid Services, as may be needed. Like physicians, dentists may need the certificate to administer FDA-waived COVID-19 diagnostic tests, as required by the Clinical Laboratory Improvement Amendments (CLIA) regulation. To obtain a CLIA waiver, dentists must submit an application and pay a $150 application fee, though the ADA is lobbying Congress to waive the certificate requirement or at least waive the application fee.

There is also a widely reported nationwide shortage of existing COVID-19 testing kits. To help alleviate the shortage, the FDA issued a policy in February authorizing laboratories to put COVID-19 diagnostic tests on the market prior to receiving FDA approval.

According to the FDA, “Currently there is no FDA-approved or cleared test to diagnose or detect COVID-19 because the virus that causes COVID-19 is new. Therefore, the FDA has issued several Emergency Use Authorizations (EUAs) for the use of new diagnostic tests to detect the SARS-CoV-2 virus, which causes COVID-19. During public health emergencies declared under section 564 of the FD&C Act, the FDA is able to issue EUAs when certain criteria are met that allows for the use and distribution of potentially life-saving medical products to diagnose, treat, or prevent the disease, which can include diagnostic tests … The FDA sees the public health value in expanding the availability of COVID-19 testing through safe and accurate tests that may include home collection, and we are actively working with test developers on this goal.”
More than 100 companies have requested and received the FDA-developed Emergency Use Authorization template for diagnostics for this outbreak, the FDA said.
Currently, according to the FDA, testing for COVID-19 typically entails collecting a sample from the nose and/or throat with a special swab at a designated collection location staffed by health care professionals. “A health care professional swabbing the back of the nasal cavity through the nostril is the preferred choice,” the guidance said. Alternatively, the health care professional could swab the back of the throat, or for patients with symptoms of COVID-19, the sample may be collected by swabbing the inside of the front of the nose. “Depending on, among other things, the type of swab used, a health care professional may collect the sample, or you may be able to collect the sample yourself at the collection site under the supervision of health care personnel.”
A different type of testing — which typically identifies specific antibodies through a pin prick and testing strip — are the antibody tests, which determine if someone was previously infected.

Antigens are proteins that are found on the surface of the pathogen, according to the National Institutes of Health. Antigens are unique to that pathogen. When an antigen enters the body, the immune system produces antibodies against it. Lymphocytes, a type of white blood cell, recognizes the virus antigen as being foreign and then produces antibodies that are specific to that antigen. Once the invading pathogen has been destroyed the immune response usually winds down.

For the ADA News story on the April 17 letter from Drs. Gehani and O’Loughlin to the Department of Health and Human Services, visit the ADA News website.
Further guidance from the ADA in regards to the pandemic is available at ada.org/virus.

Sunday, April 19, 2020

The latest mask & face shield guidelines from the American Dental Association


These are the latest recommendations from the ADA as of Sunday morning April 19, 2020.  Click on the image above for a larger and downloadable view.


Saturday, April 18, 2020

Looking for Ways to Get Your Practice Back On Track after the Quarantine?





If you are wondering what you can do for your practice to hit the ground rolling once we are cleared for elective procedures, you should check out the upcoming webinar from Debbie Seidel-Bittke.  The program titled "BOOST Your Hygiene Department After COVID-19!” happens on April 21-23.  Here are all the details:

BOOST Your Hygiene Department After COVID-19!

           April 21-23, 2020 8-10AM PDT

              6 CE Credits (PACE Approved)

This training is perfect for dentists, hygienists and their team.

You walk away with a roadmap and plan to triage and schedule your back-log of patients who you rescheduled during COVID-19.

With all the COVID-19 PPE changes you will learn time management during the hygiene appointment to stay ontime.

You walk away will a team approach to BOOST your hygiene department productivity and achieve/exceed your 2020 goals.

Learn what is included in treating the gingivitis patient: adjunctive services, appointment sequence(s), determine your fee and how to be reimbursed.

Learn how to get your patients to own their disease and want what they need.

Learn a team approach to reactive, retain and bring in more new patients after COVID-19.

You leave with the exact information to use and implement after COVID-19.

