Gar N. Chan, DDS, INC

Happy 4th of July!

This is a miniature quilt 7″ x 6″ that I made in the mid 1980’s.
Some day I plan to hand quilt the borders and maybe I will antique the fabric with a light tea dye. Although it is not perfect in design or execution, it reminds me of why I will celebrate July 4th., Independence Day.

I am thankful to those who and events which contributed to our nation’s history. I grew up thinking that through sacrifice, over coming obstacles and standing up for my beliefs were steps towards character building and fulfillment. My life’s path is far from perfect. My family’s country, the United States of America for five generations is far from perfect.

I celebrate our country’s accomplishments and I am proud to be one of its citizens. Wishing you all a Happy 4th of July!


Ask An Expert: Wearing Masks To Prevent COVID-19

Excerpts and edited notes for this blog were referenced from an “Ask An Expert” segment hosted by Stan Bunger aired on Monday, June 22, 2020 at 9:20 am, on KCBS radio station 740 FM, sponsored by Sierra Pacific Financial Advisors. The following blog is presented for viewers to validate, accept and/or decline its content and findings on their own.

As we continue to navigate these unprecedented times, KCBS Radio spoke with Jeremy Howard, data scientist and researcher in residence at the University of San Francisco (USF).

1. Stan: Jeremy, How did you get into this? You are not a medical doctor. You are a data guy. What was it about the whole mask concept that got you into this?

Jeremy: As a data scientist and instructor at a research lab,  I specialize in gathering and analyzing medical data. Earlier this year I randomly picked masks as an interesting topic for the students and I was shocked to discover that the evidence for masks was really strong, that they could be the best tool we have. The last several months I volunteered to put together a team of some of the world’s top scientists to work on this topic and we have been studying and communicating the evidence ever since.

2. Stan: So let’s talk about that evidence because the messaging  has been all over the place on this and  for a lot of people it has become politicized.  Even for people who do not fall into that camp, they are saying, “All right prove it to me”.

Jeremy:  When we started studying this, the Surgeon General said masks don’t work, don’t wear one and CDC stated they were not recommended. Now we know the reason that was said, was that they were trying to protect the supplies for the health care workers which has caused a lot of distrust and confusion.

The evidence shows cloth masks block 99% of the droplets that fly out of people’s mouths when we speak.  They are so small that we cannot see them without using a laser scattering chamber and those are full of millions of virus particles.  Being able to block out about 99% of those droplets has a huge effect when somebody who might be infected wears a mask.  You can’t wait until you have symptoms to see if you are infected or not, because about half of the infections occurs from people who do not know they are sick. That is why we need everybody to wear a mask.  The evidence shows that in the countries which have used masks widely, their transmission rates are about ten times lower than those that don’t.  We see a similar thing now in the U.S.  In states that have masks requirements, they have dramatically lower transmission rates than those that don’t.

3. Stan: And to the question of whether I am wearing it for me to protect you or to protect me from you, where do you come down on that?

Jeremy: If you are mainly protecting others from yourself, it is an altruistic thing to do. The reason is the droplets that come out of your mouth when you are speaking, rapidly evaporate into tiny particles called droplet nuclei. These are very hard for any kind of mask to filter, especially a non-medical mask. So we want to catch them before they evaporate and that is why it is important that you wear one to protect others from you. They give you some protection as well, but not as much.

4. Stan:  Do you have any thoughts on how we might depoliticize this whole mask question? It just seems like a whole other round of an endless series of arguments in this country where people cannot agree on anything.

Jeremy: It is exhausting, often depressing why this is happening.   Early on it was a bipartisan campaign and the first person to come out strongly in support was Senator Pat Toomey, Republican, who made a video about the importance of wearing masks. This was before the CDC changed their guidelines.  Laura Ingraham, of the Ingraham Angle, Fox News, was very supportive. She had me on her show talking about the importance of masks. And then something happened. I think it might have been partly Donald Trump refusing to be shown wearing one. Suddenly things started getting political.  Recent surveys show that the majority of Republican voters want everyone to wear a mask and they feel more comfortable when more people are wearing a mask than not.  We want to save lives and protect the economy. We don’t want to go into a second lock down. And this is something all voters can agree on whether they are on the right or left side of politics.

5. Stan: Which is the better option? Three ply ear loop face masks with fluid prevention or a cloth mask? I am thinking especially of my kid who may have to wear a mask for hours going back to a hybrid form of high school?

