UPDATE: June 1, 2020
To our patients, friends and colleagues,
I’m happy to announce that we are re-opening.
Managing a small business through this pandemic has been a challenge, to say the very least. No doubt, many of my fellow small business owners will decide the coronavirus pandemic marks the end of their business ownership. It was a gut-wrenching feeling to even consider closing the practice completely. However, it’s become abundantly clear to me that I have a lot more patient-centered care to provide.
Many of you know that I’ve wanted to be a dentist since high school. If it’s not clear when I see you in the office, dentistry has become central to my identity. I find incredible satisfaction in the relationships I’ve built with patient families and colleagues, the science and art of the day-to-day and the focus on life-long learning. I’ve spent the last 9 weeks reviewing the science and researching the evidence-based literature to find and implement best practices as we return to the office.
By nature, I’m quite risk-averse and a stickler for regulations (ask the team!). As I begin to re-open the practice, safety is absolutely at the forefront of my mind. So, let’s discuss safety in the context of a dental practice.
We have come to understand that SARS-CoV-2 spreads by way of minuscule, airborne droplets. These are the types of particles that erupt from your nose or mouth if you don’t cover a sneeze or cough.
We create similar airborne droplets in dentistry. Any time we rinse or dry your tooth off or use ultrasonic vibration to clean your teeth, it generates an aerosol. There is no getting around it in modern dental offices. There is some evidence from the Royal College of Dental Surgeons in Ontario, Canada to suggest that droplets remain airborne for up to three hours. This is also true of any other source of airborne droplet – say, when someone sneezes in the grocery story. What we CAN do is minimize the amount of aerosol left hanging in the air in our office.
A multitude of regulatory bodies now have something to say about keeping a dental office clean during the pandemic. The CDC. The American Dental Association. The California Dental Association. Governor Newsom’s office. Alameda County Health Department. The City of Berkeley. OSHA. I have thoroughly and repeatedly reviewed their mandates, directives and recommendations.
Unfortunately, there’s a lack of cohesion across all these sources and these guidelines are changing almost daily. In the end, the actual practice of following these recommendations falls on the individual business owners; there is not a clear “right way” forward. Be assured that we will continue to actively update our policies and protocols to align with current best practices.
Like the rest of the world, I don’t know where this is all headed. I do know that we will re-open in a way that honors the safety of our patients, our team, and our greater community.
Here is what we’re doing:
- We will see fewer patients per day.
- At the most, we’ll see a maximum of 2 patients per operatory per day for the foreseeable future.
- This spacing gives the aerosols in each room the necessary time to settle before cleaning and preparing it for the next patient.
- We will not be seeing patients five days per week, we will begin by opening for patient care on Tuesdays and Fridays.
- This maximizes the time between patients, further minimizing exposure.
- The virus is unlikely to survive on surfaces between days we offer treatment.
- This maximizes the time between patients, further minimizing exposure.
- Personal protective equipment (PPE) is required for all.
- Appropriate PPE will be worn by all staff at all times.
- Clinical staff will change gowns, masks, and surgical caps after every patient that generates aerosols.
- Patients will be given gowns and caps to wear during treatment, which will be removed before leaving the treatment room to decrease the amount of dispersed particles moving about from one room to the next in our practice.
- Our clinical staff has also been fit-tested for proper respirator mask fit per OSHA guidelines.
- We will stack care where possible
- Hygiene, exam, x-rays, and treatment will all occur on the same visit, in the same room, with the same team of providers whenever possible, with your consent, of course.
- Scheduling will be based on urgency and complexity of care required.
- The disinfectants used in our practice are all on the Environmental Protection Agency list of approved disinfectants for use against SARS-CoV-2.
- Windows will be open to allow for increased airflow rate.
- HEPA filters will run in each treatment room and front office.
- UV-C lamps will provide UV light sterilization in treatment rooms after procedures are complete.
- Isolation devices including high volume suction during treatment will be used whenever possible – and have been for all restorative dentistry procedures since I took over the office in 2016.
- Surface disinfection has always occurred multiple times per day, but we are increasing the number of surfaces disinfected such as door handles, countertops in the front office and bathroom surfaces.
What this means for you:
- We will be unable to see all patients at their regular hygiene intervals right away. We have a few months of care to catch up on, and appreciate your patience.
- We will need more background information from you when scheduling and confirming your appointment.
- Visits will temporarily be longer
- This will depend on treatment needs and allow for adequate time for check-in and out of the practice.
- Communication in-person with our clinical team may be difficult with all of our protective gear. We’ll do our best!