Register Today Here: https://bit.ly/HYGIENEWEBINAR42020

Friday, April 17, 2020

ADA Releases " ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission" Document




I came across the following story on the ADA website recently.  I was searching for the source of the document that was sent to me by a great friend in the dental consulting side of the industry.  The document contains good information and it certainly appeared to be legitimate, but I did a little checking just to make sure.  The good news is that I found a story detailing the Guidance Recommendations in the ADA News which also provided a link to a pdf.

Hats off to the smart folks at the American Dental Association for all of their hardworking in putting things together and providing such an amazing amount of resources for those of us on the frontlines of the epidemic.  This is just one reason why I love organized dentistry!


Here is the story from the ADA News:

The American Dental Association has released interim guidance for dentists on how to minimize the risk of COVID-19 transmission before, during and after treating dental emergencies.

The ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission covers dentist and dental team preparation; screening for COVID-19 status and triaging for dental treatment; instructions for patient arrival; infection control standards and COVID-19 transmission precautions, including personal protective equipment; clinical technique recommendations; steps to follow after suspected, unintentional exposure; environment disinfection between patients; post-operative instructions for patients; and steps to minimize exposure to others when going home after a workday.

The corresponding ADA Interim Guidance Flowcharts for Minimizing Risk of COVID-19 Transmission illustrate algorithms for triaging patients for emergency and urgent dental care, screening to identify COVID-19 infection for emergency and urgent dental patients, and minimizing the risk of COVID-19 transmission for emergency and urgent dental patients and health care personnel.

The purpose of the algorithms is to assist dentists and dental offices in making informed decisions concerning patient triage, evaluation and treatment during the COVID-19 pandemic. The algorithms are based on the best scientific information currently available to the ADA from the Centers for Disease Control and Prevention, World Health Organization and scientific literature.

The ADA also has created an overview document — Summary of ADA Guidance During the COVID-19 Crisis — that summarizes COVID-19's impact on dentistry, emerging science on the disease, the ADA's guidance for minimizing risk during emergency treatment and the resources the ADA has developed for dentists.

The interim guidance, flowcharts and summary document are available at ADA.org/virusresources. The ADA is developing an online course on this interim guidance and continually updating its COVID-19 resources as new evidence and information become available.

Thursday, April 16, 2020

AAAPMD and ACAM Providing Free Webinar on COVID-19 - Patients and Doctors Welcome!

 



As many of you know, I am on the Board of Directors of the Foundation for Airway Health.  It is a group that advises and teaches the dental industry about Obstructive Sleep Apnea and the ways to treat the disease.

Today I got an email from one of the group’s co-founders, Dr. Howard Hindin.  He’s a truly loving and giving doctor who things of patients first and foremost.  His email contained some exciting news.

Today at 1:00 pm Eastern Time, there will be a webinar entitled “Update on the Corona virus and the Steps You can Take for a Healthy Immune System

The webinar is a joint effort of the AAPMD (American Academy of Physiological Medicine and Dentistry) and the ACAM (American College for Advancement of Medicine)



Here is the email:


We hope you are all staying safe and maintaining the necessary precautions of social distancing. (I refer to it as physical distancing since we are finding innovative ways to maintain our social connections through the internet and other means.)

The AAPMD (American Academy of Physiological Medicine and Dentistry) in partnership with ACAM (American College for Advancement of Medicine) is starting a weekly webinar series to provide the latest information on COVID-19: latest research as well as steps you might consider to support, strengthen and fine-tune your immune system. The webinars will present information for you to use while you are still at home. There will even be time to address questions you may have. 
The AAPMD has opened this webinar for the public. Informed patients “take charge” of their health, collaborate as partners with their practitioners and have better outcomes.

Please join the inaugural weekly webinar Thursday, April 16. 2020 at 1:00 PM ET with Ahvie Herskowitz, MD.   Dr. Herskowitz is a truly unique practitioner of Integrated Medicine. He has trained and has experience in cardiology, immunology, and virology; and he has served as Associate Professor of Medicine at Johns Hopkins. He is also the current president of ACAM, one of the original integrated medical organizations.
 Covid-19 Update
  • Where are we now?
  • The 2nd Wave
  • What Treatments are Working
  • Immuno-modulation
  • Steps to Take at Home
  • Stem Cells and Other Innovative Treatments

Wednesday, April 15, 2020

FDA Clears New Sterilization Process for N-95 Masks - Could Allow for 4 Million Masks per Day




As many of you know, the shortage of PPE (Personal Protective Equipment) in fighting SARS-CoV-2 is a major problem for healthcare providers.  Standard surgical masks filter out particles of about 100µ in size or larger.  The N-95 mask filters out about 95% (hence the “95”) of particles 30µ or larger.  The virus particles we are currently fighting range between 120-60µ.  That is the reason for the use of the N-95; regular surgical masks just don’t provide enough filtration.

