Time to consider alternative protection?

Dental

The outbreak of COVID-19 has drastically changed our world. From the loss of life and its psychological impact, to the financial implications and changes to the ways in which we function at work, it has deeply affected us all. As we venture into this changed world and establish what the new normal is, comes the responsibility to adapt and make positive changes to how we implement health and safety measures in our workplaces in order to protect and save lives.

For the dental industry, the very nature of the job requires close interaction between patient and members of the dental team. Because this is at the core of the profession, it is not feasible for this human interaction to be removed. Subsequently, this puts those involved at an increased risk of exposure to airborne contaminants and aerosols. To keep people safe, increased protection measures and exposure risks have been issued by the Center for Disease Control and Prevention (CDC) that should be undertaken by employers. These include more stringent engineering and administrative controls as well as intensified use of personal protective equipment (PPE), refer to CDC guidelines for more detail. As for tasks that may or are known to generate aerosols, eye protection and a NIOSH certified respirator must be worn. In a time of uncertainty, this opens the debate for what is the best form of protection.

Traditionally the respirator of choice in dental care has been a surgical mask or an N95 mask. However, as worldwide shortages have been experienced and the effectiveness of these respirators is questioned, it has become evident the importance to reassess PPE options in healthcare settings. Surgical masks are known to offer limited splatter protection and do not prevent against inhaling infectious aerosols.

If N95s have not been fit tested and fitted properly, this not only puts the users at risk of exposure to airborne aerosols, but also the businesses at risk of fines and citations from OSHA for violating the respiratory protection standard, 1910.134.

As alternative forms of respiratory protection are sought after, the loose-fitting powered air purifying respirator (PAPR) holds a lot of the answers to the future of respiratory protection in the dental field. Where possible, it is already recommended by the CDC to wear a greater level of protection such as a PAPR. Previously this form of protection has been utilized largely by the industrial sector, as these have been designed with a greater filtration capacity for their hazardous environments. But as any environment can now be considered dangerous due to human interactions, this is a viable alternative to surgical masks and N95s.

One of the greatest features of a loose-fitting respirator is the all-encompassing protection the user receives. These not only prevent aerosols from entering the user’s respiratory system, but also reduce the need for multiple products such as safety glasses, shields, and disposable respirators to be worn at the same time. With the filtered air supply coming from behind the user, there is no moisture build up around the mouth and the positive pressure air supply allows the user to breathe as normal without overheating. Loose fitting respirators require minimal maintenance and have low ongoing consumable costs. With worldwide inventory of PPE unreliable, loose fitting respirators are an attractive, sustainable alternative to the traditional.

With shifting attitudes towards health and safety and a desire to be better protected than just the mandatory, now is the time to consider alternatives when it comes to respiratory protection.

Works Cited

Angell, S. (2020, May 7). Guidance for Resuming Deferred and Preventive Dental Care. Retrieved from California Department of Public Health: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Guidance-for-Resuming-Deferred-and-Preventive-Dental-Care--.aspx

CDA. (2020 , May 21). Employers requiring respirators must establish a respiratory protection program. Retrieved from California Dental Association: https://www.cda.org/Home/News-and-Events/Newsroom/Article-Details/employers-requiring-respirators-must-establish-a-respiratory-protection-program

CDC. (2020 , May 3). Guidance for Dental Settings. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html

OSHA. (n.d.). 1910.134 - Respiratory Protection. Retrieved from Occupational Safety and Health Administration: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134

OSHA. (2020, March ). Dentistry Workers and Employers. Retrieved from Occupational Safety and Health Administration: https://www.osha.gov/SLTC/covid-19/dentistry.html