Covid-19 Safety Implementations

OFFICE OF DON P. GUTIERREZ, DMD.

1. COVID-19 INFECTION CONTROL AND SAFETY MEASURES TAKEN TO ENSURE PATIENT, STAFF, AND PUBLIC SAFETY.
2. RATIONALE FOR CONTINUED PATIENT CARE.

A. OFFICE ARCHITECTURE REDESIGN FOR COVID-19 SAFETY
B. OFFICE STERILIZATION PROTOCOL FOR COVID-19 SAFETY
C. THE IMPORTANCE OF DENTAL HEALTH CARE FOR MAINTAINING SYSTEMIC HEALTH AS IT RELATES TO SYSTEMIC DISEASE AND A HEALTHY IMMUNE SYSTEM, ESPECIALLY DURING A PANDEMIC SUCH AS COVID-19
D. PATIENT RECOMMENDATIONS DURING THE PANDEMIC

OUR OFFICE TAKES THE COVID-19 PANDEMIC VERY SERIOUSLY.
WE WERE ASKED TO SHUT DOWN IN MARCH OF 2020.
DR. GUTIERREZ, OFFICE MANAGER YOLANDA, AND HIS ASSISTANT SARAH IMMEDIATELY BEGAN THE PROCESS OF MAKING OUR OFFICE THE SAFEST ENVIRONMENT TO PRACTICE DENTISTRY.
WE COMMUNICATED WITH DENTISTS, HYGIENISTS, AND ASSISTANTS THROUGHOUT THE WORLD TO COME TO CONCLUSIONS AND TO IMPLEMENT NECESSARY CHANGES TO OUR OFFICE REGARDING ITS ARCHITECTURAL DESIGN AND OUR PROTOCOLS.
THE FOLLOWING ARE THE CHANGES WE HAVE MADE TO KEEP OUR STAFF, OUR PATIENTS, AND THE GENERAL POPULATION SAFER FROM THE COVID-19 VIRUS.

A. ARCHITECTURE

1. VENTILATION WAS PLACED IN EVERY OPERATORY TO CREATE NEGATIVE PRESSURE IN THOSE ROOMS. OUR SYSTEMS HAVE THE CAPACITY FOR COMPLETE EXCHANGE OF AIR IN JUST ONE MINUTE.
2. DOORS WERE PLACED TO ISOLATE EVERY OPERATORY.
3. ADVANCED PHOTOCATALYTIC OXIDATION TECHNOLOGY WAS INSTALLED WELL BEYOND THAT REQUIRED TO ELIMINATE BACTERIA AND VIRUS THROUGHOUT THE OFFICE BY IONIZATION.
4. A FULL-SERVICE LAUNDRY ROOM WAS CONSTRUCTED TO MANAGE THE INCREASE IN GOWN AND SCRUB TURNOVER.
5. UNNECESSARY ITEMS WERE REMOVED FROM ALL OPERATORIES.
6. OUR WAITING ROOM PROVIDES 6 FEET OF SOCIAL DISTANCING FOR ANY PATIENT WHO MUST COME INTO OUR OFFICE PRIOR TO THEIR APPOINTMENT.
7. PLEXIGLASS SHEILDS WERE PLACED EVERYWHERE PATIENTS AND STAFF MUST STAND TO COMMUNICATE WITH ONE ANOTHER.
8. OUR LUNCHROOM WAS REDESIGNED TO PROVIDE 6 FEET OF SOCIAL DISTANCING AND PRIVATE TV TRAYS.

Don P. Gutierrez Altura Dental Center

B. STAFF AND PATIENT PROTOCOL STAFF:

1. N95 MASKS ARE WORN BY ALL PROVIDERS DURING AEROSOL PROCEDURES.
2. FACE SHIELDS ARE WORN BY ALL PROVIDERS DURING AEROSOL PROCEDURES.
3. FULL-LENGTH GOWNS AND/OR LAB JACKETS ARE REQUIRED BY ALL PROVIDERS.
4. AS ALWAYS, OPERATORY CHAIRS, X-RAY HEADS, LAMP HANDLES AND SWITCHES, AIR WATER SYRINGES AND HIGH-SPEED SUCTION DEVICES, DOOR HANDLES AND COMPUTER KEYBOARDS AND MOUSE ARE REQUIRED TO BE WIPED WITH BIREX AND/OR WIPES THAT ARE TUBERCULOCIDAL, VIRUCIDAL, BACTERICIDAL, AND FUNGICIDAL PRIOR TO BEING COVERED IN PLASTIC.
5. NO CHARTS ARE BEING USED. WE ARE PAPERLESS IN THE OPERATORIES.
6. ALL PATIENT TEMPERATURES WILL BE TAKEN PRIOR TO BEING ESCORTED INTO THE OPERATORIES.
7. MASKS ARE REQUIRED TO BE WORN BY OUR PATIENTS UNLESS THEY ARE IN THE PROCESS OF RECEIVING DENTAL CARE.