Up to this point in healthcare, standard masks have been the go to product.  Now it’s N-95.  However, the supplies of N-95 have become scarce during the current pandemic.  I’ve heard stories of hospitals issuing one mask per clinical employee and telling the employee to use it wisely as it’s the only one they will get.  Like anything else, these masks need to be changed from time to time as they become contaminated.

Since the supply chain is so strained currently, a lot of smart people have been trying to figure out a way to allow for these masks to decontaminated.  Here is the info from the FDA...

The U.S. Food and Drug Administration issued an emergency use authorization (EUA) that has the potential to decontaminate approximately 4 million N95 or N95-equivalent respirators per day in the U.S. for reuse by health care workers in hospital settings.

“Our nation’s health care workers are among the many heroes of this pandemic and we need to do everything we can to increase the availability of the critical medical devices they need, like N95 respirators,” said FDA Commissioner Stephen M. Hahn, M.D. “FDA staff continue to work around the clock, across government and with the private sector to find solutions. This authorization will help provide access to millions of respirators so our health care workers on the front lines can be better protected and provide the best care to patients with COVID-19.”

The FDA granted the EUA to Advanced Sterilization Products (ASP) for the STERRAD Sterilization Cycles (STERRAD 100S Cycle, STERRAD NX Standard Cycle, or STERRAD 100NX Express Cycle), which uses vaporized hydrogen peroxide gas plasma sterilization. There are approximately 9,930 STERRAD Sterilization systems in approximately 6,300 hospitals across the U.S. STERRAD 100S Cycle, STERRAD NX Standard Cycle and STERRAD 100NX Express Cycle vary in reprocessing times from 55 minutes, to 28 minutes, and 24 minutes. Each can reprocess approximately 480 respirators per day.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Tuesday, April 14, 2020

And the Pandemic Goes On...

 



If you are a practicing dentist, you are most likely seeing an unbelievable amount of email right now.  Daily I’m receiving 10-20 emails promising me the ‘lowdown” on all things SARS-CoV-2.

While I *have* received some incredible information and links to websites that can help provide useful information, I’ve also received tons of spam.

The current situation is highly fluid and NO ONE has all the answers yet.  I highly advise you to beware of anyone who says they do.  The current situation reminds me a bit of when HIPAA was implemented.  There were many, many “experts” who were wiling to sell you all types of over priced books, gadgets, file cabinets, etc.  Of course the sales pitch was they were “required” in order for you to be HIPAA compliant. 

The current situation as related to SARS-Cov-2 is filled with uncertainty.  No one knows for sure what the future will bring or what the profession of dentistry will look like in the future.  Yesterday I received an email advertisement offering to sell me full Tyvek hazmat jumpsuits for *only* $40 per suit.  They are also at the Home Depot for $8, if they are still in stock.

My concern here is that my profession has been idled for at least a month.  Bills still come in, but our revenues are down 85-90% at a minimum.  Most of us are taking advantage of SBA loans and other government programs so that we can keep our offices afloat.  The last thing I want to see is one of my peers being scammed into buying insanely overpriced PPE or other equipment with our revenues at an all time low.  Many offices will struggle to get back up to speed after this furlough and I feel a strong need to help protect the profession.

Remember that the CDC will make recommendations on PPE and that, along with your best judgement, is the best defense against being tricked into buying overpriced PPE or equipment at this time.

Stay safe and stay well!  #FlattenTheCurve

Saturday, April 11, 2020

Here's how your body gains immunity to coronavirus...



I found this article on The Guardian which is one of my favorite news websites.  They do a very good job of bringing hard hitting stories to the public consciousness and are not afraid to take a stand.  Basically that is everything I expect out of a news organization.
The author, Zania Stamataki, has done an amazing job with this.  Usually people who have the gift to understand science know so much about their subject that it is difficult for them to manage to cover that subject in a way that laypeople can understand.  However, in this case I feel the author has done a tremendous job of explaining things while keeping it understandable as well as readable.  If you are interested in reading the article as it appears on the Guardian website, then follow this link.  Otherwise give this is a read.  I feel it will help you understand what is going on "under the hood" of the human body & to help allay some of your fears regarding the current pandemic...


