DENTISTRY MUST CHANGE ITS ROLE TO “A COVERED PERSONS” DURING SARS-2 COVID-19 WORLDWIDE PANDEMIC

BY NORMAN J CLEMENT RPH, DDS

WARNING: THIS ARTCLE CONTAINS GROSS HUMAN AND NECK DISSECTIONS FOR EDUCATIONAL PURPOSES AND MUST BE USED WITH DIGNITY AND THE UTMOST RESPECT

The Field of Dentistry, including its specialties, can ill-afford to sit at home and must change their roles as providers of dental oral health to “a covered person” during this Sars-2 pandemic. We cannot permit those most knowledgeable in Oral Health and Oral Pathology to be sidelined. The failure to implement Oral Health protocols will result in unnecessary deaths and destruction of the world/s economy. We are at war. Dentistry has a role in our Healthcare Armed Forces and will primarily be:

a) Oral and nasal testing to identify presence or non-presence of COVID-19 Virus

b) Intervention and Prevention

c) Adopting an Oral-Healthcare Guideline.(1) 

COVID-19 is an oral pharyngeal disease before it becomes a pulmonary and systemic disease.(id.) Once this virus gets past your hands and into your mouth and nose, your dentist, the dental office, Dental schools must be brought on board and utilized for testing and identification of preventive, intervention procedures.(2) 

DENTISTRY’S EXPANDED ROLE IN THE HEALTHCARE ARMED FORCES

Dental schools, and private dental offices could be delivering health services such as:

1. Large testing centers with outreach clinics to identify those testing positive or negative and coordinating their findings with a COVID-19 National Data Bank, similar to the Prescription Drug Monitoring Program(PDMP). (3)
2. Outreach clinics made up of the offices of private dental practitioners will then coordinate their findings with a COVID-19 National Data Bank, CDC and World Health Organization. 
3. The information gathered would be used for analyzing, tracking and intervention (response phase) into triaging areas of the country for effective mobilization against this disease.
4. Dental centers and private offices would be further utilized in the response phase for Periodontal Scaling and Root Planing, Dental Prophylaxis oral hygiene with instruction and follow-up visits.

Once this virus gets past your hands and into your mouth and nose, specialties and Dental schools must be on board as part of the Healthcare Armed Forces in this War to defeat COVID-19.

THE IDEA OF MAYOR BILL de BALSIO OF NEW YORK CITY USING LOCAL PHARMACIES TO SELF TEST IN NEW YORK CITY IS INSANE, HOWEVER!

The Mayor of New York City Bill de Blasio and New York’s Governor Andrew Coumo’s plan to use local pharmacies has serious flaws.

“Under a new executive order, Cuomo plans to grant independent pharmacists the authority to conduct diagnostic tests for COVID-19 – collected samples will be tested at labs off-site. This could add an additional 5,000 testing locations in New York State. “

Yet, this executive order can be improved by using both oral and nasal cavity testing through a Pharmacy/ Dental partnership. Using just the nasal cavity test alone will lead to inconclusive results if further testing of the oral cavity is not performed. Thus, wasting large amounts of limited testing materials that could, in fact, further endanger large segments of populations if a person believes they are negative when in fact, they are carrying the virus in their mouth and are asymptomatic.

THE UNITED STATES SURGEON GENERAL JEROME ADAMS MD AND AMERICAN DENTAL ASSOCIATION PRESIDENT GEHANI

The United States Surgeon General Dr. Jerome Adams has rightly stated his concept: “Better health through better health partnerships.” Each one will teach one, Dr. Adams concept using the Pharmacist/Dental partnership here will lead to better health outcomes and success in New York. Yet, success can only be possible with more testing, testing, testing, 90 million more testing Nation-Wide. 

The American Dental Association (ADA) has sent a letter to the U.S. Department of Health and Human Services April 17 asking the agency to “issue federal recognition that licensed dentists may administer point of service tests authorized by the Food and Drug Administration” during the COVID-19 pandemic, in response of concerns why Dentistry has been relegated to the sidelines. stating:(4)

In the letter to Adm. Brett P. Giroir, M.D., HHS assistant secretary for health, the ADA explained that administering these types of tests falls under licensed dentists’ scope of practice. The Association said by issuing federal recognition; dentists would qualify as “covered persons” under the Public Readiness and Emergency Preparedness Act, which may extend protection from liability associated with the administration or use of FDA-authorized COVID-19 tests. 

“Dentistry is essential to the public’s health. Enabling dentists to test patients prior to dental treatment will help lower the ‘very high exposure risk’ of dental personnel in contracting COVID-19 when treating infected but asymptomatic patients,” wrote ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin in the HHS letter. “It would add a layer of safety for both dental personnel and the patients they treat. This is important not only now — when most dentists are performing only urgent and emergency dental procedures — but also as the nation cautiously reopens.”

The ADA also said front-end testing would “enable dental offices to optimize their personal protective equipment,” noting, “optimizing the use of PPE is particularly important now when PPE is scarce in all health care settings, including emergency departments.”

