Dear Patients,  
During this unprecedented time, I want to personally reach out, check in, and update you.  Some of you have known me for more than 20 years and others are new to our dental practice. Regardless of the time, all of you know that the health and safety of both my patients and of my employees is and always will be my top priority.   
The experience gained from my position at NYU combined with running a substantial dental practice that includes 27 residents and hundreds of patients, assisted in my quick development of a new protocol and equipped the office with necessary supplies -  with the awareness of the potential difficulties to acquire supplies during this time. I have spent time hosting webinars and answering questions from dental colleagues all over the nation, in order to help prepare the dental community on how to update business operations and practices to accommodate the ‘new normal.’  
On Thursday, April 23rd, we started seeing patients. Opening for just one day, we used the time to provide urgent and essential treatment. We tested our new protocol and it worked perfectly. I have attached the protocol which details our safety guidelines and methods for implementation.   
We will continue seeing patients once a week, only for essential treatment, with services provided by myself and Dr. Farahani. Beginning the week of May 18th, we will scale our practice operations to 2-3 days per week - depending upon patient need – and will offer all services and treatment. Hopefully by mid-June, we will return to our normal schedule.  
During this shut down period, I was available to my staff, kept them on payroll, and made myself available for anyone of you who needed me by providing my personal contact information. These are difficult times and we need to remember that we are all in this together. The virus is not going to suddenly disappear by an arbitrary date placed by some people.  The president of the American Dental Association, Dr. Chad Gehani, recently said:  “The longer dental practices remain closed to preventive care and treatment for early forms of dental disease, the more likely that patients’ untreated disease will progress, increasing the complexity and cost for treatment down the road.”   
On that note, I am a health care provider. I have willingly accepted all responsibility and risks and the care of you - my patients – is a priority. I have two genetic conditions that put me at a high risk of blood clotting. For unknown reasons, it has been found that COVID-19 causes multiple blood clots in people of my age category. With that in mind, I will not abandon ship and will continue to make myself available to my patients that have trusted me for over 20 years. We will take all the necessary precautions to keep you safe during you appointments.  My staff and I look forward to seeing you soon and thank you for allowing us to be your dental provider.

Infection Control Protocol during the COVID-19 Pandemic

Edgard El Chaar, DDS, PC 130 E 35th street NY, NY 10016

Preparations:

The office has been equipped with the following:
High volume vacuums to capture the aerosols
Air filters that recycle the air in 5 minutes
Face shields for loupes
Gowns (disposable and reusable)
KN95 and N95 masks
Level 3 masks
Level 1 masks
Hair covers
Shoes covers
Sneeze barriers
Hand sanitizers from touchless dispensers
Touchless Soap dispensers
Reconfigured the waiting room to contain less people
Garment bags for patient and staff coats
Bags for Personal belongings of patients and staff
Plastic covers for the seating area in the waiting room
Removed all water bottles, magazines, lip balms, pens, plants
Touchless thermometer
Handheld UV light

Treatment protocol:

I will detail the protocol of patient and team member management by area and by members of the team: To avoid repetition, the following abbreviations will be used:
Treatment rooms = TR, PPE (masks, hair cover, face shield, eye protection, shoe cover)
Waiting room = WR

Waiting room:

a - Each evening, the business team will contact patients for the next day and ask them: if they have fever, cough, flu-like symptoms (fatigue, body ache, watery eyes, feels shivers, not to confuse with seasonal allergies). They will be instructed that no escort should accompany them and that they will arrive on time.
b - Patients will be checked with the thermometer before entering the office and will only be admitted if they do not have a temperature.
c -At any given time, there should be no more than three patients in the waiting room. They will sit in the three designated spots. They will be required to put their coats in a garment bag that will be handed to them by the business team as well as all personal belonging hand bags, back pack or anything in the same range will be also stowed in bags. Cell phone should be kept in their pockets or bags. We will hand them a mask, and a gown, shoe cover, hair cover that they will put on before entering the waiting room.
d - The door leading to the treatment area will be closed at all times.

Treatment areas:

a - Patient will be escorted from the waiting room by the dental assistant or hygienist that are wearing full PPE, patient will be seated on the dental chair and the hygienist and providers can start the treatment.
b -At this time, patient will remove the mask and place it in a bag dispensed by the staff.
c -Patient will rinse three times with hydrogen peroxide, their mouth will be wiped with a gauze dipped in hydrogen peroxide, wiping the floor of the mouth, tongue, palate, pillars of the palate, muco-buccal folds and cheeks.
d -After the assistant members and provider have checked that all material and equipment needed for the procedure is available, the treatment will begin after verifying that their PPE is in place. e - If the treatment requires aerosols due to use of piezo, cavitron or high-speed turbine, the high vacuum suction should be in position and turned on.
f - If the provider is to leave the TR, he or she will change and drop the used PPE in a designated bag in each room at the door, take new PPE and put them on and go do what they are supposed to do. At any time a patient encounter takes place and a possibility of contamination is suspected, the PPE will be changed before exiting the treatment room, changed with a new one that will be placed on the outside of each TR. UV lights can be used to pass it over the Gown and mask again in case no contamination is suspected.
g - We will avoid crowding in the hallway, we wait until any incoming traffic is cleared by contacting the business team and they clear your movement.
h -The doors of each TR will be closed at all times.
i -At the end of the procedure, the patient will remove the gown, place it in the disposable bag and put on a new gown, their mask and escorted to the WR. They will pay by CC, that the terminal is handed to them, which will be wiped before replacement in the closed area of the business team.
j - Patient will remove and dispose of the gown, hair cover and their shoe cover in a bag placed outside and will keep their mask.

Cleaning of the rooms:

At the end of every treatment, the TR will be cleaned fully, the counters, door of the cabinets, cabinets, floor wiped, the whole dental chair wiped after removal and disposal of the plastic covers and we will wait for 10 minutes before bringing in next patient, allowing the airfilter to recycle the air in the TR. The doors of each TR will be kept closed at all time.

It will take time but we will adjust to it and we will come out better. Sincerely,
 
Edgard  
Edgard El Chaar, DDS, MS
Director,
Advanced Program in Periodontics
New York University, college of Dentistry
Diplomate American Board of Periodontology
Diplomate American Board of Implant Dentistry
Clinical Associate Professor,
New York University, College of Dentistry.

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