COVID-19 Re-Opening Strategy At Mistry Dental, we have been making significant changes to our office structure and clinical protocols in preparation for reopening. The health and safety of patients and staff remains our number one priority, and we are constantly adapting to the latest guidelines as soon as they become available. We hope reading about these changes will reassure you that we are taking this very seriously. We want our patients to feel safe and comfortable knowing that their overall health is in good hands at Mistry Dental. Air Quality:

ü Each operatory will have an Austin Air Purifier that runs 24/7 to cleanse the air. These are some of the best medical-grade HEPA filters available – each large unit contains 60 square feet of MERV-17 rated HEPA filters.

Austin Air purifiers were used by the U.S. Government to improve air quality following 9/11 and Hurricane Katrina, and they are manufactured right next door in Buffalo, NY. Whereas some cheaper purifiers cleanse the air every 20-30 minutes, these completely cleanse the air every 5-10 minutes. We have also purchased additional air filters for common areas such as the patient waiting room, staff break room, and sterilization area. We want to ensure that the air throughout our office is as clean as possible for everyone.

Enhanced Disinfection: ü Part of the COVID-19 reopening strategy is increasing the disinfection of commonly touched

surfaces such as doorknobs, payment terminals, clip boards, etc. using our usual medical grade sprays and wipes. We have purchased enough pens to ensure they are one-time use for all patients to fill out consent forms. The bathrooms will be disinfected after each use, and magazines, TV remotes, and brochures have been removed from all areas of the office.

ü We have also purchased a ULV fogger (see image on left) which will be used to further sterilize the operatories and common areas. These devices are being used by major airlines and hospitals because fogging eliminates bacteria, mold, and viruses that could be suspended in the air or trapped in porous surfaces such as fabric or carpets.

ü Our HVAC specialist is in the process of installing a UV-C lamp within our air ducts to disinfect any air coming back into the office. This is in addition to ensuring we have the highest rated filters that our air filtration system can withstand. We have also purchased a UV-C lamp that will be used to disinfect the operatories at the end of each day. UV-C light at a wavelength of 254nm has been shown to inactivate viruses and other live particles by disrupting their genetic material so they can no longer be infectious.

Mistry Dental COVID-19 Reopening Strategy

www.mistrydental.ca

Enhanced Disinfection (continued)

ü We have contracted a company to create negative pressure rooms by installing high airflow exhaust fans into our main dental operatories. Despite frequent air turnover and filtration from the HEPA upgrades, we still have to contain any aerosols within the operatory while we're working. There have been many articles about the benefits of negative pressure rooms in hospitals for aerosol-generating procedures such as resuscitation and intubation, and in dentistry we generate WAY more aerosols. Negative pressure rooms have been recommended by the CDC for dental treatment on symptomatic patients or suspected cases of COVID-19.

Aerosol Containment ü A unique challenge for dentistry is the containment of saliva and water droplets (aerosols)

produced during dental procedures. We use water while drilling to prevent the nerve inside your tooth from heating up, and hygienists produce aerosols with their ultrasonic instruments which remove calculus from your teeth during a cleaning. Sometimes those water droplets are so small that they remain suspended in the air for a long time. The HEPA filters and UV-C light in our HVAC system will disinfect aerosols, and Dr. Mistry has doubled the power of our suction motors to help contain most of the water during treatment. In addition to all of these engineering controls, we have also purchased multiple state-of-the-art aerosol evacuator systems (click for video, see image on right) which will contain and disinfect nearly all of the aerosols produced during treatment. Each unit contains its own HEPA filter and UV-C sterilization chamber for added filtration and improved air quality.

New Barriers in the Office: ü In line with the most recent recommendations from our licensing body, the Royal College of

Dental Surgeons of Ontario (RCDSO), we hired a contractor to put up temporary doors on the operatories. These doors will remain closed for aerosol generating procedures (AGPs).

Flight Defender Aerosol Evacuator

Mistry Dental COVID-19 Reopening Strategy

www.mistrydental.ca

New Barriers in the Office (continued)

ü We have installed Plexi-glass barriers around the reception area to protect staff and patients when social distancing is not possible. COVID-19 spreads through droplet transmission which can include simply talking to someone less than two metres away. The Plexi-glass company did a beautiful job, and we're happy to keep these barriers up long term as needed.

COVID-19 Protocols

ü We are in the process of finalizing our reopening strategy, which includes fit-testing staff for N95 masks and training everyone on the new protocols as mandated by Public Health Ontario.

ü We are asking patients to arrive to their appointments unaccompanied to limit the number of people in the office. If you require assistance, please let us know when scheduling appointments.

ü Patients are advised to call the office upon arrival to limit crowding in the reception area. ü We will be screening patients using a health questionnaire, consent form, and temperature check.

ü We are only accepting card payments at this time to avoid handling cash. ü Statements and receipts will be emailed to you following treatment.

ü No walk-in appointments at this time due to the new screening and social distancing protocols. When you first arrive at the office for your next appointment, it is going to feel very different but our staff will walk you through the new protocols to keep everyone safe. Until things return to normal, we are determined to make every effort possible to protect our patients and continue to provide the highest quality of dental care. We miss all of our patients, and we are very grateful for your continued loyalty and support. We look forward to seeing our Mistry Dental family again soon.

Regards,

Dr. J. K. Mistry & Staff