As the daughter of an air force officer and a nurse, I am fascinated by defence systems. There is none more impressive than the human immune system, equipped as it is with a rich arsenal to defend against different types of pathogen. Viruses have evolved to trick, bypass and evade these defences. Our immune systems have, in turn, learned to recognise and deter these virus stealth tactics. In Covid-19, the enemy is a tiny piece of genetic material wearing a lipid coat and a protein crown.
So how is our immune system able to defend against viral infections, and how does this apply to Covid-19? The virus that causes Covid-19 is called severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2), and was first detected in humans around five months ago. It is a coronavirus. “Corona”, in Latin, means crown. The virus is adorned with an outer layer of protein covered in spikes, like a crown. These spikes help the virus attach itself to target cells. The research community is fast learning about immunity to Covid-19, and we are also applying our knowledge of similar respiratory viruses to predict what to expect in this infection.
Think of a virus as a robot; it cannot reproduce so it needs a factory of materials – proteins, lipids and nucleotides – to build copies of itself. The coat allows the virus to attach itself to the target cell’s membrane. The virus then fuses with the cell and releases a shopping list of instructions on how to build and assemble new viruses. This shopping list, the virus genome, is written in nucleotides (RNA). The first job of a virus that enters our bodies is to invade target cells so that it can comfortably remove its coat and deploy its RNA.
Once inside, the virus commandeers the cell and borrows cellular machinery to build more viruses before immune cells detect the intruders and raise the alarm. Antibody proteins that are able to stick to the virus-spike proteins, and prevent attachment to the target cells, are called neutralising antibodies: generating them is often the goal of protective vaccination.
Our infected cells make the ultimate sacrifice and invite their own destruction by displaying distress signals for T-cells, which swiftly detect and kill them. T-cells are cytotoxic – powerful serial killers that can recognise peptide fragments of virus displayed on the infected cell surface. When they do, they release a payload of toxic enzymes that kill the infected cell in a “kiss of death”. This strategic martyrdom is organised by the immune system to deprive the virus of its replication factories and can lead to the reduction of viral load in the patient. It takes several days for antiviral T-cells to expand and antibodies to be generated. Here’s the silver lining: memory cells ensure that if we encounter the same virus again, we can react immediately with pre-existing defences. Sars-Cov-2 is new to humanity so we have no protective immunological memory. Vaccines prepared using harmless parts of the virus can help us build protective memory.
The virus’s enemy superpower is spreading. The virus achieves this through “shedding” from infected patients. Sars-Cov-2 is expert at hopping from person to person, and in some people, it achieves a stealthy existence with mild or no symptoms. Once many copies of the virus are made, it needs to jump to another host. It hitches a ride on droplets that can be coughed or sneezed to a distance of up to two metres. Droplets can survive on surfaces for several hours enabling pick-up by a new host, or they can be directly inhaled if another person is in close proximity. Studies are emerging into animal hosts – so far the virus has been detected in a few ferrets, cats, tigers and dogs. No animal deaths have yet been reported, and we don’t know if animals can transmit back to humans.
The age differential in fatalities for Covid-19 suggests, with some exceptions, that a healthy immune system is usually able to control infection. Meanwhile, an ageing or weakened immune system may struggle to deploy a protective arsenal. Importantly, Sars-Cov-2 cannot gain entry to our homes or bodies by itself – we have to let it in. This is why official advice has centred around cleaning our hands and avoiding touching our faces.
We know that a healthy immune system is usually able to eliminate infection in a couple of weeks. However, we have no understanding of the components of our immune arsenal that contribute to this feat: some vaccines work by creating potent neutralising antibodies; other vaccines generate powerful memory T-cells. Antiviral antibodies emerge as early as three to four days after virus detection, but are they protective against future reinfection? We believe that antibodies to other coronaviruses (Sars, Mers) last from one to three years. Because this is a new virus, we don’t yet know the answer to this question. Public Health England is recruiting 16,000 to 20,000 volunteers to monitor antibodies once a month for six to 12 months to confirm whether we can generate long-lasting antibody responses to Sars-Cov-2. Determining the quality of these antibodies will be important to understanding long-term protection.
What is our most potent immune weapon against Covid-19? Cytotoxic T-cells may play an important role. Immunologists and virologists are working together to discover the correlates of protection, to design vaccines that offer long-term defences against Covid-19. Years of investment in research means that we can use existing approaches to respond to this new threat, and early mobilisation of research funders, philanthropists and academics are diverting resources to bolster these efforts on an unprecedented scale. Experience has taught us that vaccines are able to eradicate infections from this planet (for instance, smallpox), and medicines against viruses that don’t embed their genetic material to our own (for example, hepatitis C) can also achieve this.
Our secret weapon is research. Scientists are working hard on understanding Covid-19, and collaboration is key to this effort. But until a vaccine or treatment is available, we ought to work hard to protect ourselves and our families: isolate and prevent transmission by using physical distancing, face masks and sensible hygiene. If we all do our part, this little virus holding the world to ransom won’t stand a chance.
 Zania Stamataki is a senior lecturer and researcher in viral immunology at the University of Birmingham

