Will IPC and PPE bankrupt dentistry?
Updated: Oct 18, 2020
"A house divided against itself can not stand"
Without Unity there can be no strength
I started in 1984...when AIDS was really making a wave in dentistry. It was going to be the end of dentistry! It was known to be a blood borne virus. It wasn't exactly known how much load of blood was needed to transmit. The thought was that the dental drills at the time, which were not always sterilized between uses, could be the mode of transmission.
When I started, gloves and masks were NOT popular. Imagine spending a decade or two working in what you considered a safe environment and then being told you have to change everything you were doing. Stop working. Stop using that drill unless it was properly cleaned and sterilized. The sterilizer and drill you currently have are not satisfactory. Start wearing PPE you never had to wear before.
When I started, supposedly it was the worst time in dentistry.
Yet we learned a lesson. Like all business. Like all human nature. We continually improve and adapt and find ways to not only survive....but thrive!!
The gold standard of care, the IPC bible.
I often quip when discussing 2019 SASK IPC guidelines. If the guidelines are to be known as the bible of IPC, then I am the preacher. Having STUDIED every page and passage, and looking at the research behind every reason why. Personalizing and offering advice to large groups. Sanctifying the many passages and consecrating the passages of how to wear a mask properly.
In my many years, we have gone from ZERO masks and gloves. Smoking pipes while you worked, while the assistant merrily whistled a tune about 6 inches away from the patients face. What seems ludicrous now was every day dentistry just 35 years ago...man I've been around for a while!
Since I was starting my career during an AIDS epidemic, it didn't take me long to start thinking about what has become TIMEfactors. I just started my career...I didn't want it to end! My Dad was in the business as a supply house owner. As a supplier - we were tasked with finding answers. The problem being, supposedly, was that the answers would be too financially crushing and dentistry was bound to fail. The FEES would need to be immediately raised by such a tremendous amount that nobody would be able to afford dentistry.
It didn't happen.
As my career progressed, I realized often that health care had a lot of challenges from the business perspective. There were OFTEN new materials, techniques and equipment that seemed like really good ideas. They would be FANTASTIC for the patient - but often the dentists who implemented the "new thing" would find it would cost them money! The "new thing" may have been good for a patient, but either the patient couldn't afford the treatment, or the business couldn't afford to offer it.
At the same time, many items that at first glance APPEARED to be expensive were in fact VERY GOOD for the business. Simple, sundry items that could dramatically improve performance. Like a self etch bond. Bulk fill composite. Fast cure lights. Electric highspeeds....the list is endless in dentistry. There needed to be a formula to understand if the product would be worth while. Would implementing the new item be affordable for the patient while still keeping the business healthy?
#1 good for people
#2 good for business
Any business that doesn't do these two things will fail. For example, it is absolutely GOOD for public health if we all stay home. EVERY one of us. BUT....someone needs to bring food. Keep the power on. We weigh those risks as a society and realize the "good for business" means some must "do #2" business in order to be good for #1 people.
In reverse, if we just go back to "good for business" then too many people would get sick and that would not be "good for People".
No different for us. For everything. If you make the "good for people" to onerous - then you will find people breaking the rules to suit what is "good for business". "Business" can be the business of being human.
Dentistry has done an incredible job of advancing and finding a balance between the "good for patient" and "good for business". For me, that means finding the right products, procedures to be able to provide convenient and affordable treatment.
In other words, if you make treatment of a patient to onerous or expensive one or the other will fail. We can definitely build rooms to the point they are equivalent to open heart surgery suites. Bring in a big team to monitor vital signs, observe the entire procedure and take notes. Take hours to do treatment and have hundreds of thousands of dollars of air exchangers, negative pressure. Take an excruciating amount of time to DON and DOFF the gear. Treat one person at a time. Leave the room for several hours to settle prior to the infection control team coming in to make sure every corner is high level disinfected. Pay people to properly FIT TEST our masks every time we get a different brand and buy the 3 different brands for our office because that's the only way to get one that fit. Bring someone back every time a team member loses or gains 15 pounds. Update that every 12 months.
Is this truly good for public health? When we are already at a standard of care that has proven itself for decades to be #1 good for patient and #2 good for business? We have a PROVEN and EFFECTIVE balance. Dentistry is profitable enough to keep advancing, and competitive enough to keep basic care affordable. The reason the business has continued to grow around the world is this balance! Why SO MANY people get to enjoy a health team trained to PREVENT disease!
So here we are today...
We can start renovating 90%+ of offices to build walls, or is there an actual APPROVED plastic to build a room that we know will work just as well as walls? What quality? What about the ceiling? What about measuring air flow? Negative pressure? We can definitely keep going to the point of extreme safety.. How about most of the dental teaching facilities in the world? Will we ever be able to graduate another dentist with current teaching facilities being open spaces? Orthodontics?
I am proud that our profession works with science in mind. WEIGHS risk and safety over profit. We have always leaned more toward #1 Good for patient.
There is a point, however, where human beings will say "it just isn't worth the risk". TIMEfactors #1 good for patient and #2 good for business MUST work together.
The public IS willing to go back to work. Willing to take measured risk. We get in a car every day. Take tightly packed planes. Eat at public spaces with friends. Head to a rock concert and share a beer.
Life is going to change, but it's not the end of time. We just need to find that proper balance! We need the experts to help guide us, but always making sure to weigh ALL sides of the equation. Working in tandem to find the right solution. Letting human beings take some degree of responsibility for themselves as well!
How much time is the question. Will business collapse while imposing the onerous restrictions? What is the correct balance of Good for people, and good for business. Without these two working in tandem - all of us are in trouble.