What we’re doing to protect you

We know that the news about Coronavirus and the associated respiratory illness COVID-19 has many of you anxious. While the medical community works hard to understand, test for, and contain this new virus, we want to reassure you that we are taking all precautionary measures to ensure that our office stays safe and healthy. Because we are medical professionals, our office has always followed best practices for sanitizing our office and preventing the spread of germs. With the new Coronavirus (COVID-19) developments, we continue to follow guidance from the Center for Disease Control and the American Dental Academy, and we are proactive and vigilant when it comes to sanitization and disease prevention.

Training and Educating Our Team

One of the most important things we can do during this time is train and educate our staff.

  • Our team has had refresher training in proper hand washing techniques. This may seem basic; however, it is the most important thing we can do to prevent spread of the virus. Yet research shows that it is often poorly complied with and usually not done well. Consequently, we have spent a lot of time ensuring that our team does it well and often, especially before and after every patient encounter.
  • They have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.
  • We encourage staff that is not feeling well to proactively stay home for two weeks (We have a backup team if someone is ill).
  • We have everyone in the office take their temperature at the beginning of every day and we will immediately send home anyone with an elevated temperature (100.2 F and above).
  • We limit the numbers of staff providing care to facilitate social distancing within the office and among team members.
  • We have created a specific checklist of recommendations for our team to follow so that they arrive to work healthy and go home to their families without worry. (see Checklist of Recommendations for Our Team)

Recommendations for Our Team

Before coming to work

  • Take temperature (do not go in to work if you or any other family member are experiencing symptoms; cough, sore throat, fever…etc.)
  • Remove watch and rings and leave at home
  • Tie hair up, keep nails short
  • Avoid extra accessories
  • Place phone in a Ziplock bag that you will discard at the end of the day
  • If bringing a lunch, place in disposable wrapping
  • Activate ApplePay so there is no need for cash or credit card
  • Bring work clothes in a washable bag (i.e. pillow case)
  • They have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.

At work

  • Take temperature upon arrival and record in the “Daily Screening Log”
  • Change into scrubs and work shoes (preferably plastic and wipeable) as soon as you arrive
  • Follow current office PPE guidelines and “Staff Protection Strategies”
  • Leave all clutter (pens, phones, etc.) outside of patient op rooms
  • We discourage workers from using other workers’ phones, desks, offices and other work tools and equipment when possible.
  • Clean phone handset after use
  • Discourage cell phone use at work

After work

  • Wash hands and arms with soap
  • Remove scrubs and place in washable bag or leave at work
  • Wash hands and put clean clothes on
  • Sanitize phone, glasses, etc
  • Wash hands again

At home

  • Do not touch anything upon arrival
  • Remove shoes and clothes as soon as you enter home
  • Wash clothes/scrubs in washing machine with detergent and hot water
  • Shower immediately with soap and water before touching anything (including loved ones)

Patient Interviews and Social Distancing

Before patient arrival every effort is made to

  • Filter patients during the phone call when scheduling appointments for care using established and recommended screening checklists and scripts
  • Prepare scripts and questions to recognize potential carriers
  • Reschedule patients who show any signs of a cough or fever or who describe having any concerning warning signs
  • Instruct patients to call ahead and reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat or fever) on the day they are scheduled to be seen.

To promote social distancing

  • Prioritize high risk patients (immune compromised, over 60 years old, etc.) with early morning appointments so less contact with other people
  • When making appointments, we are spreading out the schedule so there are less people in the common areas (A maximum of two people at a time)
  • If a patient is being accompanied, their escort should wait in the car to limit the number of people in the waiting room and promote social distancing
  • Utilizing a “virtual” waiting room: patients can and should wait in their car or outside the office where they can be contacted by mobile phone when it is their turn to be treated.

Safety measures taken upon arrival

  • Limit points of entry to the clinic.
  • Leave office door open to avoid contact with door handles
  • Post visual alerts (e.g., signs, posters) at the entrance door advising patients of the COVID-19 risk and advising them not to enter the facility when ill.
  • Masks and tissues are made accessible immediately upon entry and instructions are provided on how to use tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles.
  • Provide supplies such as alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues and no-touch receptacles for disposal, at the entrance, in waiting rooms and at front desk.
  • Post photos at the entrance and in waiting room to provide patients and HCP (Health Care Personnel) with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette.
    • how and when to perform hand hygiene,
    • how to use tissues or elbows to cover nose and mouth when coughing or sneezing,
    • how to dispose of tissues and contaminated items in waste receptacle

ALL these measures can help to prevent transmission to others.

