Returning to a new normal
As many states continue to extend social distancing measures, many people are asking, “When will things finally return to normal?” I’m here to tell you things should never return to normal as they were before — and that’s OK! As health care providers, it is our job to improve. It’s our job to innovate. It’s our job to create a new normal that makes us and our patients safer. Want some good news? Dentists have done this before.
My great Uncle Joe was a dentist who graduated from Loyola College of Dentistry in 1960. Like many of the dentists of his generation, Uncle Joe shared with me that he practiced without gloves, without a mask and without glasses. He mixed amalgam with his fingers. He took X-rays without lead aprons. His instruments weren’t sterilized between patients. This may seem abhorrent today, but Uncle Joe wasn’t a bad dentist — it’s just the way things were done at that time.
Although the Occupational Safety and Health Act (OSHA) was passed in 1970, safety in dentistry didn’t see considerable changes until the onset of the HIV/AIDS crisis in the 1980s. The health concerns and stigma surrounding HIV/AIDS disrupted dentistry and threw it into a rapid (and for many, unwanted) evolution. Suddenly, dentists couldn’t do things the way they’d always done them. Almost overnight, universal precautions were established and dentists were forced to change in order to protect their own and their patient’s health.
The HIV/AIDS crisis was (and continues to be) terrible in so many ways; however, the changes it spurred in safety precautions has turned out to be an unforeseen benefit. Every dentist now wears gloves and masks. Each operatory is thoroughly sprayed and wiped down with medical-grade disinfectants between patients. Instruments are heat sterilized after each use. These are all good things. Although there may have been growing pains initially, these changes are universally good.
Nearly 40 years after the onset of HIV/AIDS, dentistry finds itself in a similar position today with the COVID-19 pandemic. Just like responsible dentists post-AIDS crisis didn’t go back to practicing without gloves or masks, I believe it is foolish for dentists to assume things will go back to normal when dental offices are allowed to reopen.
Recent studies suggest that dentistry is one of the most high-risk profession to contract COVID-19 due to the amount of aerosols generated in a dental office. After looking into these studies, I often find myself thinking, “Why weren’t we concerned about this before the coronavirus outbreak?”
Just like the HIV/AIDS crisis forced dentists to consider new protections against blood-borne pathogens, the coronavirus is forcing us to look at aerosols and air quality in a way we haven’t before. Knowing what we know now, it’s our obligation to change. Although these changes will be made in response to COVID-19, the benefits will likely extend far beyond the reach of this current virus.
Unfortunately, no one knows exactly what these long-term changes will involve. Will these changes include N95 masks, external suctions, or hair nets? How about respirators, HEPA air filters, or negative pressure rooms? Who knows?! There will be no magic pill — the solution to limiting our aerosol production will likely be multi-fold.
Right now, there are many unknowns. In Facebook groups and email chains, we are inundated with new products and information whose efficacy remains unknown. Although we may not be able to commit to one solution at this time, it is important that we do commit to change. If we do, then dentistry will change. There will be growing pains as we adapt to a new way of practicing, but these changes will be universally good in the long-run.
Just like I look back at my Uncle Joe and think, “I can’t believe he practiced without gloves,” I hope that future dentists look back and think, “Can you believe that dentists used to practice without aerosol controls?” Just like dentists did after the HIV/AIDS crisis, I am confident that we can move this profession past COVID-19 and into a new normal that is safer for us and for our patients.
Dr. David Markiewicz is a New Dentist guest blogger and a member of the American Dental Association, Illinois State Dental Society and Chicago Dental Society. He grew up in Illinois and is a graduate of the UIC College of Dentistry (’19). He practices with his father, Dr. Anthony Markiewicz, at their family practice in Mundelein, Illinois. When not at the dental office, you might find David and his wife admiring their cat, Gatsby.