Office Update

To our wonderful patients,
We have an important COVID-19 Office Update. As we've been monitoring the news, it's come to light we need to change our COVID-19 policies.If you have been to one of the coastal beaches of Maryland and/or Delaware within 14 days prior to your visit, please let us know so we can reschedule your appointment. Or you can keep your appointment with a negative COVID-19 test. Out of an abundance of caution and due to the high amount of COVID-19 cases spiking in those areas, we are taking extra measures to keep our team and patients safe. 

If you are aware of coming into contact with COVID-19, here is information on how you can get tested quickly and efficiently in Maryland: https://coronavirus.maryland.gov/testing and in Delaware: https://coronavirus.delaware.gov/testing/ 

There is also testing at the Convention Center Wednesdays and Fridays 8 am- 2 pm. 

As any new information comes out we will try and keep you updated and informed as best we can.And as always I truly appreciate all the support you all have given to this practice, and the patience you've shown as we try to navigate these waters as best we can.
Stay safe! 

Dr. M


To our wonderful patients,
I hope this email finds you and your family well. We have all been through significant changes in our lives over these past several weeks, however in this unprecedented time, we remain committed to your well-being and safety.  A lot’s been happening on my end: every single day these past two months I have poured my heart and soul into making this practice better- analyzing each system between business and clinical, asking myself what we can do better, comparing strategies and resources, and restructuring things. Everything from hiring amazing staff members, to our intraoffice communication system, to patient paperwork- and *yes* creating a patient portal so that payments can be taken online. It’s been a lot on me on top of the financial stress of trying to stay afloat as a fledgling business severely impacted (and will continue to be impacted) by this, while still providing care to emergency patients, but I wouldn’t have it any other way. I want all my patients to have the best experience in a dental practice I can possibly provide, and the silver lining in all this is that I’ve fully squeezed the juice out of every moment in order to do my absolute best in this regard. And I am extremely grateful to have been able to continue to keep Kelly employed- she has been wonderful at checking in with as many people as she can, listening to your stories, letting me know how everyone’s doing.

However, it is almost June and there is *still* no guidance from the CDC or OSHA on re-opening dental practices. I naively expected more. It’s time to make decisions using what guidance we do have and my best judgement. It is time to move forward.We will be opening June 1. I need to be there for my patients- after two plus months, even things that aren’t life threatening are still just getting worse and can not be neglected for much longer. Being open will look different than it has in the past obviously and I’ll break down the main things you need to know in the following paragraphs. The most noticeable things will be the changes due to COVID 19, but there are other changes as well. Read on as much as you like, but if nothing else, just know you will receive a text the day before your appointment with instructions that we ask you to follow. You will also be receiving an invitation to create a patient portal for our software a week before your next appointment.

And if anything I discuss below makes you uncomfortable or requires a conversation, please reach out to me directly at Dr.M@baltimorewaterfrontdental.com so we can talk about it. I care for you, I am here for you, I am trying my best, and I just ask you to be patient with me as we navigate through this together.

Thank you again for placing your trust in this practice, we truly value our relationships and look forward to bringing back some normality to our lives.Looking forward to seeing you all soon,Dr. Dawn Merguerian