Jeremy: That is a good question. I know for my kid, I am mainly interested in what can I do to protect her.  Make sure that it is well fitted and made from the right materials. A mixture of cotton and silk or cotton and chiffon offers about the same level of protection according to a recent academic paper, as an N95 respirator does.  Focus on fit which can be achieved by placing rubber bands over the front.  You can use cloth and paper which has a very good filtration level. The trouble with wearing something like an N95 respirator all day is that it is much less breathable. The surgical masks are not a clear improvement over cloth masks either way. They are designed for different purposes. They have a water proof layer which can cause them to deform. They are specifically designed as the maker suggests to be used in surgical situations to protect against things other than just face droplets. So with kids going back to school, it is a tough call.  Get the best fitting and  highest filtration mask you can get which can be comfortable to be worn all day.

6. Stan: I read a Facebook comment that wearing a mask is dangerous because you are breathing in your own CO2. Please explain why this isn’t so.

Jeremy:  When you breathe out your exhaled air, which is indeed higher in CO2, it has to go somewhere.  If you are not wearing a mask, it goes out to the atmosphere around you. When you breathe in again, you could be breathing some of that back in unless it has good ventilation. If you have got a mask on, when you breathe out, there is really not a lot of room between your lips and the mask to store a lot of that breath you let out. If you did, it would be like a balloon. Again the whole thing gets breathed out into the atmosphere. So the idea that you are re-breathing that CO2, that would only be possible if you were wearing a mask that behaved like a balloon.  Then the mask would blow out and then back in again. Since that is not happening, then you can tell all of that CO2 is cast back out to the surrounding air, just like when you are not wearing a mask.

7. Stan:  Generally, how long do N95 masks last? What expires? I didn’t see a manufacture date, only use by date.

Jeremy: The answer is we don’t know . It does seem a lot of these recommendations around expiring and reuse are overly enthusiastic. They are on the conservative side on the assumption that we are never going to have shortages. If you place an N95 respirator in a warm, not hot oven, like 160 F, not very hot, for half an hour, then it deactivates any virus particles and does not cause any damage to the material, then we can see there is not any reason not to keep using them.

8. Stan: I have a couple of cloth masks through the generosity of a local woman who makes and gives them away to the community. My question is how often is cleaning required and what is the best method for cleaning?

Jeremy: Treat your cloth masks the same way you would treat a t-shirt or pair of socks. At the end of the day, pop them in the wash and just like with socks or a t-shirt.  If you drink something and are active and it gets hot and sweaty and disgusting, take it off and give it a wash before the end of the day.

9. Stan: With a long beard, is there any effective mask? Does the beard filter any virus intake? Think about a mask on an airplane, beard and mask is the question.

Jeremy: It  makes it a bit harder, but if you attach it as tightly around your face as you can and you think of cloth as absorbent, it will still catch those speech particles on the way out. It is important to realize that no masks other than medical respirators are going to do much against coughing, because that is something cloth masks cannot do.

10. Stan: What about gaps around the cloth masks? Even with gaps, are the cloth masks better than wearing nothing?

Jeremy: Gaps are a problem after heavy breathing, especially after exercising, or coughing or sneezing. If you have hay fever, then use your elbow. Otherwise, little gaps don’t matter too much. The most droplet spread occurs when the droplets are pushed forward out of the mouth.

11. Stan: In the New England Journal of Medicine, an article discusses the benefits of face shields versus face masks. Can you tell us about that?

Jeremy: That article was designed as an assertion to promote discussion. It was not based on data or research.  Face shields are not a substitute for face masks because they lack absorbency to absorb the viral droplets before they become aerosols. The Hong Kong Consumer Council recommends masks have a layer or paper tissue inside in addition to wearing a face shield on the outside. A simple, inexpensive face shield may be made from a transparent file folder with a headband slid underneath. On a plane flight, this made myself and my family feel we improved our safety a bit.

12. Stan: It has been recommended that teachers wear face shields in lieu of masks in order for students to observe, see and hear then more clearly. Would this be safe to use without a mask in a classroom of 12-20 students? What is your best recommendation?

Jeremy: It is a tough call because the teacher by necessity needs to speak loudly which creates more droplets and the droplets go farther. If the teacher is facing forward and the students are in front of him/her, then the face shield will act as a barrier from the forward movement of the droplets. That can be helpful. Because the face shield is not as absorbent as the mask, droplets can go around the sides. Then ventilation becomes imperative with all doors and windows open to allow airflow.

