The Art of Dental Comeback

Storms pass. People unboard their windows and open them again to the sunshine and fresh air. Fortunately, even pandemics don’t last forever, and as the American poet and abolitionist Theodore Tilton (1835-1907) wrote, “even this shall pass away.”

As the world waits for the covid winds to abate, and the coronavirus “hotspots” to cool (for example, Florida, as of the date of this article), dentists around the U.S. are challenged with providing service to an influx of patients, many of whom have been waiting months for service.

Many dentists are stressing that the Centers for Disease Control and Prevention has not reported any documented cases of COVID transmission in dental settings.1

“Unless you are in a very high-risk group...it is definitely safe to go to the dentist,” said Dr. Rudy Liddell, the immediate former president of the Florida Dental Association and the upcoming Florida trustee to the American Dental Association.1

“Oral health is an important part of overall health,” according to ADA President Chad Gehani, D.D.S. “Resuming regular dental visits are important because treatment, as well as prevention of dental disease, helps keep people healthy. The guidances from the ADA and the CDC give dental professionals the information they need to practice as safely as possible.”2

The Centers for Disease Control and Prevention has not reported any documented cases of COVID transmission in dental settings.

Even so, some confusion remains regarding the safety of going back to the dentist, specific strategies for keeping staff and patients safe, and even the numbers of cases. A July 27, 2020 ADA News brief3 highlights the uncertainty:

COVID Testing

According to the CDC, it does not know the exact number of COVID-19 illnesses, hospitalizations and deaths for various reasons, including that COVID-19 can cause mild illness, symptoms might not appear immediately, there are delays in reporting and testing, not everyone who is infected gets tested or seeks medical care, and there may be differences in how states and territories confirm numbers in their jurisdictions.

WHO COVID-19 situation reports present official counts of confirmed COVID-19 cases. There could be differences between WHO reports and other sources of COVID-19 data that use different inclusion criteria and data cutoff times.

Johns Hopkins uses data from the WHO, CDC, European Center for Disease Prevention and Control, National Health Commission of the People's Republic of China, DXY, coronavirus.1point3acres.com, worldometers.info/coronavirus, BNO News, the COVID Tracking Project, state and national government health departments, and local media reports. The publicly available data from these sources do not always agree, and Johns Hopkins frequently updates the data on its website, which could result in higher case numbers than may be available from other sources.

After the March 20 state executive order prohibiting non-emergency procedures, four out of five dental practices in Florida reported collecting less than 10 percent of their usual profits.

While the numbers seem to fluctuate like the stock market and various agencies and experts may differ in their interpretations and recommendations, three things are virtually unanimous:

There is an urgent economic need for dentists to see patients.

While some dentists are reducing contact by choice, many others are eager to restore normal patient volumes to make up for significant COVID-related financial losses in April and May.1

After the March 20 state executive order prohibiting non-emergency procedures, four out of five dental practices in Florida reported collecting less than 10 percent of their usual profits, and nearly 20 percent of practices suspended pay for all staff members, according to poll data collected by the ADA. Practices began to bounce back in June, but more than 30 percent of dental offices in Florida still reported making half or less of their usual profit.1

There is an urgent need for dental care, especially after months of waiting.

Many dentists are reminding their patients that untreated dental conditions can cause health issues.1 Sending emails or phone calls to the patients whose regular appointments were delayed can significantly increase your patient volume. Many people do not know that elective procedures are now available and that practices are open.

Continued measures to protect patients and staff are advised (aka “better safe than sorry)…though specific measures implemented by individual practices vary.

The Miami Herald shared one dentist’s story:1

Dr. Norberto Camacho says he’s drenched in sweat and yearning for oxygen after every shift at his dental practice in Brickell, where the AC is stuck above 72 degrees and staff are adapting to multiple new layers of personal protective equipment. At his practice, Dental World Miami, he wears two face masks—an N95 covered by a thinner surgical mask—a face shield and helmet, and heavy magnifying protective glasses that weigh down on his nose bridge leaving dark red marks.

“It’s a nightmare. It’s hard to breathe… Most days, I feel like I want to go home and cry,” Camacho said.

“But is it going to make my patients feel safer? And is it gonna make us—the staff—be safer? Yeah. Then I’m going to do it.”

Incisor would like to hear your comeback story. Which strategies and techniques is your practice using to return to full service, while also giving patients the peace of mind to know it is safe to go to the dentist? Are the extra protective measures relatively easy to implement, or are they burdensome and difficult? Do you feel your state’s regulations are sufficient to keep your patients and staff safe, or do you go above and beyond them?

Send your comments to Kelly.Walker@StrategicDentistry.com for possible inclusion in a future issue.

 

Author: Kelly John Walker is Senior Writer and Editor with Strategic Dentistry, the parent company of DOCS Education. He holds a Master of Science (MS) degree in Environmental Science from New Mexico State University and a Bachelor of Arts (BA) in English Composition.

 

  1. Ghisolfi, Caroline. “Dentists are sweating under three layers of face protection to get patients back.” Miami Herald. July 11, 2020. https://www.miamiherald.com/news/health-care/article243719932.html
  2. American Dental Association. “CDC Guidance for Dental Settings Echoes ADA Guidance.” https://www.ada.org/en/press-room/news-releases/2020-archives/may/cdc-guidance-for-dental-settings-echoes-ada-guidance
  3. Versaci, Mary Beth. Current data on COVID-19. ADA News. July 27, 2020. https://www.ada.org/en/publications/ada-news/2020-archive/march/current-data-on-covid-19

CDC and ADA Guidance2

CDC guidance provides detailed patient management and facility consideration information for before, during and after dental appointments, which is in close alignment with the ADA’s Return to Work Interim Guidance Toolkit. CDC and ADA recommendations include:

  • Request that dental staff call patients prior to the scheduled appointment to ask questions about their current health status.
  • Advise patients to wear a face covering when entering the dental practice.
  • Limit the number of people who accompany a patient to the appointment. If possible, the patient should make the visit alone.
  • Assess all patients upon arrival; temperature checks may be completed.
  • Remove items in office waiting rooms such as toys or reading material to limit potential transmission through high touch surfaces.
  • Encourage social distancing practices by minimizing the number of patients in the waiting room by spacing appointments thoughtfully and perhaps by asking patients to wait in their car until the dental staff is ready to treat the patient.
  • Advise dental staff members to wear additional personal protective equipment (PPE) as appropriate, such as surgical masks or N95 masks, full face shields or goggles with side shields to ensure an environment that is as safe and healthy as possible for patients and the dental team.
  • Place hand sanitizer generously around the office for use, and ensure surfaces are cleaned regularly.

The CDC’s updated dental settings guidance offers additional recommendations such as how patients can be positioned in the dental chair during appointments.

The ADA guidance also includes ways dentists and hygienists can reduce aerosols such as:

  • Hand scaling when cleaning teeth rather than using ultrasonic scaling,
  • Use of high velocity suction whenever possible and
  • Use of rubber dental dams whenever possible

It is important to note that both the CDC and ADA guidances are science-based recommendations and not regulations. States control what procedures are allowed to be provided, largely through their licensing boards.

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