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COVID-19 Supporting Your Practice

Lifting the Confusion about N95 Masks

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A sharp increase in global demand for PPE in the face of the COVID-19 outbreak has left healthcare professionals all over Canada scrambling for supplies. And one item at the top of everybody’s shopping list is the N95 mask. Designed to achieve a very close facial fit, the N95 delivers efficient filtration for small airborne particles.

But just how critical is the N95 in combating the spread of COVID-19, and what are the alternatives?

In conversation with Dr. Michelle Zwicker, President Elect of the Newfoundland and Labrador Dental Association, Dr. Aaron Burry eases some of the concerns surrounding N95 masks. He discusses the available alternatives, and talks about some of the wider precautions that can be taken to minimize risk of infection in the dental office.

We hope you you find the conversation helpful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
Chiraz Guessaier, CDA Oasis Manager

Full Conversation (10.27")

10 Comments

  1. Afsaneh April 6, 2020

    Thanks for sharing the information. Covid-19 infection may transmit by carriers with no symptoms. There are evidence that the droplets containing the virus can spread even by talking and can stay in the air for hours. After a patient leaves the office, the clinician and staff will remove the mask and gown but the droplets containing the virus will remain in the air of the office for hours. These droplets in the office space will cause spreading of the disease to the clinician and staff.
    As research shows proper ventilation is important too, but we don’t have any detailed information about the minimum needed ventilation. Do you have any idea about it?

    Reply
  2. Thomas Nenninger April 8, 2020

    Please be aware suction creates aerosol so does a slow speed !!!

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  3. Thomas Nenninger April 8, 2020

    All respirators should be fit tested….in BC this is the law. the elastomeric respirators must have cartridges installed with “particulate” filters equal or better than N 95…than would be an N , R or P 95 or 100 …..do not use them with carbon or gas cartridges that don’t have particulate filters.

    If creating aerosol which will happen with any handpiece fast or slow or low volume/high volume suction, cavitron or even taking an internal radiographs. the treatment room should have negative pressure to assure the aerosol is not fed back into the HAVC or inhaled by nearby individuals without respirators.

    Reply
  4. Ronald Witzke April 8, 2020

    I am very concerned with the cavalier tone of this interview.

    First an foremost SLOW SPEEDS are considered an AGMP. This is made very clear by Alberta Health Services for ENT, plastics, OMFS, Optho, and DENTISTRY. Low volume suction and high volume suctions are considered AGMP. Even Yankauer’s are considered AGMP, hence any intubation is now an AGMP. Air water syringes are AGMP, and so are certain oxygen delivering procedures.

    Secondly N95 masks are not fitted respirators and as we have seen with decades of studies they do not stop active TB transmission. Unless you are absolutely certain you are not generating an aerosol, and you are certain the patient is not going to cough or sputter, I would strongly recommend a fitted, 2 way, medical grade N95 respirator. If this is not available consider referring or as a last resort a NIOSH respirator.

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  5. Blaine Cleghorn April 8, 2020

    It should be noted that fit testing is required every 2 years for N95 masks and fit testing is required before using N95s. There have been some questions about the air exchange in operatories and how that impacts on cleaning, disinfection and patient turn around. We have posted the protocols and references that are being used at Dalhousie on our web site. Hopefully these resources can be of assistance. The link is http://www.dal.ca/faculty/dentistry/news-events/news/2020/04/02/covid_19__protocols_for_treating_patients.html.

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    1. Anonymous April 9, 2020

      Excellent resources

  6. Susan Sutherland April 8, 2020

    Thank you for raising some critically important issues in this interview. I do have some concerns, however, regarding the information about aerosol generating procedures (AGPs) and N 95 masks. First, a properly fit tested N95 mask for an AGP during this pandemic is not a “should”, it is a “must”. If dentists and their staffs do not have fit tested N95 masks, they should not do AGPs. The second issue is that the definition of an AGP is more nuanced than we may have thought in the past and I would say that the jury is still out on the evidence for that. While the use of high speed hand pieces and ultrasonics is clearly out of the question without fit tested N95 masks and enhanced PPE, other intraoral procedures should not be dismissed as having no or insignificant risk. Although, by design, other instrumentation does not generate an aerosol, the very nature of an intraoral procedure may cause droplets to become aerosolized. This might happen if a patient gags and coughs during procedures; likewise a slow speed handpiece could aerosolize droplets. We simply do not have enough evidence on the transmissibility of this disease to dental team members at this time. The one certainty about COVID-19 is that there is no certainty. The evidence is evolving rapidly and what we know today contradicts what we thought we knew yesterday.

    I think that we need to take extreme care in the procedures that we choose to do. Unfortunately, the timely and definitive treatments that we are able to skillfully provide to our patients in pain and with infection during normal circumstances need to be viewed now with extreme caution. Dentists, oral surgeons and ENT surgeons are among those at highest risk of infection and death from COVID-19. The death of a PGY-6 OMS resident in Detroit this past week should be a sober reminder of this.

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  7. James Lanoway April 8, 2020

    There is a risk to performing any dental or medical procedure during this pandemic. As health care professionals, we owe it to our patients and the community at large to try to mitigate this risk and yet still treat a patient in distress with uncontrollable pain, infection, bleeding or trauma. The risk will never be zero. If you say “Hey, I didn’t sign up for this,” oh yes you did, and that’s what makes us different from hair-dressers. Where would all the Covid-19 patients be today if all the physicians and nurses in the ICU’s and Emergencies said “I can’t do that, there is a risk I might get Covid-19 myself from that procedure.”

    Reply
    1. Thomas Nenninger April 9, 2020

      Please ensure before you pass that risk on to your employees that every precaution is taken, at this time that would include full PPE , respirators for all staff assisting in any dental procedure, which should be done in a negative pressure environment to ensure no escape of aerosol into the surrounding free office space. That does not mean you have reduced risk to zero but perhaps closer to zero than trying procedures with shortcuts that result in tragic endings and give this profession a bad rap….your staff are counting on you to reduce that risk as much as possible, this is no time to be a hero.

  8. Zak April 19, 2020

    Somewhere in Dr. Burry’s suggestion, he mentioned that after seeing a patient the whole room has to be sprayed and left alone for 3 hours, how is it possible in a single working day to see only 3 patients in that room?based on his suggestion It seems a dentist has to have at least 4 rooms for himself To be able to see 8 patients per day, no room for emergency patients, and the all hygienists will be without a job since each hygienist is supposed to see 7 patients on regular day in a single room. Not practical in the real world, giving suggestions without any consideration of its practicality is not acceptable.

    Reply

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