Dentistry in the COVID-19 Era: A Look at Dental Offices

The COVID 19 pandemic has created a worldwide crisis, and the US is certainly not exempt from this virus's consequences. However, dentistry is uniquely positioned to address the ramifications of the virus due to its significant history of providing consistently safe health care and including actions that it has taken to address other serious viruses such as hepatitis. Regular use of gloves, masks, disposable gowns, protective eyewear for both providers and patients, and continual routine disinfection and sterilization of all equipment and operatories has been a hallmark of dentistry for 50 years.

Mitigating COVID in operatories

What else is being done to address the current pandemic, and what is the day-to-day status of how treatment is being provided in private dental settings? Dr. Al Stenger is the owner of a general dental practice in Richmond, Virginia. At the outset of the pandemic, Dr. Stenger upgraded his facility with special in-duct Photohydroionization (PHI) technology to purify the air. Also, the use of very high volume suction, patient use of pre-treatment oral rinses, rubber dams and dry shields, operator face shields and N95 masks are part of the daily anti-virus routine.

Dr. Joceyln Tameta, who owns a practice in Latham, NY, has incorporated the use of an extra-oral suction device to limit the spread of aerosols. All of this is in addition to restricting the number of patients in the waiting areas, questioning patients on their potential exposures and symptoms and taking patient temperatures.

Specialty dental offices face unique challenges due to the more open placement of operatories within the office. Dr. Chris Maestrello, a group owner of a Pediatric/Orthodontic Practice in Richmond, Virginia, has had to reduce the volume of patients being seen at any one time by a third. "At the beginning of the pandemic, several parents were fearful of bringing their children in for their dental appointments, but once they began to see the protocols that we were following, they became more at ease with bringing the kids in", said Dr. Maestrello. Spacing out of dental chairs being used, and significantly limiting the time spent in the office are all de riguer.

Managing scheduling, office production

What about patient scheduling and overall office production? "Managing the hygiene schedule has been a real challenge", said Dr. Stenger, "a number of patients are still fearful, while others want to be seen immediately, after having waited a long time."

Concerning office production, most of the dental practitioners I have spoken to have echoed what I heard from Dr. Jim Reynolds in Roanoke, Virginia: "We were closed from March until early June, but once we reopened, we increased our monthly production." I have noted that high-quality offices that were doing well before the pandemic have been able to overcome the shutdowns reasonably well. In contrast, offices that were struggling pre-pandemic, have suffered. Dr. Dennis Oppenheimer of Kingston, NY, had a record year in 2020, while other dentists I have spoken to are seriously considering transitioning out of their current situations.

One consistent theme amongst all the doctors I have spoken with was the difficulty in having their staffs honor their pre-pandemic employment commitments or resigning altogether. Despite all the protocols being instituted, the dentists have stated that there has been a significant unrealistic reaction by hygienists and office personnel to the virus, sometimes based on irrational fears. Several dentists have had to resort to employing temporary hygienists daily due to their full-time hygienists' refusal to return to work. Almost every dental office I contacted mentioned this as a big issue. All of them have been surprised by this are hoping to have this situation settle down in 2021.

Going forward: good news and optimism

What about 2021 and beyond? Here there is good news. All of the dentists were optimistic that the presence of vaccines would increase patient confidence, and especially staff confidence. All are looking forward to dental office operations returning to what they were pre-pandemic, and providing patients with more elective treatments, especially cosmetic procedures. The unanswered question is: how long will this take? Dr. Stenger best expressed the consensus on what will be: "I don't think that this will last forever, and we are just looking for improvement little by little on a day-to-day basis."