I bet many of us feel like we are living in a movie these days.  I’m sure you have compared this pandemic to any number of movies. The first movie that comes to mind is  Jaws. In that movie, everyone wanted to know when it will be safe to go back into the water. And now, forty-five years later, people are asking a similar question: Is it safe to go back to the dentist?

Let’s explore the parallels.

The year Jaws came out, 1975, I was serving as a Captain in the Dental Corps at Ft. Dix N.J. During my time there I came down with Hepatitis B. I became infected from working on a patient…without gloves. Remember kiddies, this was 1975…there were no rules. It was The Wild Wild West in health care. As we all know, hepatitis is caused by a blood-borne pathogen. I became quite jaundiced and severely ill. I spent two weeks in the hospital. I started feeling better after one month.

I felt good enough to go back to work, but the U.S. Army had other plans. I couldn’t go back into the clinic until my liver enzymes were back to normal. I was tested frequently not only by the military, but also by the county Board of Health. I remember how diligent they were about the testing. They were serious…I couldn’t go back to work until I was cleared. That was mostly to protect anyone I would come into contact with. I was a known carrier, unlike the infamous Typhoid Mary who carried her disease covertly. I’m sure the public was grateful that the government was acting so responsibly. Like today, the public health department’s job is to protect the public. That trust must exist for us to function as a society.

Fast forward to 1981. I was practicing full-time in my own private practice when the AIDs epidemic arrived in the U.S. By then I had learned my lesson and I was one of a small number of dentists who wore gloves on a routine basis. But I was in the minority. AIDs changed our entire profession. By the time it was over (if it ever truly was over) the life of every dentist changed forever. This time around I learned how serious government could be in enforcing public health regulations. They meant what they said. (For those who are interested look up the case of Kimberly Bergalis). This was a classic example of the combination of bloodborne pathogens and dentistry.

One thing I noticed during that period was the public awareness of dental practices and sterilization techniques. AIDS changed everything. It wasn’t the isolated patient who wanted to see how instruments were being sterilized. Many people stayed away during the height of the crisis. In time the fear eased up but not before more stringent rules and regulations were enforced. And once again the public was grateful.

Now… almost 40 years after AIDS we have a new pathogen – the coronavirus– Covid-19. The biggest difference is that this one is an airborne pathogen. And that makes all the difference in the world. Fear is ubiquitous. There is a new shark in the water. Like Typhoid Mary, it does not show its fin.

Safety is a big concern for most humans.

Behavioral psychologist Abraham Maslow formulated the Hierarchy of Needs. At the very base of the Hierarchy are physiologic needs like food and sleep followed by safety and security needs. His theory stated that people would not seek satisfaction of higher needs (love, belonging, self-actualization), until the basic needs were met.

Forty-five years after Jaws roamed the ocean it is generally safe to go back into the water, but rest assured, we do know one thing… there will always be new and more dangerous sharks to worry about, and when it comes to humans, safety is a basic need after food and sleep.

Patients have been deciding on the essential nature of dentistry forever.

As long as fear remains and people do not have the absolute certainty of safety, they will not return to dental offices except for services they perceive as essential. If your client base is full of people who are truly health-centered and trust you, your routine dental services will thrive in the pandemic. Your patients won’t wait until they are in pain to book an appointment.

But that’s the test of what you are all about, isn’t it?

If your routine services are not thriving, then your practice has had a history of attracting a broader market of people. How is that working out for you now? Beyond COVID-19, if you are in private practice, pay extra attention to targeting individuals who want the finest health and give them ample reason to trust their safety with you… no matter what.

I think pre-operative rinsing is here to stay. Science supports it is effective against viruses, including COVID19. And it is easy to do.

Pre-operative rinsing has been discussed in dentistry for a long time, especially before hygiene visits. Today this is an even more relevant conversation, and we are examining its efficacy again with renewed interest. Here are three to consider:

Hydrogen Peroxide Mouthwash

We know hydrogen peroxide works. It is highly effective against the virus and is recommended as a pre-operative rinse right now. A readymade hydrogen peroxide mouthwash is Peroxyl. You can also take 1% hydrogen peroxide and mix it 50/50 with a flavored mouthwash. The required time for effectiveness is a minimum of 30 seconds. Some publications are recommending the patient rinse with hydrogen peroxide for two 30-second cycles. If 30 seconds is too long for a patient, they can increase the number of times they swish for fewer seconds. You can set a timer to guide the patient and make sure the patient is swishing at least 30 seconds in total.

Iodine Based Mouthwash

The literature indicates iodine based rinsing solutions are also highly effective against the virus. There are iodine based mouthwashes you can purchase for use in your practice. As some people are allergic to iodine, you will need to carefully screen patients before use, asking if they have a known or suspect allergy. Can they have betadine on their skin? Can they eat shellfish? If iodine should be avoided, then you will want to use hydrogen peroxide.

Chlorhexidine Mouthwash

The process of rinsing with chlorhexidine before an appointment and/or adding chlorhexidine so it comes through the water spray of a Cavitron or Ultrasonic Scaler is not new news. For a long time, we have been using chlorhexidine mouthwash as an adjunct to oral hygiene following periodontal treatment. There is science that chlorhexidine kills microbial cells withing 30 seconds of contact in the sulcus biofilm, but is it effective as an antimicrobial pre-operative rinse to reduce the risk of COVID19 exposure? We do not know. We cannot point to the science that would tell us it is equally effective against the virus as other options. However, I have heard studies are underway with good clinical results so far.