Tag: Coronavirus

Global News Interview: Emergency Dentist During Covid 19 Outbreak

Dr archer interviewed on Global News

On Wednesday, March 25th Rachael D’Amore telephoned Dr Natalie Archer DDS to ask about dentistry in the Age of Coronovirus. Like so many other Canadians, dentists have also had to adjust to a new business reality amid the pandemic that has now closed most dental clinics in Ontario.  Yet we search for ways to be productive and helpful.

“I think dentists, in general, feel helpless and frustrated,” Dr Archer is quoted saying in the article, and she continued. “We are health professionals too. We’re educated. We’re willing to help but, in a lot of ways, our hands are tied right now.” Dentists have a unique perspective on social distancing in the workplace; its more difficult here. Dentists and hygienists sit right beside patients; new distancing protocols amid the pandemic are particularly difficult to work around.

What exactly does ‘Emergency Care Only’ mean for dentists and patients?

Provinces and local governments have imposed increasingly tight controls to try and curtail the spread of COVID-19 and they ultimately encourage as many people as possible to stay home. Quebec and Ontario, for example, have ordered all non-essential businesses to close, but the rule vary and are slightly different in each jurisdiction.

Global News update

Those deemed essential are somewhat obvious; health-care workers, first responders, suppliers of critical goods like food and medicine, and utility workers are encouraged to go to work and help save lives and keep society functioning. So where does that leave dentists?

Ontario, Quebec and British Columbia have ordered a pause on “non-essential” dental services like teeth cleaning, teeth whitening obviously and other cosmetic procedures. Only emergency care, like facial trauma or pain that can’t be managed with antibiotics or over-the-counter medications, can be performed.  Dentists in other provinces, like Manitoba, have taken it upon themselves to put similar measures in place for their residents. But even then, there are risks.

“We have to set a high bar for emergencies in dentistry because it’s such high risk. We’re one of the most at risk in this,” said Dr Natalie Archer. “We’re still learning about the virus, but we definitely know it’s spread through things like mucus and saliva. These are things that dentists are intimately connected with… There’s no social distancing when it comes to treating patients in dentistry.”

The respiratory virus is spread mainly from person-to-person, either by close contact or “respiratory droplets.” So when an infected person coughs or sneezes, if the resulting droplets end up in the mouths or noses of people nearby, either by inhalation or contact, those people can become infected.

In health care, increased risk comes with increased protocols. In Ontario for example the Royal College of Dental Surgeons (RCDSO) has clamped down on what constitutes an emergency dental situation and has issued directives on screening procedures as well as which tools to use when.  They stipulate that only emergency care, like facial trauma or pain that can’t be managed with antibiotics or over-the-counter medications, can be performed.

What is an essential service?

Rachael D’Amore’s reporting also shared some interesting data.  Between 2017 and 2018 there were over 93,000 dental visits at the University of Toronto’s Faculty of Dentistry, which allow students to treat patients. Of those, 4,000 were considered emergency dental visits.  So based on that ratio you can see there’s a demand that will not be abated by stay-at-home social directives. Some dentistry is essential.

Readers should know that infection control in dentistry is already at a high professional standard. Sterilizers are tested every day, there are chemical indicators that show that everything’s been sterilized properly, there’s tracking of every instrument, everyone’s wearing the proper PPE (personal protective equipment),” he said.  Infection control protocol standards for dentistry are incredibly high. But that efficiency doesn’t negate the fact that dentists need to be in close contact with patients to do the job.

infection control - autoclave

Sterilization of equipment happens routinely in autoclave at Archer Dental Rosedale

“The primary thing is to keep people safe and healthy but you also really have to keep them out of hospitals unless they absolutely need to be there — the system’s already facing a burden.”

Archer Dental Emergency Dental Service in Toronto

Archer Dental patients can set up phone-call screening and counseling or FaceTime a dentist for certain inquiries. We offer emergency dental services such as it abides with RCDSO’s new required safety practices, but we can also provide some level of comfort to patients locked away at home who need advice, said Archer.  Patients are encouraged to call their office and their calls will be received and scheduled accordingly.

“I think it makes patients realize what is a real emergency right now,” Dr Archer said. “As a dentist, we have to assume that everybody we come into contact with has COVID-19. So that’s the level of care we take when we decide what’s an emergency.”

The article ends with Dr Archer’s quote; “There’s a very good chance that you’re not going to get into a dental office for a check-up for quite some time, so this is the best opportunity to take care of ourselves from a preventative side,” Natalie said. “People always tell me they don’t have time to floss. Guess what? You’ve got time. You’ve got more time than you know what to do with. Now’s the time to floss.”

