• Warren Bobinski

Dentistry WILL never close again. Why and How.

"It's your reaction to adversity, not adversity itself, that determines how your life's story will develop"

~Dieter F Uchtdorf


Arizona isn't just a vast desert....

I have a bold statement. Dentists could help prevent a pandemic, and ensure the safety of future generations. Dentists will NEVER close again!


Go ahead and be critical. Tell me how ridiculous this is. Look for all the reasons it won't work.


My entire 36 years in this business, I have been surrounded by people much smarter than I am. As a matter of fact, it's not just Dentistry. I have met these people all throughout life. It's my purpose in life to recognize the skill and talent of every person I meet. What I have realized is my talent isn't necessarily having the right idea at the right time - it's the blessing of knowing so many people!


This is why I KNOW the idea will work. This plan involves YOU. We are all one degree away from this and already know and trust the people who can make this work...and as a world we will come together to help this work.


My hope is this plan not only grows to stop this problem now, but also that it helps build a better future for ALL healthcare. That we realize, like dental healthcare has from the very beginning, that PREVENTION is the CURE!


TIMEfactors

Many years ago I developed a formula that was rather simple (but ultimately based on lots of research, models , science , evidence and numbers). The formula can be applied to ALL business. This model is particularly valid and proven every day during a pandemic!


ALL business, but particularly in health care....and particularly NOW we understand the formula. We need to devise a plan that is #1 good for people while at the same time #2 good for business. In that order. I will discuss briefly in regards to our current situation, and healthcare


TIMEfactors:

#1 - Good for patients. MUST be proven scientifically. Independently. Street credibility. Predictable. Reliable. Affordable.


#2 - Good for business. Allow a business to have profit in order to reinvest. For motive. Keep the lights on and doors open.


Human beings making decisions are weighing "TIMEfactors" every day. Some entire countries may have weighted the options and decided that the formula is to leave business open but enforce some restrictions. Like Sweden. Singapore. Korea. Canada.

Please take a minute and watch this CNBC video...Sweden may be considered a controversial country in their approach. Maybe they are right...maybe they are wrong. They have weighted the consequences using the above factor - #1 good for the people and #2 good for business. As a society, we NEED both to work! If either one fails, it lets down the other...


If we put too much weight on TIMEfactor #1. Good for the patient. Then we will wait for 100% proven scientifically regardless of cost. This happens in medicine all the time. Medicine that is developed that people can't afford. It is PROVEN to be good for a patient, and only good to a business but at a price that is too high - thus making it INEFFECTIVE for public health care. Many ideas, when first developed, are too expensive until critical mass can be reached.


This isn't just about medicine. This can be technique. Technology. We may develop a system - but if it's too tedious. It takes too long and costs too much labour. There is little incentive. "IT" will thus be too expensive! Bad for TIMEfactor #2 and thus fail (except for a niche market).


In Dentistry, this might be looked at by public health as a "closed room with negative pressure". It is absolutely an excellent idea, backed by science. Some people could afford to do it. Not the majority. Not Dental Schools. Not the majority of Dentists providing the pillar of TOTAL health care to the world for healthy immune systems.


Although many current solutions meet requirement #1, they fail at #2 and thus fail to be implemented and effective. Most of us are stuck on #2 - we need to make a living! Good for business applies to human beings home expenses...the ability to pay for shelter and food. Have hope. Help each other!


Let's look at KOREA. Singapore. Both have made decisions based on #1 and #2. Partial shut downs. Investments in testing, tracing. Examples we can use and learn from.


All we know, is that we don't know anything for certain. That's why this article should only be considered an idea that hopefully inspires you!


I DO NOT have any intention on being dangerous and starting controversy. I DO INTEND to bring out the human spirit. The entrepreneurs with ingenious, simple ideas. To encourage us to ALL WORK TOGETHER to find a balance....


I was exposed to Coronavirus.

Isolation Date Night

My wife and I travel quite a bit and have a second home in Arizona. We usually take a winter trip in early February. My work is Dentistry is very busy and the timing wasn't good this year.

Promises to my wife were to hold steady and take a last minute trip. It happened late February. We decided to book Cabo San Lucas for 5 days and then would head to Vancouver for one of the largest Canadian Dental Conferences...the Pacific Dental Conference.

We knew about Coronavirus, but there were no public health shut downs yet. We hopped a rather sombre flight.

Karen is a paramedic, and it's not completely unusual to step up to help with an in-flight medical emergency. Shortly after telling the lady seated next to her what she did for a living, and being asked if she ever has to help with on board medical emergencies....it happened!

"Is there a doctor on board?"

