Preparing for Re-Opening Your Dental Practice

A Practical Guide to Re-Opening Your Dental Practice After Covid-19 by Sherilan Sullivan, April Welker & Dru Halverson

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Doctors and healthcare professionals are the most prepared to keep patients safe to reopen. We already have been following Federal and State Infection Control procedures for decades.

A ‘softer re-opening’ will allow you to prepare your office, schedule, equipment, and team for the new changes and guidelines in order to reopen to treat your patients. Setting time aside to work with your team will ensure that the proper precautions are in place, the team feels safe to return and a plan is in place to communicate the changes to your patients.

Here are additional points to consider and implement to protect yourself, your team and your patients.

Your Dental Practice Schedule

Step 1

Plan a gradual re-opening. Additional time will need to be built into each appointment to allow for the proper decontamination procedures. Moving forward, appointments may not be allowed to be stacked each hour or one patient right after the next. For example, all hygiene appointments may need to be scheduled for 80-90 minutes the first 10-14 days after you reopen. Also, your restorative treatment appointments will need extra time as well. Give yourself some leeway. Be prepared for this schedule change to last awhile – we may not be able to speed up the process much per appointment/per patient.

Step 2

The business team will need to readjust the scheduling blocks, this should be done now. Resetting the blocks will create a new road map to follow once the scheduling triage had been completed.

Step 3

Stagger Patients: Do not stack dental appointments – ramp-up slowly. Only use chairs 1-3-5. Give yourself space and distance.

Step 4

Restorative and Hygiene Patient schedule triage must be completed. Determine patient needs and prioritize for re-appointment:

  • The hygiene team can take turns coming in to analyze their schedule.
  • The assistant team can work with the doctor to analyze their schedule.
  • Print then highlight directly on the schedule, this will become a tool for the business team when calling patients to reschedule.
    • Red – perio and high risk of re-infection = Appoint back into the schedule first.
    • Yellow – moderate risk and incomplete treatment = Appoint back into the schedule second.
    • Green – low risk = Appoint back into the schedule third.
  • The team should create verbal skills and scripts to recreate urgency and overcome objections.

Step 5

Have a dental assistant assigned to High Volume Suction for the hygienists and doctors to eliminate necessary aerosol spray.

Step 6

For Restorative Patients:

  • Defined as patients who require, in the treating dentist’s opinion, urgent care.
  • A dental procedure that was recommended a month or two ago will become urgent.
  • We want to prevent active infection, abscesses, more investment for the patient.
  • For dental procedures add an additional 20-30 minutes per patient, per procedure to help mitigate any contamination and allow for the best patient/team management.
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Appointment Confirmations

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Step 1

Patient Communication: It is the MOST important step.

Step 2

Utilize phone confirmations to ease your patients of their concerns, build rapport and foster relationships with your patients.

Step 3

All patients must be called prior to their appointment in order to inform them of the mandatory protocols and explain new safety policies. It is more important than ever that we communicate with patients. They need to understand the following:

  • The dental office will NOT allow any employee to work while sick.
  • If they have a fever, traveled out the country, or to one of the highly infected areas, you are going to ask them to postpone their appointments.
  • Their temperature will be taken, as well as, our team members and possibly the use of a finger pulse oximeter.
  • For the patients that are asthmatic, COPD, etc.; their appointment should be delayed to a later time.
  • They should plan on coming to their appointment on their own or have family members waiting in their car. Patients will not be permitted to wait in the reception area.
  • They should plan to bring their own blanket, lap quilt, jacket, etc. since your office may be much colder to accommodate any additional PPE you will be wearing. It will be cold – have them dress accordingly.

Step 4

All patients need to understand that their temperature will be taken and that they will be asked the COVID-19 questions once again when arriving at the office.

Verbal Skills Example

“We are healthcare providers and I can promise you that we always follow all of the CDC’s safety protocols. Just think about the last time you were here. We always wear masks, gloves and change our protective outerwear in between every patient. Everything is sterilized and we have increased our already-high standards.”

“Nothing is more important to us than your health, and that’s why it’s important to us to see you as scheduled. Dr. Jameson and his dental team have prepared for your appointment and are looking forward to taking care of you today at 3pm.”

Patient Check-in

Office Entry Restricted

Place a sign on your front door with the office phone number and instructions for the patient.

Possible phrasing:

  • We’re happy to see you!
  • We will bring you directly into a private treatment room at your scheduled appointment time.
  • Please call [PHONE NUMBER] to let us know that you have arrived. Thank you!

Reception room is closed

Check-in is done over the phone or text from their car upon arrival at the office. Patients wait to be called-in for their appointment once the previous patient is gone and sanitation is complete.

Only patients may enter office for the appointment

Spouses, friends, caregivers and parents need to wait outside. They can assist the patient to the front door and handed off to the sterilization technician. There may be exceptions for small children in need of care.

The patient (if a minor) will be escorted to the office door by the parent/guardian.

Only the patient is allowed in the office. The Parent/Guardian will ‘hand off’ their minor child to the dental auxiliary at the door. There may be exceptions for some of the small children.

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Patient Interaction

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Step 1

Proper patient protection will be at the door for the patient to put on before entering the office. For example, protective gear, mask and gloves will be provided to the patient.

Step 2

A ‘greeter’ or sterilization specialist will meet the patient outdoors, in a vestibule, or area close to the external door. The temperature of every patient will be taken. The COVID-19 questions will be asked and answered, either while sitting in their car when they call in, or at this point. You are not diagnosing or recommending medical steps to the patient based on temperature. You are simply protecting yourself, your team and your patients.

