Volume 7 • 2020 • Issue 7

Dentistry is moving to a higher level of infection prevention and control. The dental office is more focused than ever before on functioning like a “mini-hospital” and therefore the level of infection control is also moving up a notch. The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association. too early to speculate or know anything of substance. The handling requirements of the first COVID vaccines are likely going to be very complex. You can store a flu vaccine in a dedicated refrigerator. Some of the COVID vaccines may require storage at -70°C before they are reconstituted and injected. My understanding is that with a COVID vaccine (like those recently announced by Pfizer and Moderna) although they show great promise, they will need to be administered through special vaccination centres, because the technical requirements of handling the vaccines will be so challenging. Testing is a different ballgame. I think dentists are highly qualified and could perform the actual sampling for the tests. The problem is processing the test at a lab. We have backlogs and all sorts of issues at the provincial level and that is not something that dentistry can fix. If COVID testing becomes routine, dentistry could certainly be involved. But again, at this point, it doesn’t make logistical sense in many parts of the country. Q What are you hearing from dentists across Canada about supply chain issues? AB: Oh, it’s a nightmare. Unexpected economic disruptions are happening in different parts of the world, so it’s not possible to foresee what items might be affected next. Recently, the COVID numbers have been very high in some parts of Europe, which resulted in shutdowns and then, all of a sudden, a key element of a supply chain disappeared. Anecdotally, I’ve heard that local anesthetic was hard to come by for some time and this was because glass manufacturing in Germany and other parts of Europe was closed down, preventing the small glass vials that hold anesthetic from being made. It’s a bit like playing Whack-a-Mole; after you pop one issue down, another pops up! And it’s going to continue. Economies around the world will continue to be disrupted in erratic ways. Our advice to dental offices early on and going forward is you may need to think about having a larger or longer supply than you’re used to. Did you previously have a two-week supply? Maybe try to have a six-week supply instead. I have personally experienced that when one item is unavailable, suppliers will try to substitute it with something else. Our health centre uses disposable gowns for surgical cases and our regular ones weren’t available so our supplier sent us an alternative. It was like wearing a garbage bag; it didn’t breath at all. We were soaked to the skin after a half hour. Q Do you think that COVID has brought changes to dentistry that will be long lasting? Any positive changes? AB: Dentistry is moving to a higher level of infection prevention and control. The dental office is more focused than ever before on functioning like a “mini- hospital” and therefore the level of infection control is also moving up a notch. When I was in dental school in the 1980s, dentistry adopted the use of masks and gloves. Before that, dentists used their bare hands and breathed whatever was in the air. My father was a dentist before me and, in his work, he was exposed to aerosols and dust from a number of different sources. Dentists drilled teeth all day. Dentists worked with plaster casts. That exposure didn’t have noticeable effects in the short term, but over a long career, it couldn’t be good. Wearing a mask made a big difference for dentists of my generation. COVID has been a bit of a wake-up call. We’re figuring out how to better protect ourselves from risks in our work environment. We’re rethinking the importance of safety. We’re improving what we do so that we are prepared for the next virus. Q Shall we end on something hopeful? AB: Yes! There are a number of COVID vaccines that are far along in their clinical trials. The first ones are going to be very challenging from a cold-chain handling perspective, but others are in the works that use more conventional refrigerators and cold-chain distribution. If the history of vaccine development teaches us anything, it’s that the first vaccines won’t necessarily be optimal in many ways, but with time, newer iterations will be easier to deliver, have fewer side effects and be more effective. 10 | 2020 | Issue 7 CDA at W ork