Don P. Gutierrez Altura Dental Center

PATIENTS:

1. PATIENTS ARE ENCOURAGED TO WAIT FOR THEIR APPOINTMENT IN THEIR CAR UNTIL CONTACTED TO ENTER THE OFFICE.
2. PATIENTS ARE REQUIRED TO COMPLETE A COVID-19 EXPOSURE FORM PRIOR TO BEING SEEN. THIS FORM IS AVAILABLE ON YOUR CELL PHONE AND ALSO IN A HAND-WRITTEN FORM INSIDE OUR OFFICE.

3. AS PATIENTS ARE BROUGHT INTO THE OPERATORIES, STAFF WILL TAKE THEIR TEMPERATURES. ANY TEMPERATURE ABOVE 99.7 DEGREES FAHRENHEIT IS REGARDED AS TOO HIGH TO BE SEEN AND YOUR APPOINTMENT WILL BE RESCHEDULED.
4. WE APPRECIATE PATIENT HONESTY AND INTEGRITY. THESE ARE QUALITIES WE VALUE HIGHLY IN OUR PRACTICE.

C. RATIONALE FOR CONTINUED PATIENT CARE

THE LINK BETWEEN PERIODONTAL BACTERIAL PATHOGENS AND SYSTEMIC DISEASE AND THE IMMUNE SYSTEM ARE WELL DOCUMENTED.
AS YOU MAY HAVE HEARD OR READ, THERE ARE FACTORS SUCH AS DIABETES, CARDIOVASCULAR DISEASE, AND RESPIRATORY PROBLEMS THAT CAN PREDISPOSE PATIENTS WHO CONTRACT COVID-19 TO HAVING MORE SERIOUS COMPLICATIONS THAN THOSE WHO ARE HEALTHY.
LITERATURE SHOWS DIRECT CORRELATION OF ORAL BACTERIAL PATHOGENS TO THE AFOREMENTIONED DISEASES AND PROPER IMMUNE SYSTEMIC FUNCTION.
WE FEEL AS PROVIDERS OF DENTAL CARE DURING THIS PANDEMIC AND OTHERWISE, THAT THE HEALTH OF THE ORAL CAVITY, WHICH INCLUDES THE TEETH, THE GINGIVA (GUMS) AND THE BONES AND LIGAMENTS SURROUNDING THE TEETH (PERIODONTIUM) IS ESSENTIAL NOW AND ALWAYS.

WE STRIVE TO BALANCE YOUR DENTAL HEALTH WITH THE RISK OF COVID-19 EXPOSURE WITH DEEP THOUGHT, RESEARCH, AND CARE.
OUR DECISION WAS TO INVEST HEAVILY IN YOUR SAFETY.
AS DENTAL PROFESSIONALS AND AS FELLOW HUMAN BEINGS WE HAVE MADE EVERY ATTEMPT TO CONTINUE TO PROVIDE DENTAL SERVICE TO YOU DURING THIS TIME.
AS ORAL HEALTH CARE PROVIDERS, YOUR DENTAL HEALTH AND ITS EFFECT ON YOUR OVERALL WELL-BEING IS OUR CONCERN. WE HAVE ALWAYS BEEN COMMITTED TO THAT CARE.
WE BELIEVE THAT OUR OFFICE IS NOW OPERATING AS A MODEL FOR THE DENTAL OFFICES OF THE FUTURE.
WE ARE CONFIDENT THAT YOU ARE SAFE IN OUR MUTUAL ENVIRONMENT AND FEEL THAT WE HAVE EXCEEDED ALL EXPECTATIONS FOR YOUR SAFETY.