Step 3

The sterilization specialist will escort the patient directly to the treatment area/chair after hand sanitizer is used by patient and clinician.

Step 4

Patients should expect to see the team in head to toe protective gear from start to finish.

Step 5

The patient will be asked to pre-rinse with a dilution of hydrogen peroxide.

Step 6

Upon completion of the dental service, the patient’s guardian/parent will be
notified by phone to come to the front door of the office.

Step 7

The patient will use hand sanitizer when leaving the office. They use it twice; arrival and departure. You find that donning and taking off gloves for the patient offers more protection.

Step 8

The patient will be handed off to their parent/guardian who is outside by the door and NOT in the office.

Step 9

If a payment is required, think of new ways to receive that payment prior to their appointment – have them pay online, utilize your Patient Communication System to receive the payment, have them give the information via the phone during confirmation, or have a no-touch scanner for payment in the office.

Step 10

As always, the patient must make the payment before leaving the office.

Step 11

Rethink your consultations. Could these be done via a teledentistry method without the group in all of the masks and safety glasses?

Step 12

A follow-up appointment will be given at the time of payment.

Step 13

If you do not want the patient to stop at check out – have them walk to their car, give you another call – collect the payments that have not been taken care of and schedule the next appointment.

Step 14

After each visit every place the patient goes will be wiped down with Cavicide or an equivalent surface disinfectant.

Verbal Skills Example

“We always comply with all CDC and OSHA directives for disease prevention and protection. In addition to sterilizing our clinical areas, we are asking our patients to thoroughly wash their hands when they arrive for their appointment and before leaving. You will see plenty of soap and clean disposable hand towels in our bathroom and you will find sanitary hand gel and tissues in every room. These are there for your use and comfort and to keep us all safe.”

“Every single instrument is completely sterilized after every use. Our safety attire, including clinical jackets, face masks, and gloves are changed before seeing each patient.”

“You may not realize it, but between patients, the dental assistant wipes down the dental chair and all surrounding surfaces with disinfectant after each patient. This is part of the standard disease prevention protocol and we always do it.”

Remove Non-Essential Items

Any non-clinical items should be stored.

  • Clear ALL items from the counter-tops in the treatment room.
  • Examples: any paper items, dental display models, flyers, brochures, night guard samples implant displays, etc.
  • Have cotton rolls, cotton tip applicators, carpules, floss, etc. readily available inside cabinets/drawers on your tray set-up. Pull off the amount of floss you will need for the hygiene patient, crown seat, etc.
  • Remove all magazines, care-credit applications, etc. from the reception area.
  • Place covers over or put away curing lights, etc.
  • You are attempting to eliminate the possibility of aerosols landing and surviving on any item
    or surface.
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Personal Protective Equipment (PPE)

All employees will wear PPE

This includes a mask (level 3-N95), gown, head coverings, gloves, face shield and shoe covering.

Gloves

Wear gloves whenever carrying anything outside the op… to the lab, sterilization etc. Wear gloves when cleaning ANYWHERE in the office including the front, clinical area and then of course, for patient care.

Masks

You need to have the BEST available PPE for every clinician because N95 masks and the level 2 and 3 may not readily available.

Glasses

ALWAYS wear glasses anytime you are creating ANY KIND of aerosol. These can be washed with soap and water. Have more than one pair so they can properly dry between use.

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Face Shields

you will need to attempt to find face shields that work with your loupes and headlamps.

Lab Coats

Wear disposable or cloth lab coats. These need to cover all other clothing from neck to knees and down to your wrists.

Hair Covers

Although these may NOT be required we believe that this important. Bandanas, scarfs, surgical bonnets can be used. If cloth, wash
these as you would wash your cloth masks.

Cleaned PPE should be donned from top down and reversed for removal

This should be practiced as a team to ensure that all team members are completing the steps correctly. Utilize the CDC or ADA for videos and additional information.

It is recommended that once you start a procedure you do not leave the room (doctor, assistants & hygienist) unless this is absolutely necessary, all PPE will need to be replaced.

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Dental Team Procedures

  1. Clinical shoes and scrubs should stay in the office. A laundry service or in-office washer and dryer should be used. PPE should be worn when handling exposed clothing.
  2. Wear clothes in – change into clinical attire at the beginning of the day. Properly store your garments in a plastic bag for safety. After work – change into your clothes – if washer and dryer in facility – wash there every night. Use hot water. If you utilize a laundry service determine a way to get the clothing to them safely. Put in plastic bag for safe storage.
  3. After you dispose of your PPE please wash your hands with soap and water for at least 45 seconds.
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Other Considerations

Dental supply deliveries

All supply deliveries from package carriers or dental suppliers must be accepted outside and sanitized once in practice.

Contain all aerosol spray

  • Use rubber dam to contain spray.
  • Minimize the aerosol spray – minimal use of hand pieces, ultrasonic scalers, air polishers, rubber cup polishing.
  • Always have a dental assistant help all providers and use a high-volume ejector (HVE) for all procedures.
  • Watch the saliva is red video as a reminder for the team.
  • Do not assume the entire team has the same understanding of aerosols.

Sanitization Technician / Environmental Dental Assistant

A new dental position. This could be a roaming dental assistant – the one that is most qualified for this new job. They will be responsible for monitoring and sanitizing all areas of concern. Also, making certain that the team members are following the new PPE and patient care management protocols.

Team Meetings

Continue to schedule regular team meetings, the reopening may be chaotic, it is vitally important to keep team communication constant.

Key Dental Advisor

Utilize your Jameson advisor to review and practice your office systems to ensure that we maintain clear expectations for the team and patients.