Apr 30, 2020
May 19, 2020 - Arminco Inc.
Déjà vu in Dentistry: Comparison of early HIV and Covid-19 concerns in Dental Practice The practice of dentistry may never look the same again. And while we may not feel this way now, maybe that is a good thing."In 1983, a retrovirus (later named the human immunodeficiency virus, or HIV) was isolated from a patient with AIDS"1. Many of us now likely do not remember the start of the AIDS pandemic or had to live and practice through the changes and its impact on dentistry. Those times have been reduced to mind blowing and sometimes humorous stories we hear from the previous generation of dentists…"Back in my day, we didn’t wear gloves!" My dad laughs telling the story of seeing his dentist, bare handed in the middle of an extraction, with a cigarette hanging out of his mouth. These things today, we could not even imagine, and they seem downright prehistoric in comparison to the practice of dentistry we know and operate in today. But during the origin of Standard Precautions, no one was laughing. Dentists were not only panicking about getting, giving, or spreading HIV, but were sheerly overwhelmed with the challenge and cost of bringing in personal protective equipment (PPE), equipment, and protocols to adapt. It was not until as recent as 1985, that the Centers for Disease Control (CDC) introduced the concept that all bodily fluids could be infectious and treated as such2.The term "Standard Precautions" was then introduced in 1996. During the roughly 10 years between the emergence of HIV, the evident need for a shift in precautions in health care, and implementation of standard precaution practices, there were a good number of dentists that went kicking and screaming. Concerns ranged from ability to work with gloves and mask, PPE interfering with patient report and relationship building, and flat out cost of supplies. Prior to the 1980’s, gloves were used by dentist only about 20% of the time, and mostly only for cases of documented HBV. The SARS outbreak of the early 2000’s and a brief resurgence of TB, led to the more regular use of isolation practices such as dental dams and suctioning units, pre-rinsing with an antimicrobial for appointments, as well as the use of N95 masks3."The usage of rubber dams can…reduce microbial aerosolization by up to 70%"4. Similarly, many changes have occurred over the years, such as closed bag sterilization of handpieces, disposable burs, and the flushing of dental lines.
Could you even imagine, today, anyone trying to convince you that you were safe in a dental office where providers did not wear this basic PPE, or you could not visualize bags of sterilized instruments? It would be unheard of. Perhaps, we are at the beginning of a new and similar era, in light of COVID-19. Albeit, we are talking contact precautions vs droplet and airborne precautions, but ultimately, change is coming. Some things are not even that much of a change. According to an article from JADA in 2010, "Respiratory hygiene and cough etiquette measures are considered a component of Standard Pre-cautions and should be practiced routinely in dental settings"5 .
Let us learn from history and not repeat it. We adapted to a once life threatening disease, and emerged better and stronger as a community, profession, and vital branch of the healthcare system. Healthcare cannot and will not be able to go on without dentistry. So yes - we are facing uncertain times ahead - but also opportunities to improve the health and safety of our patients, staff and ourselves. For more information about this, you can contact us here.
1 n engl j med 354;23 www.nejm.org June 8, 2006
2 JADA, Vol. 141 http://jada.ada.org May 2010573
5 JADA, Vol. 141 http://jada.ada.org May 2010573
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