13. Stan: Is covering the nose important?

Jeremy: To protect yourself, you should definitely cover your nose. To protect others from you, others do not have to wear their cloth masks to cover their noses. Some individuals cannot wear masks over their noses and they should not be shamed for not doing so.

14. Stan: An on-line video shows how paper masks can be folded to be more effective. Is it worth the extra effort.

Jeremy: The paper is folded horizontally in the center and made into a diamond/rectangular shape. It takes a few extra seconds to do so. It is only worth it if you wish to achieve the filtration of a surgical mask.

15. Stan: Does wearing a face shield without a mask meet the state mandate for wearing a face covering?

Jeremy: I am not sure.

16. Stan: Does wearing a cloth mask promote and collect mold?

Jeremy: There is no sign or data to support that. Over 95% of the world now wear masks and there have not been any reports of that occurring.

17. Stan: What is the best type of filter to slip into a cloth mask?

Jeremy: Simple paper towels work well.

18. Stan: Do you think mask wearing should ultimately be left to the individual to decide since we are all ultimately responsible for our own health?

Jeremy: I wish that were possible, but it is similar to drunk driving and speeding. There are things that hurt other people. Me wearing a mask is not enough to protect me. My protection is dramatically more effective if you wear a mask when you are around me because of the droplets you create when you are talking. The problem is that by not wearing a mask, those who do not, hurt others.

19. Stan: What is your position on people out exercising without a mask?

Jeremy: Personally, it is not a problem due to ventilation. Being outside has a twenty times lower possibility of viral transmission than being inside.


Happy Father’s Day

To all of the fathers in the world,
we celebrate their very presence and influence on all of us
both past, present and future.

Thank you, dear Dads, for all that you do and mean to us!


COVID-19 Testing In the Dental Office:

Note:  Excerpts for this blog were referenced from an article which appeared in:  Perio Implant Advisory, Author:  Vicki Cheeseman, Jun 1st, 2020

How, when, and why? Is it really necessary to test patients for COVID-19 in the dental office? What do those tests tell us, and why are they so important to our patients and the pandemic as a whole?

Daily the Centers for Disease Control and Prevention (CDC) report the number of cases of SARS-CoV-2 (COVID-19) in the United States and of those cases, the number of people who have died.1

One chart dated May 31, 2020 on the CDC website gives us a graphic to visualize COVID-19 cases by age1:

  • Age 0–17: 54,921 cases
  • Age 18–44: 560,226 cases
  • Age 45–64: 485,373 cases
  • Age 65–74: 143,545 cases
  • Age 75+: 170,100 cases

These statistics show that the population group with the highest risk of contracting the virus is also the smallest segment. What does this mean for dental offices? Dental professionals need to be aware of the trends in viral contraction and identify their patients who have COVID-19 symptoms and/or those who may be asymptomatic but still carrying the virus.

Several studies have suggested that mortality rates of COVID-19 are lower than many previously predicted.2 For us screening patients for COVID-19 in the dental office is routine. Certainly the outcome of testing would be helpful in determining how to provide further treatment of infected patients in a way that keeps uninfected patients healthy.

What do COVID-19 tests tell us?

Currently there are two types of tests for SARS-CoV-2: antibody tests and viral tests.3 Both test results yield different findings because they test different things. Antibody tests can tell us if individuals have previously had an infection, since the body produces antibodies one to three weeks after contagion. Viral tests, on the other hand, can determine whether an infection currently exists.

Why is testing so important?

Our World in Data says it best: Without testing there is no data. Testing is our window onto the pandemic and how it is spreading.4 In areas without testing, the true number of COVID-19–infected individuals is likely to be much higher than the number of confirmed cases.

Scott Froum, DDS, editorial director of Perio-Implant Advisory, adds this:

“What the new CDC data shows is that a small segment of the overall population is the one with the greatest risk of disease severity and case fatality. If we can identify those patients who have greater risk, we could limit hospital visits.

In addition to all the controls implemented in Dr. Chan’s office, our screening questions  ask about co-morbidities associated with COVID-19. Those patients who fall into this category are treated at times during the least office traffic.”

Read the rest of this entry »


Why Online Registration is Essential During COVID-19

Reasons Why Online Registration is Essential During COVID-19 for Dental Patients

 

Social Distancing Business Best Practices

If you haven’t tried online registration to access and complete your dental office forms yet, there’s no better time than the present. In fact, many dental offices have found that it’s become necessary over the last few months as we attempt to comply with physical distancing orders.