Karen always responds and helps. As a paramedic, she deals with emergencies all the time and since no doctor stepped up it was welcomed help. Twice actually. And a third time after we landed!

We boarded a bus after the airplane, and a little old lady cut her leg really badly stepping onto the bus. A deep gash to the bone, my wife quickly responded and we stayed until local paramedics arrived.

We spent the next few days at the resort.

We flew back to Vancouver. Our daughter Sarah lives in Vancouver with our twin toddler age grandsons. The grandsons were sick. Runny noses, coughs. All those things you would normally not worry about. We did Grandpa and Grandma things. Washed hands. Avoided touching people and things.


I attended the Pacific Dental Conference on March 4-6. Used gobs of sanitizer, didn't touch anyone. Spent the rest of the weekend visiting friends and family.


We got home from the conference and back to work on March 9. Karen still had a couple days off but was scheduled to go back to work March 11. I had been away a couple of weeks so made up for lost time and visited most of my customers. We heard rumors that a dentist at the conference was infected. Received an email shortly after that from work that in an abundance of caution anyone who had attended the conference would "self isolate" until March 23. Karen let her work know and they decided it best that she stay home as well.


Karen was experiencing some symptoms, and we called our local health line to get tested....The health care system had already started to struggle and we couldn't even get through to the agencies. We waited and eventually she was tested and cleared. I also had some mild symptoms - but not enough for concern. Runny nose, no fever. No reason to test....but it leads me to this conclusion...


Dentists Should NEVER close again.

Why couldn't I get a test?

Dentists, and Dental health teams, are trusted health care providers. They have regular access to the majority of the population. In Canada, in 2015, there was 1 dentist for every 1622 people. Statistics say that over 80% of Canadians saw a dentist within the last two years, and over 50% went more frequently.

Many countries have a similar situation with Dental Health Care providers, if they don't - you will find most countries likely had huge growth in this industry. There is opportunity.


Dental health care has always focused on PREVENTIVE measures. The reason for a regular visit is to DIAGNOSE and PREVENT disease! Oral health is vital to systemic health. Using saliva and blood testing can help diagnosing some systemic health issues.....and it could be used now!


Dental health teams are abundant, with excellent abilities controlling aerosols and contaminated environments. Dentistry was considered by the New York Times as "The Workers who face the greatest Coronavirus risk".

Dentistry has faced these types of risk with EVERY disease EVERY day since the beginning. It's the reason our profession has evolved so highly with infection control - following very strict and expensive standards to provide a reasonably priced and needed health care. PREVENTIVE care. Maintaining a high standard of infection control yet still being able to provide affordable care.


Dentistry is an excellent example of how health care can work for everyone. Using TIMEfactors as an example; #1 - good for the patient and #2 good for business. We have been able to continue to grow. Continue to provide PREVENTIVE care with systemic health benefits at reasonable price. To the majority of the population. Voluntarily! Huge education opportunity! Excellent TOTAL HEALTH opportunity!


Dentistry shows exactly how a public-private funded healthcare system can excel. Allowing enough profit to continue to advance the PREVENTIVE care initiative. Leaving incentive to continually improve, but also to stay competitive and keep costs for services reasonable.

Developing materials and techniques that are constantly improving while constantly improving patient and provider safety.


Dentists can use this perfected system to help the world.


TESTING is KEY

The ADA recently asked that COVID testing, in the most accurate and approved forms, to be in the scope of practice for Dental Health Care professionals. In ADA News release April 22 "Dental groups seek federal approval to administer COVID-19 tests". Here is the statement from the ADA about Covid testing and discussion with it's members.


The tests would have to meet criteria like "good for the patient" and "good for the business". In other words, APPROVED and scientifically proven.. Our current system in dental care works very well. A private-public initiative.


If a company wants to go back to work, they could pay to get employees tested. If they have a public health issue, they could quickly get tested. Wherever it's most convenient.

Testing on this massive scale would help public health make decisions. Everyone would benefit.


It would meet criteria #1 and #2. Good for patients. Good for business.


Not just for now, but for the future!

The advantages of using Dental Healthcare teams, in conjunction with Medical teams and public health is data.


Using data provided by Dentists, who already test saliva and blood REGULARLY as a diagnostic tool and for preventive measures could really benefit ALL of healthcare. Using current technology and gathering data using systems (like FDI data hub) could give us a LOT of important data. Beyond the covid virus, but for prevention of many diseases overall.


Dental health care workers around the world could use the cloud and a central hub to gather evidence of many health issues. If scientists combine this data with data from other healthcare providers, algorithms, maybe some predictive AI, , I feel we could start to identify and PREVENT many health issues. All in an affordable health care model.


