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

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:

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 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

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

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

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.”