Editor’s note: Please refer to Guidelines for Dental Settings by the Centers for Disease Control (CDC) for definitive information on the evolving situation of the COVID-19 pandemic as it relates to dental practice precautions.
Finally this past winter and spring spring, we saw something of a light at the end of our long, dreary, tunnel. The moment that our 2020 selves had been waiting for—options to become vaccinated against SARS-CoV-2 became widely available to the general public. As we take the next steps into the future of “normal” lives, let’s stop and think—what does “normal” look like now? Will dental offices revert to their old ways from 2019? What’s next?
Wait! Don’t throw away your face masks, cough etiquette posters, and office thermometers just yet. According to the Centers for Disease Control and Prevention (CDC), health-care facilities must continue to screen patients for symptoms of COVID-19 and exposure to COVID-19, and require patients to wear face masks while inside the facility.1 The American Dental Association (ADA) recommends posting visual alerts at the entrance of your office, as well as in strategic places, to help source control of COVID-19. Additionally, your employer must provide supplies for infection control, such as PPE and alcohol-based hand sanitizer, for free.2 Long story short, dental offices must keep their current practices of screening patients, wearing face shields, and maintaining the mask requirement. After all, wasn’t it lovely dodging the common cold and other respiratory pathogens last winter?
Current OSHA orders
Don’t forget to update your records. The Occupational Safety and Health Administration (OSHA) issued the Emergency Temporary Standard (ETS). Although the ETS doesn’t directly apply to most dental practices, it does incorporate important information for all health-care facilities. This standard requires that offices must develop and implement a plan that highlights the policies and procedures taken to protect employees from COVID-19.2 So, not only must dental offices continue their protocols to prevent COVID-19; they should also write it down on paper and ensure the office’s designated safety coordinator enforces these policies. Offices must have an exposure control documenting information on bloodborne pathogens. With the ETS in place, we must now wipe the dust off our exposure control plan and update it with information regarding SARS-CoV-2.
What about if you’re fully vaccinated but recently discover that you were in close contact with someone confirmed with COVID-19? According to the CDC, you don’t need to refrain from work, nor quarantine, as long as you’re asymptomatic; however, you must monitor for symptoms for 14 days post-exposure. If you are symptomatic after an exposure, regardless of being fully vaccinated, you’re still required to take get tested for COVID-19 as soon as possible. If you test positive for COVID-19, a 10-day quarantine is indicated.3
The uncertainty of Delta
Don’t forget to educate your patients! Many may assume that they’re invincible now that they’re vaccinated from COVID-19. This is not true, and we must inform our patients of that. Although fully vaccinated individuals have a reduced risk of transmitting the alpha variant of COVID-19, they should still isolate themselves if experiencing symptoms and upon returning from international travel.4 Just when we think we’re nearing the end of this drawn-out fight with this dreadful virus, it has now shape-shifted and returned fire in the form of the Delta variant. As far as we know, vaccinated individuals still have a reduced risk of contracting the Delta variant but can still transmit it to unvaccinated individuals.5 This variant is 50% more contagious than the alpha variant, has now become the dominant strain in the United States—and experts are predicting another surge in unvaccinated communities.6
I know what you’re thinking: “At least I’m vaccinated, so I have nothing to worry about, right?” Wrong. The more this Delta variant spreads, the more opportunity it has to mutate again into a deadlier strain with increased binding affinity and immune escape, which experts are most concerned about.7 This is why it’s essential to encourage our unvaccinated patients and peers to get vaccinated. I know this can be a touchy subject to bring up, which is why I am here to help provide information to refute some common arguments against getting vaccinated:
“Most vaccines take over a decade to develop, and this one was whipped up in less than one year. I don’t trust it.” Just because this vaccine was developed more quickly doesn’t mean that steps were skipped. This virus poses a threat to the entire world. Rather than pharmaceutical companies competing with each other, countries around the world collaborated, shared data, and pooled money together, allowing for more resources in the process of development.
“But what about the risk of blood clots and myocarditis?” Out of the hundreds of millions of vaccines that have been administered, this has only occurred in a minuscule percentage of individuals. After thorough investigation, the FDA and CDC have observed these as rare occurrences, and any cases of myocarditis have been mild and resolved quickly. Therefore, the benefits of vaccination exponentially outweigh the risks.8
As health-care professionals, we must continually stay updated on new research and recommendations and educate our patients on these recommendations and the safety of vaccination. As prevention specialists, we must do our duty in not only preventing oral pathologies, but also preventing the transmission of disease by staying updated on compliant practices, as well as maintaining superb infection control protocols in the office.
References
1. Burger D. ADA providing guidance on updated mask recommendations from the CDC. American Dental Association. May 19, 2021. https://www.ada.org/en/publications/ada-news/2021-archive/may/ada-providing-guidance-on-updated-mask-recommendations-from-cdc
2. ADHA interim guidance on returning to work. American Dental Hygienists Association. June 15, 2021. https://www.adha.org/resources-docs/ADHA_TaskForceReport_9.pdf
3. Interim public health recommendations for fully vaccinated people. Centers for Disease Control and Prevention. May 28, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
4. When you’ve been fully vaccinated. Centers for Disease Control and Prevention. June 17, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html
5. Crist C. What you need to know about the delta variant. WebMD. July 21, 2021. https://www.webmd.com/lung/news/20210712/what-to-know-about-covid-delta-variant
6. Crist C. Delta becomes dominant coronavirus variant in US. WebMD. July 7, 2021. https://www.webmd.com/lung/news/20210707/delta-dominant-us-coronavirus-variant
7. Hagan A. How dangerous is the delta variant (B.1.617.2)?. American Society for Microbiology. July 30, 2021. https://asm.org/Articles/2021/July/How-Dangerous-is-the-Delta-Variant-B-1-617-2
8. Maragakis L, Kellen G. Is the COVID-19 vaccine safe? Johns Hopkins Medicine. July 16, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/is-the-covid19-vaccine-safe
Joy McCarthy, MsEd, BSDH, RDH, has been practicing in the state of Massachusetts for over five years. In private practice, she holds the title of OSHA infection control coordinator, where she keeps the office updated on current CDC guidelines and OSHA protocols. She received her bachelor’s degree from the University of New England in Portland, Maine, in 2016, and completed master’s degree in health-care education at St. Joseph’s College of Maine in May of 2021. For more information, email her at [email protected].
