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International Dental Hygiene during COVID-19

Once we emerge from this pandemic intact as a profession, we should be more prepared to face communicable diseases than ever before.

Dental hygiene is continuing to be practiced despite the risk of infection from COVID-19. Dental hygiene procedures are considered to be elective. How important are elective dental procedures during COVID-19? Where does this type of treatment rank in Maslow´s Hierarchy of Needs?

Dental Hygienists At Risk During Covid-19

Does protecting our lives takes a backseat to achieving an acceptable smile? Are dental hygiene procedures necessary during a pandemic? Do the demands from lenders take precedence over good judgment?

According to an analysis published by Marcus Lu, a contributor to the World Economic Forum, many professions are at risk. His study showed employed dental hygienists carry a high risk of infection. More risk than dentists, dental assistants, respiratory therapists, and even nurses!

Photo courtesy of Marcus Lu, World Economic Forum April 20, 2020

Dental Hygiene From the Other Perspective

The overriding sentiment that I observe from dentists in Germany is that the spread of this disease is over-hyped. Many feel that the standard PPE and disinfection that have been practiced for years is sufficient for business as usual throughout the pandemic. Thus, many dentist-employers have obliged their hygienists to return to their posts or lose their jobs.

There are dental hygienists who prefer to work now. They would rather work than see their incomes adversely affected by the pandemic. Whatever side we as hygienists are on, the pandemic won’t go away for the foreseeable future. We are now facing some hard choices. We are forced to shoulder the risk and join the list of ‘front-line’ workers.

In Germany, the infection rate is lower than Italy, Spain, the U.K., or the U.S. The pressure to return to clinical practice is stronger than ever. Employers reason, that since the infection rate in Germany continues to stay low, the risk to hygienists is also low.

On the ‘Front Lines’ in Germany

Despite the daily broadcasts boasting containment success, the uncertainty still concerns many. Hygienists still reach out to each other. They to see how those who never stopped working, or who started back already, are managing. Here is what I have been able to gather so far:

Some offices have a reduced patient load, whether intentionally or unintentionally. Some offices provide N95 masks, while others do not. This is under the pretense of the lacking scientific proof to justify the cost.

For offices that do provide N95 masks, the quantity is limited and the masks sterilized and reused. The more fortunate use the regular masks plus the N95 on top during treatment. Most offices provide face shields.

Some offices allow for a rest and disinfection period. This ranges from 15 to 30 minutes between patients. Others, unfortunately, do not allow for any extra time. Patients do not wait in the waiting room. Instead, an effort is made to grab them directly from the reception area.

Some offices have installed a barrier at the reception. This keeps as little contact between patients and the front desk as possible. For example, in Germany, patients sign in by a card reader. Some offices allow patients to swipe their own cards to reduce direct contact

Most hygienists use only hand instrumentation. Hygienists and patients accept that poor quality is better than nothing at all. Other hygienists still selectively use ultrasonics and piezos.

Many feel that they are doing their best under the given circumstances. However, the changes and the pressure lead some to question their future in the profession. It also makes me wonder what future this leaves for our newly graduated hygienists.

The Way Forward

This pandemic will push us to be innovative. That means we will have to fight for yet another set of rights. This as if we don’t already have enough to fight for! For example, local anesthesia, simple fillings and general supervision will have to take a back seat.

Will we get a mandate specifying that N95 masks are to be designated for hygienists? What other minimum PPE must the employer provide to hygienists? Should operatory rooms be specially fitted with air purifiers or evacuation units? Will laws protect us if we are aware of an immediate danger but still forced to work? Hopefully, we will proactively find a solution long before tragedy forces us to do so.

The American Dental Hygienists’ Association recommends postponing elective dental procedures until further notice. This is in line with the U.S. Centers for Disease Control’s recommendations. When that is not practical or possible, the ADHA has created “Interim Guidance on Return(-ing) to Work. You can download it below.

Download the ADHA Guidance Document

While this guidance is as fluid as the pandemic is, it helps us to protect ourselves in clinical practice. A downloadable checklist also helps us identify holes in our armamentarium.

Dental hygiene is a wonderful profession. At this time, we share a unique bond with our fellow hygienists. Once we emerge from this pandemic, we will be more prepared to face communicable diseases than ever before.

Let’s continue to stay vigilant and supportive of each other. We are all trying to find our way through this thick cloud of uncertainty.

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International dental hygienist Sarah Twiford

International Dental Hygienist Sarah Twiford, RDH, BSDH

Living or studying abroad was always the dream of this international dental hygienist, Sarah Twiford. After backpacking around Europe in 2016, she felt she had to see more of Europe. See how Sarah came to work as an international dental hygienist in Germany.