D. PATIENT RECOMMENDATIONS

YOUR DENTAL HEALTH IS SO IMPORTANT TO US. THE FIRST TWO RECOMMENDATIONS ARE RELATED TO WEARING MASKS.
THERE ARE TWO ISSUES HERE WE WOULD LIKE TO ADDRESS:
1. "MOUTH BREATHING" WE BELIEVE THAT "MOUTH BREATHING" IS MORE APPARENT WHILE WE WEAR MASKS. THIS CAN LEAD TO A DRYER MOUTH AND DRY MOUTH LEADS TO A HIGHER INCIDENCE OF TOOTH DECAY AND GINGIVITIS (GUM INFLAMMATION). WE SUGGEST BRUSHING MORE OFTEN DURING THIS PANDEMIC.
2. DEHYDRATION: THE ABILITY TO DRINK PROPER AMOUNTS OF WATER DURING THE DAY IS LIMITED WHILE MASKS ARE BEING WORN. WE ENCOURAGE CONSTANT REMINDERS TO DRINK FLUIDS AND AVOID DEHYDRATION.

OUR FINAL RECOMMENDATION IS TO PLEASE KEEP YOUR DENTAL APPOINTMENTS!
TOOTH DECAY AND GINGIVITIS (GUM INFLAMMATION) ARE PROGRESSIVE DISEASES. WITHOUT TIMELY TREATMENT, YOUR ORAL HEALTH CAN WORSEN RAPIDLY.
PREVENTION IS THE KEY TO YOUR DENTAL HEALTH AS WELL AS TO YOUR OVERALL HEALTH.
WE LOOK FORWARD TO SERVING YOU AND KEEPING YOU SAFE IN ALL REGARDS.
BE VERY SAFE AND LIVE LIFE FULLY!
SINCERELY,
DON P. GUTIERREZ, DMD AND PROFESSIONAL STAFF - PLEASE TAKE THE TIME VIEW THE FOLLOWING PHOTOS OF OUR OFFICE AND TWO OF THE MANY ARTICES WE RESEARCHED TO SUPPORT OUR DECISIONS. THANK YOU

Advanced Photocatalytic Oxidation Technology

8

USAnanocote.com

THE LINK BETWEEN PERIODONTAL BACTERIAL PATHOGENS AND SYSTEMIC DISEASE

About one in two adults in the United States has periodontal disease. Chronic periodontitis is an oral disease affecting the supporting structures of the teeth leading to progressive loss of the attachment apparatus and bone around teeth. It is characterized by gingival pocket formation and/or gingival recession. A growing body of literature suggests that there is a link between periodontitis and systemic diseases. These diseases include cardiovascular disease, gastrointestinal and colorectal cancer, diabetes and insulin resistance, and Alzheimer's disease, as well as respiratory tract infection and adverse pregnancy outcome.

7

The diagram above shows the bacteria that live in the periodontal sulcus and their associated systemic disease associations. This cascade of inflammatory response ultimately leads to increased osteoclastic activity and bone loss. Individuals with periodontitis have increased systemic levels of acute-phase proteins. plasma antibody levels, coagulation factor, total white blood cell count, neutrophilia C reactive protein (CRP), and cytokines such as INF- gamma (Interferon-gamma), INF, (Tumor necrosis Factor- Alpha), IL Ontedeukiro-I IL-2 and 11,4. Periodontitis works on the same chronic inflammation model seen in systemic diseases. There is sufficient evidence to suggest a bi-directional link between the two.
CONCLUSION: The mouth is the first place in the body to prevent disease. The health of the mouth influences the health of the whole body.
This case report is provided by Dr. Kevin C. Harrison D.M.D; M.S. Board Certified Periodontist It is meant as a way of sharing current periodontal information with the dental community.

Oral Health and the immune system: What's the connection?

There is a strong connection between your oral health and overall health, and scientists are finding more connections all the time. If left unchecked, bacteria in your mouth can affect many different systems in the body. Heart disease, lung conditions, dementia, and diabetic complications have all been linked to poor oral health. Today we're going to look at the connection between your oral health and the immune system.