Infection Control Protocol at Archer Dental Offices

Infection Prevention and Control at Archer Dental - Rosedale

Infection prevention and control is an important part of safe patient care. Concerns about the possible spread of blood-borne diseases, and the impact of emerging, highly contagious respiratory and other illnesses, require practitioners to establish, evaluate, continually update and monitor their infection prevention and control strategies and protocols.

sterilization of surgical equipment in dental office - infection preventionAt Archer Dental, each operatory and all applicable equipment, dental instruments, and all areas touched by either patient or dentist or hygienist are cleaned and disinfected and sterilized after each use. Semi-critical and critical instruments, those that come into contact with mucous membrane or used to penetrate soft tissue or bone are reprocessed and sterilized following each dental procedure.

Sterilization at all three Archer dental locations is achieved by steam under pressure (autoclaving). In the photo to the right, you can see the dental assistant labeling the instrument package for sterilization with the date, time and load number which is used for quality control and documentation. This information must be collected according to the infection prevention and control standards of practice.

Staff at Archer Dental adhere to and comply with infection prevention and control policies and procedures. Staff understand that each patient expects the highest quality of safe dental care and that is what Archer Dental provides. We are veterans at safeguarding against the spread of harmful viruses and bacteria. We’ve been very active on this front for many years, long before the current health crises griped the planet (Coronavirus #Covid_19) and put new emphasis on the subject.

Dr Natalie Archer is a recognized expert in the field of infection control in dentistry. She spoke on Global News in 2017 about infection control in Ontario dental offices.  Dr. Archer, along with Joan Hutchings, RN, CPN, BA, MSc, MPA, have taken the lead in creating a program to educate other dentists called SAFE Dentistry Inc.

SAFE Dentistry, infection control in dental officeSAFE Dentistry delivers a customized infection prevention and control audit program that evaluates and assists office staff to implement best practices. The four-pronged program reduces the risk of transmission of infection and disease for both patients and staff.

SAFE Dentistry’s program bring together fifty years combined clinical experience. It was in part developed by our own highly respected, successful dentist Dr. Natalie Archer, alongside the extensive knowledge and experience in infection prevention and control of an epidemiologist, surgical suite specialist, Joan Hutchings. Together they’ve created a province-wide service that arranges infection control consultants to assist Ontario dentists and staff working in dental clinics. The infection prevention and control specialist educate, advise and provide hands-on instruction assisting staff to achieve and adhere to recommended standards of practice, a requirement to provide safe services to the public as described by Royal College of Dental Surgeons of Ontario, Public Health Ontario and Ontario Ministry of Health and Long-Term Care.


Patients can help SAFE Dentistry by becoming expert hand washers.

Patient Care at Archer Dental

Our staff use Personal Protective Equipment (PPE) to protect patients and themselves. Examples of PPE are masks, gloves, eye wear, gowns and drapes.

dental surgery at Archer Dental

Patients and staff are provided with protective eye wear to shield their eyes from spatter and debris created during dental procedures. Protective eye wear is worn by patients throughout the dental appointment, then cleaned and disinfected after each use by dental assistants at each location.

Gloves are always worn by our staff when performing dental care. Depending on the type of procedure, our practitioners will choose between procedure gloves or sterile gloves. In most cases you will see the staff member put on gloves taken from a box. These gloves are disposable and are discarded immediately after each use. In addition, before gloves are put on, staff members will clean their hands by either washing with soap and water or using hand sanitizer. Sterile gloves are used only for specific surgical procedures. Sterile gloves come packaged individually and our policy requires staff wear these gloves to maintain sterility.

Protective draping
Get ready to wear a bib. Here at Archer Dental, single-use bibs or drapes are always deployed to protect patients’ clothing and reduce their exposure to spatter or any moisture created during dental procedures. Single-use strips are used to secure bibs and drapes, in place of reusable daisy chains.  We all suit-up in single use gowns during any form of dental surgery at Archer Dental

We use rubber dams and high-volume suction
Archer dental goes to great lengths to minimize the spread of droplets, spatter and spray created during dental procedures. Accordingly, we use a rubber dam whenever feasible, and high-volume suction is used whenever the creation of droplets, spatter and spray, if possible.

Waiting Room Etiquette 
SAFE Dentistry, infection control in dental officeIn our waiting rooms you will find Kleenex, hand sanitizer, masks, signage and a waste basket.
Please note our sign – If you do not feel well on the day of your appointment, report your condition to the secretary (please contact the office and have your appointment rescheduled). If you have a cough or runny nose, please help yourself to a Kleenex and dispose of it immediately in the waste basket.
Please cleanse you hands with hand sanitizer, using two full pumps, spreading the liquid over all surfaces of the hands by rubbing hands together for 15 seconds or until hands are dry. If you cough, please cough into a Kleenex and discard directly into waste basket, repeat hand hygiene. If you continue to cough, please put on a mask to reduce the possible spread of germs to others in the room.

Standards Achievement Facility Evaluation

We invite dentists and staff to take our mini survey to quickly determine how knowledgeable you are of the recommended infection prevention and control standards.