Before the global pandemic of COVID-19, the benefit to modernizing patient intake with online forms ranged from patient convenience and satisfaction to front desk efficiency and cost-savings in data entry. But now, as we continue to wait for sheltering orders to be lifted, and as we slowly and cautiously ease back into in-person appointments and care, secure online forms and registration are a must.

Why is secure online registration essential?

Aligns with Physical Distancing Orders

We are all faced with a long road ahead as we navigate public health strategy and relax physical distancing measures. Online forms help patients comply with physical distancing and shelter in place orders, limiting exposure for you and your staff.

Ensures HIPAA Compliancy

All of us understand the importance of a secure website and the necessity of a secure and safe way of collecting and documenting ePHI (Private Health Information) between patients and providers. An online patient form system for dental practices that fulfills all HIPAA requirements is instrumental in ensuring patient information remains confidential.

Offers Convenience

COVID-19 or not, online forms are more convenient and efficient for patients because they can be completed at home from a desktop, tablet, or mobile phone rather than at the dental office. Believe it or not two-thirds of patients prefer digital scheduling to paper, and nearly half would consider switching providers for the ease of online registration.

Provides A Way To Go Green & Be Time Efficient

Paper charts use our precious resources and cost money. And more expensive than the price of the paper and copying and printing is the time spent on data entry, scanning, and filing. Practices using online registration are saving thousands of dollars and countless hours of clerical work.  These monetary and time resources can be better re-allocated towards safety measures and equipment.

Eliminates Data Entry Errors

Why enter data twice when a one-time online form filled out by the patient would do the trick? In addition to being integrated with practice management software and customized for specific needs and specialty, online registration eliminates tedious yet important data entry. Our staff can simply verify, accept, and convert the collected data into a new patient account, saving valuable time and avoiding potential errors.

Helps Us Become Paperless

A paperless office begins with a paperless chart.  Because we have moved on to digital records, we are well on our way. But a true paperless office bypasses all time-consuming and redundant paper stages entirely. When we move from storing information electronically to receiving and retrieving that information electronically as well, we have nailed the paperless goals.

Collects E-Signatures

Who needs pen and paper for acceptance of treatment or consent? Our patients are provided with the luxury of signing their secured documents electronically in the office.

Easily Plugs into the Practice Website

Digital form registration has never been easier than with our software which is a secure, HIPAA compliant system that enables patients to send their forms directly through our website prior to their visit. The information is automatically transferred into our practice management software and safely stored.

Integrates with Existing Software

Online registration systems like our software integrates and auto-populates medications to appropriate forms, streamlines workflow, and eliminates potentially dangerous errors when office staff input names of prescriptions, dosages, and frequency of administrations. This seamless integration improves both patient care and clinician satisfaction.

Offices who have adopted online form completion have reported that over three quarters of their patients use the online system, saving about 15 minutes per chart or 7.5 hours a day in preparation and data entry. This leaves our staff more time to spend making sure our facilities are sanitized,  kept safe for all, and most of all, to provide necessary and needed dental care.


Dental Infection Control Through High Volume Vacuum

Our office continues to introduce and use new technology to protect our patients and staff.  To reduce dental aerosols caused by using a high speed handpiece or an ultrasonic device, we now employ an autoclavable device which quickly removes dental aerosols.  The device is called a Xuction HVE and uses a patent pending design.

Studies have shown that positioning of the HVE extraorally can be beneficial. A HVE device positioned extraorally within one inch of the commissure of the mouth resulted in reduction of particulates from 89.7% to 90.8% when compared to the intraorally positioned standard saliva ejector.

See the photo and video below and see for yourself, how the Xuction captures the aerosols.

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Let’s Face It!

Dr. Chan is wearing his PPE, including a face shield,  face mask and his magnifying loupes.

After several months of waiting,  today our face shields finally arrived after being on back order. These protective face shields are worn by staff during procedures which produce a high volume of aerosols.   The face shield protects the wearer from spatter and debris.

During specific procedures the use of a high volume suction evacuation system helps to minimize the amount of aerosol particulate matter in the air.

Often Dr. Chan uses his magnifying loupes, to gain greater precision. This requires that the face shields fit over or through them.

Do you like Dr. Chan’s new look?


We’re back! Open to Meet Your Needs!

