Orthotown July/August 2020 - 68

Fig. 2

coronavirus infection through aerosols in
an orthodontic setting, regular and routine
point-of-care testing is the only way that
we could consider returning to standard
precautions.
While we screen patients for fever and
other symptoms, there is still a chance that
a patient could be an asymptomatic carrier.
Returning to the basic premise of infectious
patients, we must assume all patients are
asymptomatic carriers to keep our patients,
staff and selves safe. Below, we focus on the
advanced PPE needed for transmission-based
precautions.
Respirators and surgical masks.
Ac cording to the CDC and OSHA, an
N95 respirator (Fig. 1, p. 67) or another
respirator that provides a higher level of
protection-disposable filtering facepiece
respirators, powered air-purifying respirators
(PAPRs)or elastomeric respirators-should
be used in orthodontic settings.
Given that that orthodontists typically
generate lower amounts of aerosols than
other dental professionals, knowing that
there is a global shortage of PAPRs, and
appreciating the difference between treating
a patient in an operating room setting versus
an outpatient orthodontic clinical setting,
N95 respirators are the best option. In the

68

event that an N95 respirator is not available, a
combination of a surgical mask and full-face
shield should be employed. The surgical
mask should be approved and cleared by the
Food and Drug Administration (FDA). It
is important to note that the use of at least
an N95 respirator is recommended when
performing aerosol-producing procedures.
Eye protection. Must be worn at all
times. Acceptable options include goggles
or face shields (Fig. 2) that cover the front
and sides of the face. Contact lenses and
personal eyeglasses without custom-fitted
solid-plastic side shields are not appropriate
eye protection and must be supplemented
with the use of goggles or a full-face shield.
Gloves. Clean, nonsterile exam gloves
should be used and changed between patients.
As with all other PPE, the supply of gloves
has become scarce and the cost has increased.
Gloves may not be reused or washed, but it
is still prudent to optimize their use.

Gowns. Clean gowns that extend to
the knee and tie in the back (Fig. 3) are
recommended to be worn and changed when
soiled or at the end of the day. Disposable
gowns must be discarded after use and
reusable cloth gowns must be laundered
after use.
The purpose of having gowns extend to
the knees is to cover things when providers
perform "sit-down" procedures. The purpose
of having the ties in the back are to allow for
a cleaner, more efficient doffing procedure
for one's PPE. A gown or protective clothing
should be worn during procedures likely to
generate splashing or spattering of blood or
other body fluids.
Novel measures. If it is said that necessity
is the mother of invention, one could argue
that desperation is the father. During the
COVID-19 response, there has a been a flurry
of "novel" and "innovative" techniques that
may be used to further increase protection

Fig. 3

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Orthotown July/August 2020

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