PPE
We have always followed the regulations on appropriate protective clothing, but that has now changed- though it’s still fluid. We are wearing face shields over our masks as well as bouffants with our fluid resistant gowns- all of these being changed between patients.Let me break this down further. There are three levels of acceptable head gear protection. Going from least risk to most risk: N95/eyewear/faceshield; mask level 3/eyewear/faceshield; or mask level 3/eyewear.We are wearing Level 3 ASTM masks at this time- true N95s have been impossible to get (I’ve already placed orders and waiting), and I held off on ordering KN95s because (as I knew it would) it turns out many of these that were being presented to dentists are in fact counterfeit. As soon as I could find a trusted, FDA approved KN95 mask I jumped on an order, but of course we’re still waiting on those, as well as the fit test to check them once they arrive. Once we have them they will be offered to every team member. It is a voluntary thing though, as I’m learning more about the risks of N95 use. Fun fact- I had tuberculosis when I was younger that left me with permanent scarring in my lungs. They work fine most of the time, but if you’ve ever been anywhere near me during a track workout, you can really hear that breathing start to kick in, or any time airflow is less than ideal. So personally, I will always choose Level 3 masks over N95s because I cannot get enough oxygen otherwise. As far as faceshields go. We have them. Team members are wearing them. I have tried them, but if you’ve ever noticed, I wear 6x magnification loupes to do dentistry. Anything less is not up to the standard of care especially for root canal treatment. My loupes do not fit under the face shields that are available. There are companies that are working on that- I have placed orders, they have taken my money and promised orders to be shipped out, and of course I am still waiting. I am tirelessly searching for faceshield options, but until I actually get them, I will personally be wearing a level 3 mask with my eyewear. I accept this risk, I cannot practice dentistry otherwise. With all of this, there is a $15 fee we are adding due to the costs of PPE and the overhead of all these extra measures such as more laundry, more wiping down of non-treatment surfaces, adding air filtration, and adding intraoral equipment for procedures. Most insurance companies are paying these fees- if they do not, do not be afraid to discuss with us if this is a financial hardship for you.

What we are doing in the practice daily
We have gone through the OSHA form 3990 and have created a contingency plan and respiratory protection plan in accordance with their guidelines, meeting/exceeding all the requirements.At the start of each day, as a team we will take our temperatures and review COVID 19 screening questions, sending home anyone who exhibits any signs of sickness.Throughout the day, besides sterilization protocols in the treatment rooms, we are wiping down all contacting surfaces throughout the office and logging it.When you call the office to schedule an appointment you will be asked screening questions before being scheduled. The day before your appointment you will receive a text with instructions for how to check in and a web link. The morning of the appointment click on the link to fill out a new screening questionnaire and consent form. When you arrive, we request that you to call us or text us so we know you’ve arrived, and then remain outside. We will re-ask the screening questions, confirm receipt of your signed consent, and then once we know we have your treatment room ready, we will respond back for you to come to the door with your mask on.  When entering the office, your temperature will be taken. No unnecessary guests will be allowed in. Only one parent/caregiver will be allowed in the treatment room if the patient is a minor or one guest for patients who require assistance, for example with sedation cases.

We will take you directly back to the operatory. Please try to use the bathroom ahead of time, but if necessary to use ours, we ask that on top of regular hand hygiene, please use the provided hand sanitizer next to the door. Once in the operatory, you will remove your mask and we will have you do a pre-rinse with hydrogen peroxide. We will also have more involved suction devices used with each procedure. For any aerosol producing procedure we will be adding the use of a rubber dam where possible, or a Dry Shield (https://www.dryshield.com/) when not. The operatories will be running HEPA 13 Filtering systems capable of removing up to 99.97% of all virus/bacteria- they change the air in each treatment room in less than 15 minutes (the rooms are 135 square inches and the CADR for each unit is 250).

Once we’ve confirmed there’s no other foot traffic up front, we’ll be ready to take you to check out and we’re providing fresh pens for you to use and please take as well as hand sanitizer for you to use to help with the check out process. Our new merchant also accepts Google/Apple/Android Pay to help reduce touches. A sneeze guard will also help provide protection. Again, all of these surfaces being cleaned regularly and logged. 

HIPAA Policies
As I’ve had time to sit down and make sure every aspect of my business is holding up best practices, I’ve come to realize it’s time to upgrade our HIPAA policies. Truly, any email beyond a basic appointment reminder should be encrypted to protect your electronic protected health information. This includes those post-op check-in emails I like to do and sending any treatment plans, explanations of procedures, etc. So starting June 1 any communication coming from our office that has any ePHI will be encrypted. If you want to send us an email securely, just give us a call and we can set up a patient portal for you to do so safely. This portal that we’re adding will also give you the ability to pay bills online- so at least that’s exciting!We will also be adding Authorization Forms. If you have anyone who you would like us to be able to share and discuss your information with (such as a spouse or adult child) please fill out the Authorization Form. Parents/guardians are not required to do this.

Patient Portal
This is a great feature that will allow you to pay your bill online and send me encrypted emails. There are other features that will be rolling out soon, but this is a fantastic start. You will be receiving invitations to this about 7 days before your appointment and if you haven’t received it, please let us know.

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