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Dentistry in the Time of COVID

 
(805) 682-5600

 

Dear friends and patients,

We seem to have entered a new phase on the world stage and the dental theater, pandemically speaking. My practice, originally under Drs Yeoman and Williams, has safely treated patients for almost 70 years and we in this for the long haul, though we find ourselves hauling down a new and uncertain road! My office is taking the steps necessary to safely treat our patients, following guidance from the Public Health Departments and the State of California, as well as observing standards in excess of those recommended by the CDC, which are, IMHO, politicized and inadequate. Overall, we expect to prioritize necessary treatment until further notice. We have put in place systems for patient care, like rotation of treatment rooms, 50-60 minute room disinfection & sterilization downtime between patient visits, specialized vacuum systems and HEPA filtration throughout the office. There are barriers in place, every treatment room has open windows, so it makes it a bit noisy, as we live the "New York dental experience" with sound effects generously provided by State Street traffic.

I have hired additional employees for patient screening, and Juli does coronal polishing for all patients prior to Carrie's hygiene/perio maintenance visit. If you call the office you should have an employee answer your questions, get a recording or even get me (lucky you!). Regardless, you can text me directly at my cell # 403-9103 in the 805. Feel free to leave a message!

HOW WE WILL CONDUCT YOUR APPOINTMENT:

At Home/Online:

1. Take the ADA self assessment query: Click Here.

Please do not come in if you feel unwell! This includes signs of cold or flu, coughing, fever, recent loss of taste/smell, runny nose, sneezing, headache, diarrhea, muscle aches. Likewise please inform us if you have traveled by plane in the past 2 weeks or been in a larger gathering (greater than 8 people). We are happy to reschedule with 48 hrs notice.

At the Alamar Dental Center Parking Lot:

1. PLEASE ARRIVE 10 MINUTES EARLY. Call our office from your car, give us your car's description and we may come out to your car for a screening. Alternately you can come to the front door. At the front door you can use the hand sanitizer and a staff member will screen you. Please wear a facemask. We will take your temperature and review your paperwork.

2. We will escort you into our office directly to your treatment room and review your conditions before we start.

4. You will remove your mask and Dr. Mintzer or his hygienist will don PPE before beginning.

FOR ALL APPOINTMENTS:

For patients seen in our office, we will allow 50-60 minutes for individual room turnover (air filtration and disinfection) before another patient is seen. The CDC recently relaxed their guidelines from 15 minutes to zero, nationally, which I believe inadequate.

HOW HELPFUL IS COVID-19 TESTING?

We all want to find out if we, or our patients, are now or have had contact with the COVID-19 virus and can transmit this disease. The tests that are being used are generally helpful, but type, timing and predictability are less than 100%. I hear of test results taking between 30 minutes and 5 days, There are two basic types of tests, one (the antigen) looking for parts of the virus itself from nasalswabs (Q-tips) and one from the blood (serous) looking for antibodies we develop in response to the virus. The former is more accurate, and can show if you're "shedding" virus from your mouth/nose, but only if the swab is a good sample. If it's not, this may lead to a false negative result. There aren't many "false positives," however, if you get a positive result then you're contagious and may know it! Likewise, you could be asymptomatic and capable of transmitting the virus. The second test type requires a small amount of blood to see if you've had contact with the disease over the past weeks to months but not within the last week or two, when you could be contagious. Again, more false negatives can be produced. Testing really tells us who is already sick/contagious and should be quarantined but has not been used effectively to locate the asymptomatic "super spreaders" who are most responsible for infecting others. The idealized, best way is to have 330,000,000 tests given to everyone in the country, on the same day, with results given that day, and actions taken afterwards to quarantine or treat those affected. Unfortunately NOT a possibility.

INTERESTING FEATURES OF COVID-19

  1. Masks! Masks! Masks! Facial coverings are crucial and may be more important than hand washing.
  2. Re-Infection: This is a rare phenomena that has been documented in a couple dozen cases world-wide, but subsequent disease appears overall "lighter" than the initial disease. This follows textbook experience with past viral infections, but there is no guarantee that the  coronavirus has read the textbook, however, as a case 10/11/2020 in NV illustrates. It is thought that antibodies formed by prior exposure to the disease will ultimately fade, regardless, requiring a booster vaccine. Flu virus's change so frequently that last year's vaccine offers almost no protection against this year's flu. The coronavirus isn't as bad, but could become a way of life.
  3. The coronavirus is very large for it's class and contains "proofreading" instructions to maintain the fidelity of its copies. This makes it generally more stable over time and easier to target a vaccine against. By 9/21/2020 a point mutation was observed that led to the substitution of one amino acid in the spike protein for another, making the virus easier to spread, but should not affect the targeting by vaccines, as of yet. The initial report was not peer-reviewed as of 9/25/2020.
  4. The amount of virus you become exposed to may important in that a more massive/extensive exposure may lead to a more severe outcome, all other things being equal.
  5. Many researchers assume that, given enough time, we will all get either the virus itself or the vaccination, until some point herd immunity is established, at whatever percentage of the population that stabilizes at. A vaccine, if demonstrated to be both safe and effective, doesn't have to protect us completely from this disease, just enough to diminish its worst effects. There is expected to be much confusion arising from competitive vaccine efficacy, as all have been tested against a placebo, rather than each other. It is quite possible that the best vaccine may depend upon your age and medical status.
  6. Predicting how you will respond if you get sick from this virus is evolving and critical. There are the "usual" risk factors but a recent paper from a highly respected journal claimed to show that genes left over from our intermingling with Neanderthals may increase our susceptibility! Zeberg, H. et al. The major genetic risk factor for severe COVID-19 is inherited from Neanderthals. Nature https://doi.org/10.1038/s41586-020-2818-3(2020).

THE POLITICS BEHIND IT ALL?

In multiple reports the CDC has, under the Trump Administration, suppressed or altered staff epidemiologists recommendations, apparently for political gain. This is beyond sad, and absent a national set of standards, states are left up to their own when it comes to the public health guidance. California and Santa Barbara appear to have done a pretty good job, with Santa Barbara Public Health putting together a new dashboard in November, statistics heavy but great for piercing behind the viral veil.

MY TAKE...

I am very optimistic in the long-term about our ability to defeat this virus, but not in the short-term. Santa Barbara is in a little bubble, but should follow national trends regarding case #'s and care protocols.

Nov-Feb:   Winter is coming and computer models show national positive peaks close to 2 million new cases weekly, or roughly 250,000 daily cases.  Even though limited vaccinations become available, hospitals will be overwhelmed nationally and new stay-at-home solutions mandated. Getting by these next/last few months presents a strong argument to wear a mask and not take unnecessary chances, think Thanksgiving, etc.. Regarding the vaccines, there should be limited Pfizer, Moderna vaccines available to at risk and healthcare workers (probably 10-30 million doses nationally, with storage/refrigeration issues, and 2nd dose after 3 weeks). Also available will be antibody therapies to assist with home care solutions.

Long-term: Vaccines routinely available, with boosters. Life goes on, invest in Band-Aids.

I believe there's a light at the end of this long, dark tunnel! Hang in there... until we meet, be well; these times will pass!

Roy Mintzer, DDS

HELPFUL COVID-19 LINKS (DATED & ONGOING):

NOVEMBER Santa Barbara YouTube COVID Stats & Advice

Santa Barbara Public Health Department Summary

Santa Barbara COVID Dashboard

International, National & State-Wide Comparisons

US - Overall Mortality Rates & COVID Animation through the Pandemic

Map - Johns Hopkins Coronavirus Resource Center

  


 

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