Tuesday, April 7, 2020

Decontamination and Reuse of Filtering Facepiece Respirators


In the tough times we are currently all facing, drastic measures and methods are necessary to ensure that we keep everyone safe and that especially applies to those on the front lines as primary healthcare providers.  As has become commonly known, there is a critical shortage of N-95 masks currently.  Below are recommendations from the CDC on how to sterilize & reuse them.  The complete page with all information can be found by following this link.


Disposable filtering facepiece respirators (FFRs) are not approved for routine decontamination and reuse as standard of care. However, FFR decontamination and reuse may need to be considered as a crisis capacity strategy to ensure continued availability. Based on the limited research available, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat showed the most promise as potential methods to decontaminate FFRs. This document summarizes research about decontamination of FFRs before reuse


Introduction
Reusing disposable filtering facepiece respirators (FFRs) has been suggested as a contingency capacity strategy to conserve available supplies for healthcare environments during a pandemic. Strategies for FFR extended use and reuse (without decontamination of the respirator) are currently available from CDC’s National Institute for Occupational Safety and Health (NIOSH).

The surfaces of an FFR may become contaminated while filtering the inhalation air of the wearer during exposures to pathogen-laden aerosols. The pathogens on the filter materials of the FFR may be transferred to the wearer upon contact with the FFR during activities such as adjusting the FFR, improper doffing of the FFR, or when performing a user-seal check when redoffing a previously worn FFR. A study evaluating the persistence of SARS-CoV-2 (the virus that causes COVID-19) on plastic, stainless steel, and carboard surfaces showed that the virus is able to survive for up to 72-hours [1]. One strategy to mitigate the contact transfer of pathogens from the FFR to the wearer during reuse is to issue five respirators to each healthcare worker who may care for patients with suspected or confirmed COVID-19. The healthcare worker will wear one respirator each day and store it in a breathable paper bag at the end of each shift. The order of FFR use should be repeated with a minimum of five days between each FFR use. This will result in each worker requiring a minimum of five FFRs, providing that they put on, take off, care for them, and store them properly each day. Healthcare workers should treat the FFRs as though they are still contaminated and follow the precautions outlined in our reuse recommendations. If supplies are even more constrained and five respirators are not available for each worker who needs them, FFR decontamination may be necessary.

Decontamination and subsequent reuse of FFRs should only be practiced as a crisis capacity strategy. At present, FFRs are considered one time use and there are no manufacturer authorized methods for FFR decontamination prior to reuse. On March 28, 2020, FDA issued an Emergency Use Authorization (EUA) permitting the Battelle Decontamination Systemexternal icon at Battelle Memorial Institute to be authorized for use in decontaminating “compatible N95 respirators.” The FDA websiteexternal icon should be checked to determine if other EUAs have been issued since the posting of this crisis capacity strategy guidance. Only respirator manufacturers can reliably provide guidance on how to decontaminate their specific models of FFRs. In absence of manufacturer’s recommendations, third parties may also provide guidance or procedures on how to decontaminate respirators without impacting respirator performance. Decontamination might cause poorer fit, filtration efficiency, and breathability of disposable FFRs as a result of changes to the filtering material, straps, nose bridge material, or strap attachments of the FFR. CDC and NIOSH do not recommend that FFRs be decontaminated and then reused as standard care. This practice would be inconsistent with their approved use, but we understand in times of crisis, this option may need to be considered when FFR shortages exist.

