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Jonathan Shenkin is a pediatric dentist in Augusta and faculty member in health policy and pediatric dentistry at Boston University School of Dental Medicine.
In March, the New York Times alerted dentists and their clinical staff members that they were at the greatest occupational risk of contracting the coronavirus. To conserve personal protective equipment (PPE) and reduce the risk of transmission, governors ordered the closure of non-essential health care around the U.S. Dental offices shuttered for weeks, and many clinical staff feared for their safe return to dental practices. Some dental professionals even warned the public of the risks of returning to dental offices.
Fast forward six months, and there still isn’t a single known case of transmission of coronavirus in a dental setting between a patient and dental staff member in the United States and internationally. While many health care workers have become infected, clinical dental staff appear to have avoided this fate.
Several days before the New York Times infographic on the risks of being a dentist, I wrote an OpEd for the BDN titled, ”Dentistry is well poised to ensure the safety of our patients”. The backbone of the March 12 OpEd was that dentistry has been faced with a myriad of infectious diseases for decades, diseases from tuberculosis to HIV, hepatitis to herpes. Standard precautions were introduced into the dental profession in the 1980s to prevent transmission of these and other diseases. Dental chairs have essentially become small hospital operating rooms, with diligent protocols for safety and infection control.
While few countries report on the mortality of dentists, Italy has been tracking the number of dentists who have died from the coronavirus. As of this past week, 14 dentists in Italy have died. At first this chronicling of death among dentists seems ominous. But when some simple mathematics is applied to the death rate of dentists versus the death rate of the general population, a fascinating discovery occurs. Dentists in Italy died at a lower rate (0.28 per 1,000 dentists) than the general population in Italy (0.59 per 1,000 people), despite being in close proximity to the unmasked mouths of their patients.
Since late May, states started reopening dental offices again, and dentistry is essentially business as usual. Armed with some additional PPE, additional patient screening, as well as reductions in aerosols, the practice of dentistry has changed little, with dentists reporting business at around 75 percent of what it was before the pandemic.
Why has dentistry succeeded at preventing the transmission of infections? This can be attributed to adherence to strict infection control guidelines that have long been in place in dental offices. Although dentists screen out dental patients who may have symptoms, science has shown that those who are infected with coronavirus and without symptoms can still be infectious. Surely one of these asymptomatic patients has gone to the dentist. And we have likely seen countless patients in dental offices with mild symptoms from coronavirus who have not been screened out. With infection rates skyrocketing in regions of the United States, the opportunity for dental office transmission has been ripe, yet still none have been reported.
One possible rationale is that clinical dental staff are accustomed to PPE; it has been part of our everyday life since the 1980s. Many in health care aren’t accustomed to wearing PPE, and adjusted, like the public has, by touching their faces more when wearing PPE. One recent study from China speculates that those who wear glasses are at a far lower rate of infection from coronavirus, presumably protection from aerosols being absorbed through the eyes. All clinical dental staff have worn eye protection for over 30 years.
The dental care system closed for many weeks earlier this year to protect the dental team and patients from the spread of coronavirus. Many governors deemed dental care “non-essential”, worrying that there was too much risk providing dental care. While we haven’t identified any dental office-based transmission between patients and dental staff, surely there could be some, though currently unmeasurable.
What we now know is that the benefits of continuing dental services far outweigh the risks in the age of coronavirus, and that dental offices are one of the safest health care facilities for the public to be, and dental care should remain an essential health care service as the pandemic continues.