If all healthcare worked together, would this have merit?


Consider that Dentistry is PREVENTIVE driven healthcare. Working closely with medicine by early diagnosis this would have a tremendous effect on reducing the risk of pandemic.


If you are a dentist and interested in this idea, and wonder how we can continue to provide these high levels of proven care....basically - get back to work...read on!


ADA provides guidelines for dental offices that may reopen


I will not re-write what is already excellent and science backed about the safety of care provided by dental health care teams. The current OSHA, CDC, IPAC and other IPC protocols. We were ALREADY at a proven safety level. I will just add a few IDEAS on how to AFFORDABLY and REASONABLY reduce risk so we can get back to providing much needed healthcare!


#1 - We need PPE! The supply chain needs to be fixed. In order for dentists to never be closed again - we need to consider how CRUCIAL PPE is to dental health teams. Just to keep emergencies out of hospitals means that public health systems should be redirecting some of the critical care items to dental offices. It wouldn't take much in the current situation to help ease the burden of the hospitals.

In some areas, like where I live Saskatchewan, it appears we have reached the critical plank.

Considering our health services locally may be able to SHARE some of the resources the same way this community stepped up and SHARED their gear when it was asked would help provide some evidence to public health (This is my own personal opinion and access needs to be confirmed)

My opinion is that PPE will be resourced and available in a measured manner in order for dental clinics to get back to work. We can't allow a hoarding situation, or a broken supply chain to force some offices to be able to work while others remain closed. Or some distribution to take advantage of a competitive situation.

The system needs to be fixed prior to opening or it will be #2 bad for business and then #1 bad for patient.. it would fail.

In Saskatchewan I would suggest a plan be formulated between our College, the members, public health and distributors as well as manufacturers. A rollout that includes limited use of PPE until the supply chain recovers.


We DO KNOW that A LOT of private companies have pivoted to provide PPE locally. We can and WILL be able to get to a solution on this matter.


Let's assume this is fixed. Dentists can get appropriate PPE....


#2 We need testing This isn't just about pre-screening for treatment. This is about public health, statistics, reporting data and developing a system where DENTISTS work with all health care teams so we NEVER have this issue again!

If a patient is screened, tested and meets requirements - treatment should remain at the discretion of the professional health care provider and the patient.

Testing and reporting would include temperature readings which get charted and reported. Reporting cancellations due to sickness. Anonymous, but good data that may help public health identify issues.


#3 - Protocols. Dr Cesar Solano Jr released what he thinks protocols will look like. It is well thought out, and good for discussion! ADA and some states and provinces are releasing protocols. We need to be ALL TOGETHER on this!

In Saskatchewan, like many places, we are still restricted to Emergency only. The current guidelines for emergency identifies local clinics by their ability to provide limited treatment. Level 1, 2A and 2B and 3. This has a lot to do with PPE - but now includes environmental concerns. Its different than other jurisdictions.

It would be good to provide a more universal guideline that aligns well with protocols that were scientifically proven and worked well up to just a few weeks ago with an understanding of reducing risk in the current environment to a reasonable degree by the standards of TIMEfactors (Good for patient, good for business).


Based on this, I would offer that we need to continue to REDUCE RISK but be REASONABLE so business can open. There needs to be oversight and accountability (please go ahead and debate this!). ADA is asking professionals to use current guidelines to make informed professional decisions with patient consent. I TRUST our community to do this.


Please read Dr. Cesar Solana Jr "What will dentistry look like after the COVID-19 pandemic"


My only suggestion, as an experienced dental consultant is to consider AFFORDABLE WAYS to reduce risk. PPE is the best way to reduce risk for the team. Environmental concerns would be the aerosols and I would offer that EXTRAORAL evacuation be considered as an effective way to reduce risk. There is limited scientific evidence, but beyond the scientific evidence it seems logical and obvious. It COULD be a relatively affordable and inexpensive way to ENHANCE aerosol control within the treatment areas and avoid costly renovations and closures of open plan clinic. Including the majority of teaching institutions.

There are many other methods to consider, even if for a short time, to reduce risk. Such as Environmental foggers (not currently CDC recomended due to limitations). Possibly air exchange ideas. Keeping in mind the #1 and #2 TIMEfactors. Has to be reasonable!


Summary.

Saskatchewan, along with many US states have been fortunate enough to have kept COVID-19 virus "under control". Using strong measures, and good advice it's my goal that we continue to see success on these initiatives.


It's my opinion that provinces and states that have proven to have controlled the outbreak be allowed to work closely with public health to get dental offices back to work safely. Providing the needed PPE, and guidance that is reasonable and effective. Monitoring.


Let's start with testing.




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