An effective FFR decontamination method should reduce the pathogen burden, maintain the function of the FFR, and present no residual chemical hazard. The filter media in NIOSH-approved respirators varies by manufacturer. The ability of the respirator filter media to withstand cleaning and disinfection are not NIOSH performance requirements. The NIOSH’s National Personal Protective Technology Laboratory (NPPTL) and other researchers have investigated the impact of various decontamination methods on filtration efficiency, facepiece fit of FFRs, and the ability to reduce viable virus or bacteria on the FFRs. This research is summarized below.

Crisis Standards of Care Decontamination Recommendations
Because ultraviolet germicidal irradiation (UVGI), vaporous hydrogen peroxide (VHP), and moist heat showed the most promise as potential methods to decontaminate FFRs, researchers, decontamination companies, healthcare systems, or individual hospitals should focus current efforts on these technologies. Specifically, the effectiveness of using these methods should be explored further with specific FFR models based on the manufacturers’ support to better understand the impact on the respirator performance, including filtration and fit. The respirator manufacturer should be consulted about the impact of the method on their respirators prior to considering the use of any method.

When information from the manufacturer or a third-party is available showing that respirators can be successfully decontaminated without impacting respirator performance, then FFRs decontaminated following those recommendations can be worn for any patient care activities.
In the absence of guidance or when information is available that a respirator cannot be decontaminated without negatively impacting the performance, respirators may still be decontaminated. However, given the uncertainties on the impact of decontamination on respirator performance, these FFRs should not be worn by HCPs when performing or present for an aerosol-generating procedure.

No current data exists supporting the effectiveness of these decontamination methods specifically against SARS-CoV-2 on an FFR. Other pathogens may also be present on FFRs and there is only limited data available for other pathogens. Further work is needed to assure SARS-CoV-2 and other pathogens are inactivated. Therefore, even after decontamination, these FFRs should be handled
carefully.

HCPs should take the following precautionary measures prior to using a decontaminated FFR:
  • Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the FFR.
  • Avoid touching the inside of the FFR.
  • Use a pair of clean (non-sterile) gloves when donning and performing a user seal check.
  • Visually inspect the FFR to determine if its integrity has been compromised.
  • Check that components such as the straps, nose bridge, and nose foam material did not degrade, which can affect the quality of the fit, and seal.
  • If the integrity of any part of the FFR is compromised, or if a successful user seal check cannot be performed, discard the FFR and try another FFR.
  • Users should perform a user seal check immediately after they don each FFR and should not use an FFR on which they cannot perform a successful user seal check.

Saturday, April 4, 2020

Fight to Overturn the Department of Treasury and SBA Interim Guidance on the SBA 7(a) PPP Loan and EIDL Loan



As if the pandemic weren't bad enough, now we've got the "bureaucracy-demic".  It seems that after all the assurances that the federal government would help small businesses, they are now trying to make sure that doesn't happen.  Dentists need to read this and follow this link at the bottom to make their voices heard. 


Fight to Overturn the Department of Treasury and SBA
Interim Guidance on the SBA 7(a) PPP Loan and EIDL Loan
Hello, Fellow Dentists:

Since the COVID-19 pandemic began, dentists and dental offices across the country have been feeling the strain. We have seen the federal government issue numerous regulations and guidance. Along the way, we have told you that we need to be prepared to deal with unforeseen government edicts—particularly with respect to regulations and guidance—that do not consider the impact they may have on many sectors of our economy and our profession.

Today, we are faced with such a circumstance.  

The U.S. Small Business Administration has just issued interim guidance pertaining to the SBA Economic Injury Disaster Loan (EIDL) and 7(a) Paycheck Protection Program. The guidance stipulates, in effect, that small businesses must choose between the two loans; small businesses can’t receive both loans unless a qualified business receives their EIDL loan money on or before April 3.  

The guidance clearly contradicts the law (CARES Act) as written and as interpreted by the very committees of jurisdiction who drafted the legislation. The committee summaries and Q&A documents make it clear that qualified small businesses can apply for both the EIDL and Paycheck Protection Program loans, without specific date restrictions.