It Starts with Bacteria
Most of the problems that can arise with your oral health start with bacteria. Your mouth is the perfect environment for colonies of bacteria to thrive — it's moist, warm, and usually has lots of nutrients for the bacteria to feed on. Food particles that are left in your mouth help bacteria grow; that's why it's so important to brush and floss daily, in order to clear out the bacteria buffet and control growth.
When bacteria grow out of control, they can cause both periodontal (gum) disease and tooth decay (cavities). As these conditions worsen, bacteria can move from the mouth into the rest of the body.

CRP and Heart Health
Sustained high levels of CRP in the bloodstream have been linked to an increased risk of heart attacks in both men and women. Doctors check C-reactive protein levels to assess your risk of heart attack or stroke. The higher the level of CRP, the higher risk you have. When CRP stays in your system for a long period of time, it contributes to the stiffening and clotting of the arteries.

The Effects of Inflammation
If you don't properly care for your teeth or see your dentist regularly, you can basically have a bacterial infection the size of your fist sitting there inside your mouth at all times. Bacteria from your mouth get into your bloodstream by way of diseased gums or places where teeth are damaged or missing.
This sets off an immune response in the body, and C-reactive protein, or CRP, is released from the liver. CRP is a substance that is released whenever there is some sort of inflammation. In the short term, it is a natural and appropriate response and doesn't do any harm, but if CRP is being released constantly (possibly due to bacteria in the mouth causing inflammation), then it can set off a chain reaction that eventually leads to other health conditions.

Immune Response In Pregnant Women
This same immune response has been proven dangerous for unborn children as well. Pregnant women with a heightened immune response can actually activate their baby's immune system. While in utero, the immune system isn't meant to be used because it hasn't fully developed. This can be damaging for the child and has been connected to the development of cerebral palsy. Bacteria in the mouth can also lead to pre-term birth, which can cause other complications for a newborn.
Regular trips to the dentist and a consistent at-home care regimen can help you to avoid oral health problems and these more serious concerns. Preventative care is the way to go when trying to stay healthy, so make sure you're brushing for two minutes twice a day and flossing once a day.

The following is a statement from the NM Dental Association issued November 15, 2020

Dental Advisory Team Issues Guidelines on Public Health Order Compliance

As we reported on Friday, the new health order does not differ very much from the language that has governed dental offices during the last six months. Dental offices provide essential services and should continue to be open during the sheiter-at-home order. The order also, however, does not mean business as usual. As health care providers we should continue to be responsible for the overall health of our patients and staff, as well as their dental health. During a shelter-at-home order there is a responsibility for offices to not only provide essential services in a safe environment, but also help people to stay home, if they can. The public health order relies on professionals, like us, to make the right call.

1) Take the surging number of cases seriously and respond accordingly. We have supplied tools and guidance on how to do this but are leaving it to your professional judgement to decide the right plan for your practice. The situation Is 10 times worse now than It was just a few weeks ago. As health care providers, you should consider what that means for your daily activities. The actions you take today In your office may affect your practices ability to continue to function during the pandemic.

2) It Is Inevitable that as numbers go up, there will be asymptomatic staff and patients that will enter more practices. We've seen it already to an alarming degree. The measures you are taking may suddenly be under more critical scrutiny. This is a time for you or your staff to be particularly vigilant about compliance. Refamiliarize yourself and staff with COC and ADA guidelines for safe practice in this environment. As always, staff with any symptoms that might be attnbuted to COVID-19 should not enter the office and potentially expose others.

3) Consider carefully how your practices are compliant with both the letter and the spirit of the public health order. If you were asked to justify what you were doing as essential, are you prepared? The Team is recommending that you think about that carefully and write It down now.

4) Each practice needs to consider what their essential care plan should be based on their individual situation. For example, if canceling hygiene patients means that they will not be seen for months, they should probably not be canceled. If you could delay some patients and see them within a couple of weeks without affecting their health, perhaps that is a time to consider the delay and let staff stay home.

5) Talk with your staff. Help them understand that what they are doing is essential too. If your staff doesn't feel comfortable working during this time, consider other opportunities. Are there things that some could do from home? The shelter-at-home order affects them both at home and at the office.

6) Review the reopening guidelines to make sure you can continue to provide essential care safely. Taking extra precautions and prioritizing the care of your patients is an important part of being essential.

Don P. Gutierrez Altura Dental Center
Don P. Gutierrez Altura Dental Center
Don P. Gutierrez Altura Dental Center
Don P. Gutierrez Altura Dental Center
Don P. Gutierrez Altura Dental Center