- All patients must complete a health and screening questionnaire 24-48 hours before their appointment, AND on the day of their appointment.
- Please wear a mask on your visit. We will ask you to remove it when we are ready to begin.
- Everyone (patients and team alike) will have their temperature and oxygen saturation taken BEFORE entering the office.
- Please call us when you are on the front porch, and one of us will meet you outside.
- You’ll be asked to clean your hands when you enter the office and rinse with a virucidal mouthwash before any treatment. You’ll also be asked to wash your hands before leaving the treatment room.
- If you need to bring an additional person or support animal into the office with you, please remind us when we do your health and screening questionnaire so we can be sure to allow adequate spacing between patient appointments to accommodate.
- We ask that you leave any unnecessary items outside the office.
- We will have some small plastic tubs with lids for cell phones, keys, etc. to keep those from exposure to additional aerosolized particulates.
- It is not likely that you’ll be sitting in our waiting room, as patients will be adequately staggered.
- Magazines, books and toys have been removed.
- Our waiting room is marked with appropriate social distanced areas to sit, if needed.
Our goal is to begin more routine treatment including hygiene visits by mid-June, but that is all subject to local and state recommendations and the availability for us to continue procuring adequate personal protective equipment. I ask if you have access to a qualified vendor, please do reach out, as much of dentistry’s supply chain has been disrupted significantly.
I thank you personally for your support of our practice and small business, the trust you’ve placed in our team and for your patience and understanding as we navigate this together.
For those of you that have been walking up the stairs to the door at 2519 Ashby since 1970, when Drs. Ware and Brigante submitted a request to the City of Berkeley to convert the house into a dental office, I especially thank you. This is not how I envisioned celebrating 50 years of dentistry in this place that is my second home, but know that I will do everything possible to keep it going for many years to come.
Be well, and we hope to see you soon.
Lauren Yasuda Rainey and team
Sources reviewed for the guidelines above:
UPDATE: May 13, 2020
The City of Berkeley, the California Department of Public Health the California Dental Association and the American Dental Association recently released updated guidelines on dental care during the pandemic, which enable us to continue to treat emergent dental conditions. Our office will be honoring the shelter in place recommendation through the end of May for routine dental care visits.
After the shelter in place orders are lifted, we will be prioritizing care, per CDC guidelines, for those “conditions that are likely to lead to dental emergencies if treatment is not provided in a timely manner.” Our office will begin to contact those patients that had appointments rescheduled due to COVID-19.
We thank you in advance for your patience and understanding as we begin to evaluate care on a case-by-case basis so that we may provide exceptional patient care just as efficiently, and safely as possible. Our schedules will be staggered to allow for adequate distancing between patients coming and going, and for increased sanitation measures. We have always taken infection control very seriously, but you may notice some updated protocols the next time you’re in our office.
Our top priority is maintaining a professional overall health-centered environment for our patients, our team and our community.
In the meantime, take good care, floss often, and we look forward to seeing you just as soon as we are able!
UPDATE: March 20, 2020
The following guideline from the California Dental Association was released today:
The California Dental Association strongly recommends that dentists practicing in California suspend all in-person dental care with the exception of emergency treatment, until further notice.California Dental Association
In order to keep our community safe, we will be suspending all scheduled treatment at this time. If you have questions, the best way to reach us is at firstname.lastname@example.org
March 13, 2020
To our patients, friends and colleagues –
I am writing to update you on temporary changes at our office due to the growing concerns with COVID-19.
We hold ourselves to the highest standards for care, which has always included management of clean work and waiting spaces, including sterilization and disinfection of the instruments and treatment rooms we use. All dental professionals also receive ongoing training in infection control. We have taken extra steps in infection control since the outbreak of the novel coronavirus to assure we provide a safe environment for our patients and staff.
To reduce the risk of spreading the novel coronavirus, we are scaling back to provide urgent emergency treatment only. We’re asking all non-urgent visits to reschedule until after April 1, 2020. You will be contacted by someone on our team to make changes to existing appointments. We anticipate more data and recommendations available specific to dental offices by then, however, we do recognize this a rapidly changing situation. We will keep you updated if additional appointments need to be postponed.
This is not a decision I take lightly, but one that I hope will keep our community healthier, stronger and better equipped to address this public health emergency as it unfolds over the coming days and weeks.This is an opportunity where we can be proactive about our health and the health of our communities.
Please do not hesitate to contact us at email@example.com with questions in the interim.
As always, thank you for entrusting us to partner with you to care for your oral health.
Lauren Yasuda Rainey, DDS and team
More information available from the CDC and the City of Berkeley