 

Last week Santa Clara County informed our office that following safety protocols and practicing physical distancing, we may re-open our family dental practice.  The County noted that we may resume providing general dentistry services for our patients, including  continuing care maintenance and restorative procedures.  On Tuesday, May 26th, 2020 we will re-open our doors to welcome existing and new patients.   We are prepared to provide dental treatment services the only way we know – to do it exceptionally well.  Call us today to reserve your place.  408-847-1234.


How Dr. Chan in Gilroy Is Making His Dental Office A Safe Place Post COVID -19

In light of COVID-19, many  patients wonder whether dental offices will ever be safe places again.  Although many of us have kept up with the news, preparing to return to our regular routines, has been a heavy cloud hanging over our heads.

Dr. Chan himself has been on a personal journey to making our  dental practice aseptic yet welcoming.  Throughout the Shelter in Place (SIP), he has been doing extensive research on whether there are protocols to follow as we reopen our dental practice.

Following the annotated notes of  professional journals, associations and governing bodies, Dr. Chan answers  a variety of questions about when, what, and how he has implemented changes in his dental practice to ensure the health and safety of his team and his patients.  Perhaps your concerns can be appeased from reading about Dr. Chan’s plans in this time of uncertainty.

1.  First off, Dr. Chan, have you resumed normal business hours in your dental practice and is your entire team back in the office?

We have  resumed our office hours as of May 26th, 2020 with our entire staff.  Prior to that we were only seeing emergency patients.

Dr. Gar Chan

2.  What steps did you take in order that  your team could resume practicing dentistry?

We made sure that our infection control measures were current by reviewing and updating infection control protocols with the entire staff.  Also, we implemented elimination, substitution, engineering, and administrative controls.

3.  In light of COVID-19, what are the things you consider absolutely essential to change or upgrade in your practice to make it safe that are different from those pre-COVID-19?

I would say a good pre-screening system and adherence to good infection control standards are a must.  Post-COVID-19, we:

  • do more pre-screening
  • schedule patient-distancing appointments
  • do symptom-checking upon arrival
  • reschedule and/or refer symptomatic patients
  • do more online communication

4.  What have you done to make your dental team comfortable with the level of workplace safety in your practice?

We bought adapters to maximize our high volume evacuation (HVE), extraoral vacuums, and of course use proper PPE, including face shields which will fit over our magnifying loupes.  We removed portable fans and removed extra items off counters.   We placed antiseptic soap dispensers throughout the office. We ordered more laundry friendly clinical jackets.  We ordered a new touchless thermometer.   All staff were asked to be tested.

5.  What steps help to make sure your patients feel like your practice is safe?

Pertinent email and phone communication.

6.  Do you test your staff for COVID-19, and if so, how?

Yes, all staff have been asked to be tested for COVID – 19 prior to our re-opening date.  We have left it up to the individuals, as to the specific testing procedure.

7.  Did you raise your fees to cover increased safety measures performed in your office?

Yes, we now include a nominal PPE charge for each visit.  Since most insurance fee change approvals are only permitted annually, we were unable to include the increased safety costs  into each procedure.

8.  Do you use teledentistry, and if so, for which patients?

Not yet, but we will soon have that capability.  Yes, for a variety of situations, including post-operative patients.

9.  Do you have any advice to share with your patients?

  • Keep abreast of the latest developments and knowledge regarding COVID-19 as the material and agency recommendations are constantly changing.
  • Follow social distancing
  • Frequently practice hand sanitization
  • Eat healthy choices
  • Exercise regularly
  • Enjoy life
  • We miss our patients and the relationships we have built over the years.
  • We hope to see you soon!

Covid-19 Testing Now Available

Dear Friends and Family,

My neighbor and her husband were tested for free (please check for yourself) today at Christopher High School for Covid 19, as part of Gov. Newsom’s plan to have 80 test sites throughout California.  See below.

I made appointments for our family for tomorrow.
If you would like to consider doing this, see the following info:

1. Link to make appointment for Covid testing:
http://www.lhi.care/covidtesting.

2. Link for background info:

Santa Clara Co. Opens Two Testing Sites In Latino Communities Hit Hard By COVID-19

Note that although the website says it is free, please check to make sure it applies to your circumstances.

3. For further information: 888-634-1143.

Take care,
Rhona Lee, HEF, MS
c/o Gar N. Chan, DDS, Inc.
7880 Wren Avenue, Suite E-154
Gilroy, CA. 95020
408-847-1234
www.Gilroysmiles.com