Measures Upon Arrival

Patients are

  • Immediately escorted to a hand washing station
  • Escorted into an examination room with the door closed as quickly as possible upon arrival to avoid lingering in front office.
  • Asked about the presence of symptoms of a respiratory infection and history of travel or contact with possible COVID-19 patients.
  • Assessed for respiratory symptoms and fever (with a non-contact digital infrared forehead thermometer) and they will be asked to sign a health declaration form.
  • If fever temperature of 100.2 degrees F or higher or respiratory symptoms are present, they will be advised to seek medical treatment and their visit will be rescheduled.
  • As testing for the virus becomes more available, we will be incorporating this added benefit to screen patients.

Measures Taken Upon Patient Entry to the Clinic

  • If an examination room is not readily available, ensure social distancing in the waiting room by placing seating a minimum of 6 feet apart.
  • Remove all clutter and anything that is not easily disinfected from the waiting room (magazines, area rugs, pillows, toys, etc)
  • Cover all furniture which cannot be disinfected with disposable covers (including chairs and couches) which will be replaced after each patient
  • Frequent wipe down of waiting rooms, bathrooms, door handles, tables, light switches, computers…etc.

Reception Room and Front Desk Safety Measures

  • Install physical barriers or partitions (e.g., glass or plastic windows) if possible, at reception areas to limit close contact between reception and potentially infectious patients.
  • Headphone use is encouraged, so hands are free and only one person uses it.
  • Place air-handling systems (with appropriate filtration, exchange rate, etc.)
  • No handshaking or physical contact in throughout the office

Protocols of the Clinical Team

We adhere to usual standard and transmission-based precautions in operatory but with greater attention to detail and ensure that procedures are followed consistently and correctly.

Furthermore, we will employ an additional team member/ assistant whose main focus is only on sterilization. This team member will be responsible for cleaning, sterilizing, disinfecting and wiping down everything in the operatories and in the waiting room; chairs, handles, light switches, tables…etc on a regular basis.

Hand Hygiene is performed by our staff

  • Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment (PPE), including gloves.
  • After removing PPE in order to remove any pathogens that might have been transferred to bare hands during the removal process.
  • Washing hands with soap and water for at least 20 seconds

Personal Protective Equipment

  • Wear PPE (masks, gloves, cap, eye protection, face shields, gowns)
  • Masks should be replaced if soiled
  • N95 (or KN95) respirators should be used instead of a facemask when performing or present for an aerosol-generating procedure.

Eye Protection

  • Put on eye protection (i.e., goggles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area.
  • Remove eye protection before leaving the patient room or care area.
  • Reusable eye protection (e.g., goggles) must be cleaned and
    disinfected according to the manufacturer’s reprocessing instructions
    prior to re-use.
  • Disposable eye protection should be discarded after use

Gloves

  • Put on clean, non-sterile gloves upon entry into the patient room or care area.
  • Change gloves if they become torn or heavily contaminated.
  • Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

Gowns

  • Put on a clean isolation gown upon entry into the patient room or area.
  • Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded and cloth gowns should be laundered after each use.
  • Gowns should be prioritized for all aerosol-generating procedures and during activities where splashes and sprays are anticipated.

Shoe Covers

  • These will be worn over running shoes unless staff is wearing plastic shoes that can be wiped down and disinfected.

Patients in the Operatory

  • Health care personnel (HCP) should strictly follow basic infection control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment).
  • Limit transport and movement of the patient outside of the room
  • Consider placing x-ray equipment in patient operatories to reduce the need for patient transport.
  • No other team member should enter the room during a procedure and if necessary, should use PPE as described above.
  • Room doors should be kept closed (where possible) except when entering or leaving the room, and entry and exit should be minimized.
  • Once the patient has left the operatory, HCP refrain from entering the op until sufficient time has elapsed to remove potentially infectious particles.
  • After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use
  • Special precautions will be taken when performing Aerosol Generating procedures (AGP); in particular, procedures that are likely to induce coughing are avoided if possible.
  • Patients undergoing aerosol-generating procedures are in a separate op.