More importantly, it has been reported in the literature, The Journal of the American Dental Association, Vol 135, issue April 4 2004, Pages 429-437, Aerosols and Splatter in Dentistry: A Brief Review of the Literature and Infection Control Implications, by Stephen K. Harreld, DDS., John Molinari, Ph.D.;(2)

” The saliva and nasopharyngeal secretions also may contain other pathogenic organisms. These may include common cold and influenza viruses, herpes viruses, pathogenic streptococci and staphylococci, and the SARS virus. The use of universal precautions with all patients initially was based on the assumption that all patients may have an infectious bloodborne infection, such as with hepatitis B virus, hepatitis C virus and HIV. It also should be assumed that all patients may have an infectious disease that has the potential to be spread by dental aerosols; thus, universal precautions to limit aerosols also should be in place.”

Drs. Gehani and O’Loughlin said the Association recognizes that COVID-19 testing kits are “currently scarce,” but pointed out that approving dentists to administer the tests now “will expand the nation’s medical surge capacity, optimize the use of PPE in health care settings, and create a safer environment for treating dental patients who would otherwise seek care in overburdened emergency departments.”

Citing research from the ADA Health Policy Institute, they noted, every year, more than 27 million people visit a dentist but do not see a physician:

“Federal guidance for dentists to administer FDA-authorized COVID-19 tests would help make every encounter an opportunity to test those individuals,” they concluded. Therefore we must increase testing by manufacturing 80 million oral-nasal tests.

BETTER HEALTH THROUGH BETTER PARTNERSHIPS

The United States Surgeon General Dr. Jerome Adams, who advocates “Better Health through Better Partnership,” he believes, “there is no us or them,”

Dr. Adams stated.

” I have seen this throughout my career in Indiana, “I’ve seen this in the operating room, and I’ve have seen it as The United States Surgeon General.”

“We have to bring together people who have not worked together,” says John Nichols of The Nation Magazine. “Better health through better partnerships,” says United States Surgeon General Jerome Adams, “if you make forging better partnerships better health is sure to follow.”

Dr. Jerome Adams States:

“We’ve got an opportunity, a mandate to win this game if we all figure out our roles, where we can be valuable on the field and play our part.” 

See below video U.S. Surgeon General Jerome Adams/from the conference on mental health/opioid. Crisis April 26, 2018) Let Philip Adams out of prison and into life long rehabilitation.

dac32633-4f04-4509-b7ce-0d17039e6005“Better Health through Better Partnerships”

When these above points become accepted, the World will prevail in defeating COVID-19

Drs. Gehani and O’Loughlin said the American Dental Association recognizes that COVID-19 testing kits are “currently scarce,” but pointed out that approving dentists to administer the tests now “will expand the nation’s medical surge capacity, optimize the use of PPE in health care settings, and create a safer environment for treating dental patients who would otherwise seek care in overburdened emergency departments.”

Citing research from the ADA Health Policy Institute, they noted, every year more than 27 million people visit a dentist but do not see a physician.

“Federal guidance for dentists to administer FDA-authorized COVID-19 tests would help make every encounter an opportunity to test those individuals,” they concluded. 

THROUGH DENTISTRY WE CAN REDUCE OR CONTROL THE DENTAL VIRAL LOAD

As the coughing increases, negative pressure causes the COVID virus, to jump into the lungs. Thus the understanding of the Clement Jumping Penguin Postulate(CJPP). However, through dentistry and dental oral hygiene, and Pharmacy followed by COVID-19 dental intervention guidelines ,we can reduce Oral Viral Load (OVL).

In gross dissected structures, we can see the anatomical relationship between the nasal sinus. oral cavity. and tongue to get a better understanding of the oral physiological component 

In the next gross dissection, the tongue is drawn back to demonstrate the teeth, tongue, and nasal sinus relationship. 

Also seen here, is very a small section of the lower part of the nasopharynx wall and the oropharynx wall which sits directly behind the back part of the tongue. It is from this section of the oral structures where it is theorized the COVID virus jumps into the esophagus and trachea. 

This photo gives the reader a clear understaning of the relationship of the nasal sinus, oral cavity and tongue for a better understanding of dental oral anatomical components

Therefore, along with washing your hands frequently, one should brush your teeth/ tongue and roof of your mouth, along with flossing at least 6 to 8 times daily, as well as rinsing your mouth with an over-the-counter antiseptic mouthwash and swishing, and expectorate(spitting)and at least 5 to 7 times daily. It may save your life.

DON’T DISCOUNT GRANDMA’S HAND

While having attained degrees in both health sciences of Pharmacy and Dentistry, let’s not forget our faith, spiritual beliefs and some of those cultural and generational remedies from those who have endured and gone before us or Grandma’s hands.

Every person whom I’ve spoken to that has recovered from COVID-19, has had two strong beliefs in common:

1. A strong sense of Spirit, Faith and God; “…after you’ve done all you can…you just stand and let the Lord see you through“
2. Ginger, Ginger root, Jamaican Ginger Beer warmed and with a slice of lemon.

While Grandmas may have not been physicians, pharmacists, dentists or lawyers, their remedies work because warm ginger with lemon reduces the Oral Viral Load(OVL) in the oral pharyngeal Cavity because the Achilles heel of the COVID virus is heat.

I grew up in Detroit so my preference has always been warm Vernors Ginger Ale with a slice of lemon, sipped slowly. Of course one can use Ginger Beer, Ginger Root boiled and served, but there is a third belief which comes from Grandma.

3. “USE GOOD COMMON SENSE,” because, ” A HARD HEAD WILL MAKE A SOFT BEHIND”

FOR NOW

YOU’RE WITHIN THE NORMS