COVID-19 PROTOCOL,  based on CDC, ADA & AAO Guidelines- May 2020

In our office you will notice changes to our spaces, sections of our office are cordoned off with barriers. We have installed several types of air scrubbers including HyperHEPA filtration and UV light filters. We are requiring our patients to wear a mask until they are seen by the Doctor or Hygienist. We are requiring that our patients wait outside our office until their appointment times. We are using an electrostatic sprayer with EPA level 4 hospital disinfectant cleaner.

As a note to our patients, these are the protocols we are following in our office in addition to pre-COVID safety precautions. to keep our patients and our staff safe. This documentation is directly from our internal protocol to provide our patients transparency into our process and where we are basing our recommended protocols from. We realize these are are extreme measures, however, we feel these are extreme times and we want to do our best for the safety for all of our family's, our patients, our staff and our community.

STAFF, EMPLOYEES, DENTISTS: Attire and Duties

• Clinical staff wash hands in treatment rooms when patient is present, prior to wearing gloves.
• Front desk to disinfect surfaces, tablets, after use by each patient.
• Front desk to ensure maintenance of a safe distance (6 feet) between them and patients.
• Staff are to bring their own utensils and plates for the safety of themselves and each other.
• No use of cell phones outside of the break room.

SCHEDULING
*********** Inform the patient of the following protocols before/upon arriving the office *****

• Only patients to be present in the office (NO spouse, friend, etc. …) – only one parent can accompany a child under 12 yrs of age by waiting in the reception room. Parents, guardians or other responsible
  parties may wait outside the office or in their cars. Our office will inform them of any treatment
  decisions during and after the visit. Siblings of the “minor” patients or children of the adults in
  treatment may not be present in the office (unless being treated).
• Wellness Screen to be done to determine infection risk : Taking temperature and reviewing the
  “Supplemental Health Questionnaire”. Inform the patients to avoid taking anything hot/cold before
  arrival.
• Ask patient to arrive wearing a mask (all patients over 2 yrs of age) and bring own pen and hand
  sanitizer (if they prefer that to hand washing).
• Ask patient to brush & floss before appointment.
• Patient should call the dedicated number when arrive: (202)-362-7413.
• Patients to wait outside or in the car until they are called/texted back.
• “Supplemental Informed Consent” and “Supplemental Health Questionnaire” forms to be downloaded from the website/email and signed by the patients/parents one day before appointment.
• Multiple members of family with adjacent appointments may be scheduled at the same time or one appointment after the other. For the latter case, the parent must wait with the child not being seen outside of the office building.
• Stagger appointments to minimize the number of people entering and exiting the office at a time.
• Lengthen the appointments to allow extra time to prepare the operatories for the next patients.
• Consider giving priority to those whose dental needs may precipitate urgent or emergent care if
  not addressed sooner.
• High Risk Patients: Strongly consider the risks versus benefits for patients in higher-risk groups such as those over age 60, those with compromised immune systems, those with lung or cardiac dysfunction or those who are diabetic. If treatment is necessary, consider scheduling these patients when office traffic is minimal.

FACILITY: RECTION AREA, & BATHROOM

• Tooth brushing is prohibited in the office both in the operatories and in the bathroom. Patients to brush their teeth at home.
• Chairs in reception area to be positioned 6 feet apart.
• No pens or other items on top of front desk counters; Suggest patients to bring their own pens.
• Children must remain in control of parents.
• Payments: When possible, arrange for payment via credit card over the phone or in the operatory to minimize the number of people in the checkout area. Receipts can be emailed/ mailed.
• Appointments: Follow up appointments can be made over the phone and confirmed via text or email.

CHECK-IN PROCESS

• Call/Text dedicated phone # and remind the patient to wear mask before entering the office.
• Take patient temperature &amp if 99.6 degrees proceed with appointment.
• Ask Wellness Screening Questions.
• Ensure that the Health Questionnaire and the Covid-19 Consent forms are signed.
• Escort patient to the Operatory / treatment chair.
• Patient keeps the mask on until procedure starts and replaces after procedure.
• ****  Any insurance verification must be done prior to the appointment ****

CHECK-OUT PROCESS

• Only one patient to check-out at a time; social distancing of 6 ft minimum. Treatment plan presentation: to be discussed.

TREATMENT AREA
Patients to rinse with a diluted peroxide solution (1-1.5% hydrogen peroxide) just prior to initiating
dental appointment and a saliva ejector to suction the solution.

Hygiene:

• Scaling and Polishing: Hand scaling for hygiene is preferred. Mechanical polishing with a
  hand piece can be a splatter generating procedure which is left to the doctor’s discretion
• Ultrasonic Scalers: If ultrasonic scalers are used, the DHCP should wear appropriate PPE and the use of high-volume suction should be considered.
• Hygiene Checks: Consider brief discussions after hygiene checks if needed and further Treatment:
• Every effort should be made to minimize aerosols and keep number of staff in the operatory to
  the minimum required.
• Tooth Isolation: Rubber dams are encouraged for all restorative procedures along with high-
  volume suction and standard four-handed technique.
• Nitrous Oxide: Use disposable nasal hoods; tubing should be either disposable or sterilizable
  according to the manufacturer’s recommendation.
• Limit Aerosols: Minimize use of air and simultaneous use of air and water via air-water
  syringe.
• Minimize Cross Contamination: Minimize moving from one treatment area to another.
• Soiled PPE to be discarded before seeing other patients.
• Prepare Your Operatories: Flush water lines, check air lines, check inhalational anesthesia
  unit gas lines and suction lines. Cover keyboards and monitors, limit or eliminate paperwork
  in operatories.