Protocols After the Clinical Treatment

  • All non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
  • We are also in the process of purchasing a mobile, self-contained germicidal cleaning device that uses proven ultraviolet emitting radiation technology to help reduce and eliminate bacteria, viruses, and other pathogens on environmental surfaces and is approved by the FDA.

Safety Measures After the Visit

  • Encourage payment by ApplePay, GooglePay or credit card over the phone to encourage social distancing with front desk
  • Review of estimates and insurance forms can be carried out via phone call or video conferencing and sent via mail
  • Patients wash hands before leaving

At the End of the Day

  • A thorough cleaning of our facilities will be completed in order to prepare it for the following day

We are confident that these guidelines will help to create a safe environment for all of our patients and team members, and hope that you can feel secure in the knowledge that we are doing everything in our power to provide the safest clinical conditions in order to protect our patients, our team and our families.

You can help us keep our office safe for our patients and staff by complying with CDC and ADA recommendations and following these protocols:

  • If you are experiencing any respiratory illness, fever, or other flu-like symptoms, please call our office before arriving for any scheduled appointments. We will discuss treatment options with you at that time.
  • Similarly, if you suspect you have been exposed to Coronavirus (COVID-19), or if someone in your home has a respiratory illness with flu-like symptoms, please call our office before arriving for any scheduled appointments. We will discuss treatment options with you at that time.
  • Follow CDC recommendations regarding handwashing. Frequent handwashing—using soap and warm water for a minimum of 20 seconds—is your best defense against viruses of all types, including Coronavirus (COVID-19).
  • Avoid touching your face when possible, and use hand sanitizer when you are unable to find a sink.
  • If you are experiencing respiratory distress or trouble breathing, seek medical care right away.

When it comes to keeping our patients safe, we are committed, highly trained, and vigilant. Rest assured, you are in good hands at Relax Dental. If you have any questions, please contact our office.

How Dental Insurance Works

The term “dental insurance” is not exact. A more accurate term would be “dental benefits.” Misunderstandings about the expected insurance payments, and the patient’s responsibility for co-payments, are a potential source of conflict between dental staff and patients. Dental insurance is not insurance in the traditional way we expect insurance to work. If you bought an insurance policy for your house and it burns to the ground, you would expect your insurance to cover the rebuilding of an equivalent house. If your tooth broke, you would expect “dental insurance” to pay for its replacement.

If a patient wants some dental service and has what is considered “good insurance” and expects most of their fees to be covered, the conversation may go like this.

“How much does my insurance pay for a crown.”

“Since this is major work, it would be fifty percent of the UCR minus your $50 deductible.”

The insurance company determines UCR (Usual, Customary, and Reasonable) fees, and the patient can misunderstand them. The fact of the matter is that the UCR for a particular zip code is different for different insurance companies, and so it is clear that they are not using the same statistics to determine UCR.

The insurance company will not tell you how they determine what a crown should cost in your zip code. They are a for-profit business, and they have to pay out less than they receive to remain solvent. A patient’s benefits are related to actuarial tables and how much money the insurance company collected for premiums. If you are part of a PPO (Preferred Provider Organization), you may receive a schedule of services that the plan will consider for reimbursement. You have no recourse if a preventive service is not covered; you will have to pay for it.

Out of Network Providers

You will be considered “out of network” if you go to a dentist who is not signed up with the network, and the consequences will be lower reimbursement. Patients who understand this model should know the patient’s benefits or the diagnosis is their responsibility, and they have to decide their course of treatment even if it costs them more.

Dental Reimbursement Plans

Direct reimbursement plans repay patients for dental work they have already paid for, using a formula that allows patients to direct where they spend their money. The freedom patients have to choose their dentist and how the reimbursement is allocated has increased this type of plan’s popularity. The American Dental Association has provided information for its membership to encourage patients to solicit their employers to consider this type of plan.

Dental benefit plans that allow you to use any dentist will also have a fee schedule. Still, you will not necessarily know all of the reimbursement fees unless you do a predetermination of benefits. Many states have insurance commissioners who will support you in your right to receive a benefit if you were entitled, even if there was no predetermination.