If this interim guidance stands, it would pose great harm to the vast majority of our dentist owners and other small businesses who have applied for but have not received any EIDL loan money by April 3.

The Grassroots Action Alert that we are asking you to respond to today is being sent to U.S. Department of Treasury Secretary Mnuchin and U.S. Small Business Administration Administrator Carranza, and much like the letter the ADA sent to them last night, we are “strongly recommending that the SBA work with Treasury to change the interim rule to clearly indicate that entities can apply for both loans and that they are still eligible to apply for both, even if EIDL loan funds are received after April 3. This would ensure that SBA and Treasury are following the congressional intent of the CARES Act…”

You should know that when you send your action alert to Secretary Mnuchin and Administrator Carranza, a copy of the alert will go to your Representative in the House as well as your two Senators. Your members of Congress will also know of the harmful effects of this interim guidance to your practice, your patients and the public.

This is interim guidance that we must oppose, and oppose with the same intensity that we brought to bear when we sent nearly 400,000 emails to Capitol Hill from more than 120,000 dentists regarding final passage of the CARES Act.

Please click on the link and let Secretary Mnuchin and Administrator Carranza know your opposition to this SBA interim guidance.

Thank you for what you are doing for your practice, your patients and dentistry!

Stay well,

Chad P. Gehani, DDS
President

And the Pandemic Goes On...

 


This whole Covid-19 thing has put pretty much everything into a tizzy in my life (not sure what a “tizzy” actually is, but my grandma used the word a lot and I really like it).  Like most dental offices, we are only seeing emergencies until at least May 1 and probably longer thereafter, but at this point no one really knows...

I have several unique perspectives on this whole pandemic.  I’ve got the healthcare view and that means I’ve got to protect my fellow man while being as careful as possible not to spread this thing.  I’ve got the business owner view and that means I’m dealing with furloughed employees that I’m worried about.  I’m a doctor with a recurring schedule of patient care and that means I worry about my patients even if it has nothing to do with dentistry.  My patients are people I care for but also care *about* and I want them all to be safe and well

The other perspective I have is due to the fact that I live in Kansas and practice in Missouri.  The state of Kansas is on a governor ordered “shelter at home” while Missouri is not.  Because of that I am seeing the virus spread more rapidly just to the east of my home.  It also means that the virus is more prolific in the area where my business is located.  In the big picture will that make a difference?  At this point everything is a guess, however I do know that keeping away from others is the best way to prevent spread of the infection.

Yesterday I did a virtual presentation on Chartless Dentistry for the Western Regional Dental Experience.  I’ve done a fair number of webinars in my career, but never one that was 3 hours long.  I have to confess, that it’s tough to talk to your computer screen for that long when the only live person you can see is you in a small thumbnail on the screen.  However, the event came off really well.  There were *a lot* of people logged in and I got some good immediate feedback.  There were a couple of tech glitches, but they were overcome.  I think this very well might be the CE platform of the not too distant future.  We’ve all seen how popular Zoom has become and with the proliferation of broadband connections, this will only get better.

As a final note to this post, hats off to whoever created the hash tag #FlattenTheCurve!  It sums up exactly what we all need to do right now.  We are living in perhaps the most uncharted time in recent memory.  We’ll get through this, but it’s going to take some time.

I’ll continue to post at pace that is stranger than normal.  You may see one post a day like always, or you may see 3 a day.  In times like these, nothing is a sure thing.

Stay safe and be well! 

Friday, April 3, 2020

ADA Extends Closure Recommendation Through April 30th



In a statement issued April 1, the ADA issued an interim recommendation that “dentists keep their offices closed to all but urgent and emergency procedures until April 30 at the earliest.”

The ADA’s original recommendation, issued March 16, was set to expire on April 6.

The interim recommendation is in keeping with the recent U.S. Centers for Disease Control and Prevention’s recommendation to perform only emergency or urgent dental care.

According to the statement, “The ADA also recognizes that existing and future local or state government mandates supersede ADA recommendations. In addition, state dental associations may best understand local challenges being faced and make recommendations appropriate to members in their areas.”

In addition, “The ADA believes individual dentists should exercise professional judgment and carefully consider the risks outlined in the ADA’s interim guidance and weigh those risks against any possible benefit to the patient, the practice employees, the community at large, and the practitioner. Critically important is the availability of appropriate personal protective equipment (PPE) to minimize any risk of transmission during emergency and urgent care. Due to the proximity of individuals during dental procedures, and the generation of aerosols, dentists, staff and patients are at high risk of transmission.”

