June 11, 2020
I hope this letter finds you and your family safe.
I want to take this opportunity to share some thoughts with you regarding Covid-19 and your periodontal care. First of all, it is safe to say there is a tremendous amount of unknown relative to this situation and we are nowhere near the end of this pandemic. Right now about 5% of the American population has been infected. Historically, a virus does not run its course until about 60 to 70 percent of a population has been infected OR an effective vaccine has been developed, tested and administered….and we are nowhere near either one of those points.
Zeroing in on our situation specifically in Alabama…. In Alabama, the number of new cases now is approximately double what it was during the lockdown and we may see that increase even further as many businesses have partially or completely reopened. Several counties in Alabama are approaching a critical point relative to new cases and there is concern that the hospitals may not be able to handle this new patient load.
Now, let’s discuss the impact of Covid-19 on dentistry in general (we’ll discuss the specific situation of periodontics later). As you know, under order of the Governor’s Office and the Dept of Public Health all medical and dental facilities were ordered closed, except for emergency care. This order was recently lifted and partial opening is now allowed. The only problem is…. Covid-19 pandemic is new territory, so there is no agreement on what represents proven safe infection control measures in the dental environment. Covid-19 has some special features that make this tricky business. The dental industry is inundated with confusion on the subject of covid-19 infection control. The measures that are proposed cover a wide spectrum. Everything from ultraviolet light boxes mounted every 10 feet on walls, a large vacuum cone that fits over the patient’s head to suck up aerosols, fogging machines that constantly fog the clinic with an acid spray, super filters added to HVAC systems that have to be so occlusive to air flow that they trap the tiny corona virus (which then burns up the compressor in the HVAC unit)….and on and on to no end. There are even some reports that corona is spread by shoes as the virus particles land on the floor after falling out of a dentally generated aerosol.
So, as your periodontist that you trust to provide your periodontal care in a medically safe manner, let me share my thoughts with you on this subject. As some of you may already know, before I graduated from dental school and then a periodontal residency, I pursued a full time career as a basic scientist performing research, publishing scientific papers and teaching basic science courses in the medical and dental schools. This background gives me a unique perspective on dentistry which serves my patients well for medically relevant periodontics. For those of you that may be interested, you may want to visit our website brittperio.com for more information on this subject.
Putting aside all political and economic considerations, this is my position on providing medically safe periodontal care for the patients in Britt Perio. Rather than speculate on unknowns, let’s start with what we know as fact. Everyone agrees that the main method of transmission of covid-19 is by AEROSOL, thus the masks and social distancing. Herein lays the problem. Unfortunately, traditionally, the instruments and techniques used by dentists and dental hygienists produce large aerosols….. thus the unproven gadgets described above to try and deal with the aerosols. And by the way, there are tremendous financial incentives for dental vendors to push the sale of these unproven gadgets to dental practices. As a basic scientist, dentist and periodontist specializing in medically relevant periodontics, this is my answer to this situation. My approach is to PREVENT the creation of an aerosol in the first place, rather than implementing unproven methods to try and deal with the aerosol. At Britt Perio, we have been very busy during this lockdown period developing instruments and techniques to provide excellent periodontal care without creating aerosols. This is not an easy undertaking because it requires special instruments, special techniques, specially trained hygienist and periodontist with a background in medically relevant periodontics. These non aerosol techniques also require a lot more time and effort on the part of the clinicians. At the present time, this non aerosol approach is the only plan that makes any sense to me. As we get closer to reopening, I will be sharing more information with you on the details of the non aerosol approach.
One extremely important fact that I would like to leave you with in closing…..please do not fall into the trap of grouping all dental patients into one big homogenous group. Nothing could be further from the truth. The patients in a periodontal practice (who are mature adults with compromising medical conditions) represent a very high risk sub group of dental patients. In Alabama, 95% of the deaths from covid-19 are in people 50 years of age or older. That age group describes nearly every patient in Britt Perio (as well as me). The kids in a pediatric dental practice or young adults in a general dental practice (who appear to have a degree of resistance to the life/death effects of covid-19) have NOTHING to do with the adult patients in a periodontal practice who have concurrent chronic medical conditions….thus putting them in the very high risk category. As your periodontist, I feel a tremendous responsibility to look out for your best interest in providing medically safe periodontal care.
Your friend and periodontist,
George N. Britt MS, DMD, board certified periodontist –innovative, minimally invasive, medically relevant periodontics