Some people use the excuse “I don’t have dental insurance” because they do not take care of their teeth. The correct term that represents the dental plans is “dental benefits.”

Employer Dental Plans

When your employer shops for benefits, they compare premiums and consider benefits. Some benefits are sold as PPOs (Preferred Provider Organization), where dentists sign up to accept decreased fees in return for a listing in the plan and more patients. The reduced costs are usually about 20 percent less than UCR (usual customary reasonable) and may require the dental office to cut overhead in some way to maintain a reasonable profit. Many good dentists accept PPOs as a service to their patients. The contracts are very strict; some services are not covered, and the dentists can charge their total fees if their patients want a service that is not covered. The contracts are long term, and the major ethical dilemma for me as a dentist when I accepted these plans came when the patient wanted what the insurance paid for, and I knew that was not the best treatment for their diagnosis.

Patients should choose their doctor deliberately and not because “I have no choice; they accept my plan.” In the early days of dental insurance, “But you take my insurance” meant “Please do your billing, so I do not have to pay anything out of pocket.” That is unethical.

When the insurance company sets the fee that the doctor will accept and only pays a part of that fee, the patient must pay the balance. If the price for a root canal set by the insurance company is $800 and they pay $640 minus $50 deductible, meaning a net payment of $590, the patient is responsible for paying the $210. Patients nowadays understand how insurance benefits are paid and set their budgets for dental services accordingly.

As DNA studies have improved, so has our understanding of the disease processes that affect oral structures.

Some of the pathogens that cause the most severe gum diseases can be passed from one family member to another through direct or indirect means: directly by kissing or indirectly by sharing utensils. The kind act of a mother cooling soup to feed to her infant child or tasting the food before she feeds her child could transfer infectious pathogens that lead to advanced disease (e.g., A.A. Actinomycoses Actinomycetemcommitans a significant pathogen for periodontal disease). The patient’s dental care and oral hygiene program, or lack thereof, influences how well the germs take root in the space between tooth and gum.

Leftover food between the teeth and gum, plus the mouth’s warmth, allows pathogens to thrive. The body sets up the immune response, and the by-products produced and excreted leads to a breakdown of bone and supporting tissues—loose teeth, bad breath, exposed roots of the teeth, and eventually tooth loss results. The inability to properly chew food affects our ability to maximize our nutrition.

Currently, we know that bacteria from gum disease and infection from rotten teeth can get into a patient’s bloodstream and cause heart problems. Chronic gum infection in a pregnant woman can lead to premature birth; I have referred patients to their physicians for screening for diabetes based on my observation of their early onset of infection and difficulty treating their gum disease. Healing can be slowed if the patient is an undiagnosed diabetic, and control of diabetes is sometimes enhanced and easier when there is decreased infection in the body.

A young child in Washington, DC, lost his life when the abscess from his tooth precipitated a brain abscess and led to his untimely death. Death from a rotten tooth is a horrible way to go and could have been easily prevented.

If you paid extra money for four preventive visits to the dentist per year, most of your major dental problems would be detected early, and they would be less costly. There are times when worn teeth will need to be crowned—another way of replacing worn enamel.

You may choose to improve the function and concurrently improve the looks of your teeth.

Large nerves run directly from the oral structure to the brain without traveling through the spinal cord. They are so sensitive that you can detect a strand of hair in your mouth or a small fishbone. Children use their mouths to interact with things they come in contact with; it is one way they explore the world. When you are stressed, it even manifests in your oral structures.

In the coming years, DNA will provide clues about those who are more susceptible to oral and other diseases. Currently, dental offices provide screening for oral cancer, high blood pressure, diabetes, and other physical ailments. There are even in-office tests for the presence of harmful bacteria and inflammation in your body that can help guide your dentist in determining the best treatment for you. Nutritional awareness and training have been a part of the dental curriculum and will assume more importance as more research became available. The best is yet to come from dentistry.

In 1840, the first dental college in the world was founded in Baltimore, Maryland. The Baltimore College of Dental Surgery University of Maryland Dental School was formed because of Horace Hayden and Chapin Harris’s two men’s vision. Hayden and Harris were unsuccessful in convincing the medical school to train dental specialists, as some of their counterparts in Europe, so they took the matter to the legislature. The Maryland state legislature persisted, voted to allow the dental school’s formation, and dentistry became an independent profession.