The statement concludes, “The PPE required to reduce the risk of transmission during dental treatment to its lowest levels — as noted in algorithm No. 3 of the ADA Interim Guidance for Management of Emergency and Urgent Dental Care — are scarce. Asymptomatic patients cannot be assumed to be COVID-19 free. As of March 31, point of care tests exist, but are extremely difficult to obtain. Unless point of care tests are readily available to the dental practice, no one can be assured that they are treating a non-infected individual. The safety of their patients, staff and themselves should be foremost when dentists exercise their professional judgment, and information regarding the relative risks is available from the ADA, via the Interim Guidance, to assist in making those decisions.”

Monday, March 30, 2020

A Nifty DIY Respirator that has the Potential to Provide Better Filtration than N-95

     

 


One of the things I truly love about dentistry is the passion that many of us feel for the profession.  This morning's post is going to go right along with that sentiment.  As we all know, the big news story of the last month has been the novel Corona  Virus with can lead to Covid-19.

The virus originated in the province of Wuhan, China and then rapidly spread across borders, demonstrating how amazingly contagious the virus is.  As it initially began to infect people in China, doctors, public health officials, and epidemiologists tried to get a handle on how the virus managed to spread so rapidly and efficiently.

A virus has always been trickier to deal with than a bacterium for a variety of reasons.  We won't get into all of those here today, however I would like to detail ONE trait that a lot of folks  outside  of medical realms are unaware of.  A virus (or viral particle) is *tiny* compared to a true bacteria.  Due to their size, they can frequently get through filtration mediums that stop other infectious agents in their tracks.

In many practices of medicine, dentistry included, a surgical mask is part of the everyday PPE (Personal Protective Equipment) that practitioners wear.  The surgical mask is a 2 way street.  It not only protects the healthcare worker from receiving infectious particles from the patient, but it also prevents the patient from receiving infectious particles from the healthcare worker.

It's also the same story for gloves.  Studies that had been done back in the times when dental professionals worked without gloves found that bacteria from the mouths of patients seen on Monday could be cultured from under the fingernails of workers on Friday afternoon.  Basically that meant that every patient seen for a week left their bacteria on the dentist's hands and therefore into the patient's mouth.  Scary right?

But for this discussion we're going to concentrate of the mask.  Recent studies of the Novel Corona Virus show it to be somewhere between 140 nanometers and 60 nanometers in size while the average size of bacteria is around 300 nanometers.  Surgical masks usually filter to about 100 nanometers while N-95 respirators filter to 30 nanometers.

Surgical masks are designed to cover the moth and nose loosely but are not sized for individual fit.  However, N-95 Respirators are designed to fit the wearer closely.

As the Covid-19 pandemic has progressed we, in healthcare, have seen an incredible shortage of N-95 masks as there is a scramble to protect healthcare workers from becoming infected and potentially passing the virus along to other patients and healthcare providers.

Now one of my pet peeves, as many of you know, is that when someone asks why we do something a certain way, the answer is "because we've always done it that way."  That's just a plain lousy answer.  So the question I've been asking the past week or 2 is "why do we always buy masks from distributors" and the answer is... you guessed it.

Then I came across a small website called www.firedbycorona.com  This website was put together by Dr. Mark Causey who is an orthodontist in Georgia.  Dr. Causey is a forward thinking guy and uses a 3D printer in his office.  His idea was, rather than buy N-95 masks and then throw them away, why not print a N-95 framework that you could theoretically use for years and simply replace the filtration when it was no longer working.  Genius!  Dr. Causey even designed the framework, saved it in an stl file, and made it available *for free* on his website.

His thought process is that if everyone that has a 3D printer started to produce these frameworks, we might very well cut the N-95 mask shortage.  His website goes through the entire process of creating a N-95 mask from a printed frame and readily available HEPA filters.

Since discovering this website, I've been printing these mask substructures pretty much non-stop on my Ender-3 printer in my home.

We are now creating masks that help prevent the spread of the Novel Corona Virus while also keeping masks out of the landfill.

I'll be doing more posts on this fascinating subject in the next few days.  I'm proud of Dr. Causey for his hard work and outside the box thinking.