Matt Kolkman
I am a dentist from around Fort Wayne, IN (Grabill Family Dentistry), chair of the IDA communications committee, member of the IDA Task Force for COVID-19 Response, and soon to be IKDDS Treasurer. This is a long post so please bear with me. What follows is my professional opinion and should not be construed as the opinion of the CDC, ADA, IDA, IKDDS or any other person or professional entity. If you get through it all, I’m impressed 😊. If you have questions please feel free to reach out directly, my personal email is matt.kolkman@grabilldentistry.com
First of all, this is a scary and challenging time for us all. I completely understand the fear and uncertainty that many of you are feeling since the recent announcement by the Governor earlier this week. There is an inherent risk that is present for all of us catching COVID-19. Unfortunately, there is nothing anyone can do to provide you with 100% certainty that you will not get sick. This is true in the dental office, grocery store, Starbucks, or even sitting at your home. All of the recommendations that have been presented by the CDC, OSHA, ADA, and even IDA are strategies to DECREASE risk, but NOTHING will eliminate the risk. That being said, each and every person has varying degrees of risk tolerance. If your individual risk tolerance is different from your dentist or anyone else in your office, it will create a significant strain in your offices’ work environment. Therefore, I strongly suggest you communicate this and see if a mutually acceptable plan can be created. If this isn’t possible perhaps the best move would be to separate yourself now. That means different things based on your situation, but it may mean you take an extended leave of absence and stay home, you retire, or you find a new place of employment…
Secondly, I wanted to address some of the misinformation I have been reading specifically related to Indiana’s return to work and the dental office recommendations. OSHA has released categories: very high risk, high risk, moderate risk, and low risk to describe patient encounters and susceptibility to transmitting COVID-19. Very high and high are procedures completed on suspected or known COVID-19 patients. Moderate and low categories are for patients that do not have COVID-19. Since we have no way of effectively discerning exactly who has it and who doesn’t then we must assume everyone is at minimum a carrier for the disease.
PPE – I want to make one thing clear regarding PPE. Most of us are all scientific minded that like to see things in black and white, right and wrong, YES and NO. Unfortunately, the topic of PPE involves 50,000 shades of grey. Everything provided by the CDC, ADA, and IDA in terms of “best practices” are currently recommendations, NOT mandates. Mandates are laws which are established by the state or federal government. And, up to this point, there are no specific mandates regarding appropriate PPE. N95 masks with face shields are considered “ideal”. However, wearing surgical masks with goggles is considered “acceptable”. Disposable gowns for each patient are “ideal”. However, wearing scrubs which are removed and laundered at the office is considered “acceptable”.
• Does a N95 provide better filtration/fit than a surgical mask? —- Yes.
• Does better filtration and fit mean that you won’t get sick? —- NO!
So, until we know more, PPE is a good-better-best debate. Each dental office and practitioner must determine what PPE is most appropriate for the procedures they will be completing. Higher risk procedures (ones which result in more aerosol and/or more time spent in front of the patient) should be appropriately treated using higher levels of PPE. Lower risk procedures (with less time in front of the patient and no aerosol) could be completed using our standard precautions.
CHAIRSIDE COVID-19 TESTING – In order for a chairside test to be appropriate for use in a dental office it must accomplish a few things.
o Rapid – it must provide results quickly –preferably under 10-minutes.
o Appropriate– it must answer the question – IS THIS PERSON CONTAGIOUS?
o Accurate – it must give us certainty that the results are true and consistent
o Inexpensive – it must be cheap enough that we can do it on every person, every day
Unfortunately, there are no tests available that check all of these boxes. Current viral-activity tests are taking 3-5 days to have results back, they are 70-85% accurate and dentists are not approved providers. Abbot Labs’ new rapid viral-activity test requires very expensive equipment which isn’t practical for most dental offices. Antibody testing evaluates the body’s immune response which may occur several days after a person catches the disease and becomes contagious. Hopefully this will change, and there will be a test developed that is as simple as chairside glucose screening. Unfortunately, we are not there yet.
Finally, I want you all to know the reason most of your bosses are wanting to get back to work. And, believe it or not, it has NOTHING to do with making money. We have all taken an ethical and moral obligation when we entered this profession to do no harm and to do what is in the best interest of the health and wellness of our patients. We have now gone a full month completely neglecting the dental health of our patients.
We are experts in the oral/systemic connection and educate patients every day on how the health of the mouth is connected to the health of the rest of the body. This viral outbreak has not eliminated the oral-systemic connection. We all have patients suffering from high blood pressure, diabetes, congestive heart failure, etc. which we know are tied to periodontal disease. These patients need to be on regular periodontal maintenance in order to stay healthy and keep their systemic inflammatory markers low. We also have patients with active tooth decay and oral infections which will only get worse with time. How would you feel as a patient if you had a deep cavity or restoration which needed completed right now? If these rather routine procedures are put off too long our patients will become dental cripples or worse yet, die. Now, I understand this is a bit of an exaggeration for most patients. However, if you don’t believe that maintaining dental health is important and that we have a role to play in ensuring the long-term systemic health of our patients then perhaps you are in the wrong profession.
My final question for everyone to ponder… If not now, then what time would be appropriate for you to return to work?
This virus is not going away. It will be here one week from now, one month from now, six months from now, and likely even a year from now. The risk of getting sick will be present from now until the time we have a reliable vaccine. So, if you are uncomfortable returning to work because you don’t want to be sick and/or don’t want to risk getting anyone else sick, then stay home (and know, it could be a long wait). If you are uncomfortable returning to work because you don’t feel like your boss is taking things seriously, then I suggest you have an open and honest conversation with them. If they are unwilling to listen, leave. It’s not worth the stress and risk to work for some one who won’t listen to you. However, most of you will find the exact opposite happens. They will listen to you! The truth is that, as business owners, we are just as scared. We have families and loved ones that are at risk. We are worried about making them sick. We are worried about making you (our team members) sick! We are doing the best we can to prevent this disease from spreading while at the same time fulfilling our professional obligations. Please help us, we can’t do it without you!!