“Let me tell you something you already know. The world ain't all sunshine and rainbows..I don't care how tough you are, it will beat you to your knees and keep you there permanently if you let it. You, me, or nobody is gonna hit as hard as life. But it ain't about how hard you hit. It's about how hard you can get hit and keep moving forward; how much you can take and keep moving forward. That's how winning is done!”
— Rocky Balboa
, 2006

Boxer

We all know that the “invisible enemy,” a tiny virus christened SARS-CoV-2, and best known by the disease COVID-19, has hit the world’s economy like a heavyweight face punch.

And the dental industry was hit right on the chin.

Dentistry has taken a direct and devastating hit from the “slow-the-spread” shutdown strategy. But the good news is that, we may be down, but we’re not out. Once dentists and their teams get back up from the canvas, everything changes.

94% of Seattle’s dental assistants filed an initial unemployment claim

The first recorded case of coronavirus infection was reported in the State of Washington in mid-January of this year. A man in his 30s from the Seattle area had spent months traveling in Wuhan, China, and began manifesting symptoms the day after he returned home. Washington state quickly became the initial "face" of the COVID spread. According to the Seattle Times, about 94% of dental assistants in the city filed an initial unemployment claim—exceeded only by bartending as the most impacted profession. About 71% of dentists in Seattle also filed for unemployment.

Anneliese Vance-Sherman, an ESD regional labor economist, was quoted as saying that the top hardest-hit jobs lined up “very squarely with the identification of nonessential activities due to physical distancing.” (It’s hard to keep a distance when you’re working in someone’s mouth!)

Unfortunately, what happened in Seattle didn’t stay in Seattle.

The health care sector lost a record 1.4 million jobs in April led by more than half a million job cuts at dentist offices.

Writing for CNBC, Bertha Coombs reported that,

  • “The [US] health care sector lost a record 1.4 million jobs in April led by more than half a million job cuts at dentist offices…a 53% decline in dental practice employment over two months.”
  • All but 3% of dental offices nationally were shut down except for emergency appointments.
  • Nearly 9 out of 10 dental offices across the nation laid off staff.
  • One of the biggest challenges to practices reopening is finding enough PPE for staff. However, the ADA asked Congress to provide tax credits to dental practices to help cover the increased costs of PPE.
  • Dealing with aerosolization, produced by dental drills and ultrasonic tools, is another significant challenge.
  • Some dental practices resuming service have been seeing about a quarter of their usual patient volumes, to maintain safety.
  • Dentists are facing higher costs because of new safety protocols to protect themselves and their patients.

Women have taken perhaps the hardest hit of all during the pandemic.

Women have taken perhaps the hardest hit of all during the pandemic. According to the American Dental Hygienist Association, 98% of all dental hygienists are women.

“And even as restrictions are eased, many are still out of work,” according to Tracey Amick Peer, in a report for 11Alive. “Like Sue Dupart. who after 38 years of work got a phone call she won't forget,” said Peer. "‘That we would be closed until further notice and the person at the front office was applying for unemployment for the staff.’"

“Dupart said it reminds her of when AIDS was on the forefront years ago. She predicts when they start back in June some things may change, like checking in from the parking lot and discontinuing the use of some cleaning equipment.

“’We might go back to paste polishing and then having people rinse with mouthwash before examining their mouth.’"

In China, “Routine dental care was suspended in January 2020 and three months later [was] starting to get back to normal,” according to Paul Coulthard, writing in the British Dental Journal.

Most of the jobs could come back online over the next few weeks.

In the U.S., “Most of the jobs could come back online over the next few weeks,” according to Coombs. “The first week of May saw nearly half of dental practices bringing workers back.”

48% of dentists in reopened states have fully hired back their staff.

Coombs’ May 9 article quoted the American Dental Association’s Chief Economist, Marko Vujicic reporting that, “28 states have reopened…in those states we’re finding 48% of dentists have fully hired back their staff, which is a considerable jump from two weeks ago.”

However, “protocols like spacing patients out—and even some states are requiring exam rooms to be left vacant, so the aerosols can settle—all these things are going to reduce productivity and increase variable costs for dental offices,” said Vujicic. “That’s not a constraint to reopening, but it’s definitely going to affect profitability and depends on…who bears the cost of that increased PPE expense.”

On April 1, 2020, the American Dental Association (ADA) issued an interim recommendation that “dentists keep their offices closed to all but urgent and emergency procedures until April 30 at the earliest.”

Joshua L DeMichele, DDS
Joshua L. DeMichele, DDS

“The ADA believes individual dentists should exercise professional judgment and carefully consider the risks outlined in the ADA’s interim guidance and weigh those risks against any possible benefit to the patient, the practice employees, the community at large, and the practitioner. Critically important is the availability of appropriate personal protective equipment (PPE) to minimize any risk of transmission during emergency and urgent care. Due to the proximity of individuals during dental procedures, and the generation of aerosols, dentists, staff, and patients are at high risk of transmission.”

Cave Spring Dental Arts, led by Joshua L. DeMichele, DDS, re-opened its doors after the April 30 benchmark. The practice has been advertising with RAMP Results for years, with what he calls, “very successful” results, particularly in radio.

“It occurred to me during the shutdown,” Dr. DeMichele told Incisor, “that advertising was falling on deaf ears because everyone has been so scared to go back into public, including to the dentist. We needed to reach out in a way that addresses that fear.”

Working with his dental marketing agency, Dr. DeMichele crafted a radio ad that communicated changes to their day-to-day operations to keep people safe as they return to care—extra steps he says set their office apart from others in the area.

Cave Springs Dental Arts shared the following protocols they have added, post COVID-19 shutdown:

Open for business
Open for business!
  • HEPA filtration/UV light/ionization of air in each operatory and every common area of office
  • All operatories are separate, isolated, completely enclosed rooms.
  • Each operatory is shut down for a minimum of 50 minutes after dismissal of the patient for sanitization of all surfaces and filtering of air in the operatory.
  • All appointments staggered to reduce patients encountering one another in hallways, etc.
  • Reception room is closed. Patients are waiting in their vehicles to be pre-screened, then accompanied directly to their operatory through one of two rear entrances into the building. They are given a mask to wear if they did not bring their own.
  • Patients are asked to pre-rinse their mouths and wash their hands before being seated. They are asked to wash their hands again before dismissal (patients touch their noses/mouths often during their appointments).
  • Once treatment is complete, patients are dismissed to one of two front desk areas equipped with clear Plexiglas shields. They exit through the front door, essentially creating a one-way flow of all patients through the office (back to front)
  • Staff members are designated each day for infection control (disinfecting operatories as well as surfaces throughout the building).

“We started running the ‘safety’ radio ad the day before we re-opened,” said Dr. DeMichele. “By day two, one of my morning patients said she’d heard us on the radio. She had been planning to cancel her appointment, but when she heard about all the changes we have made, she changed her mind. The safety practices put into place convinced her to keep her appointment.”

DeMichele has since reported a return to a fully functioning and very busy practice.

Bringing dentistry back up off the mat is going to be a challenge, but not one that’s insurmountable. Taking steps to ensure the safety of patients, and communicating the plan to your patients is a critical one-two punch to get you back in the game.

 

Sources

Balk, Gene. “Coronavirus unemployment: Bartenders, dental assistants top list of Washington’s hardest-hit jobs.” The Seattle Times May 8, 2020.

Coombs, Bertha. “Dental practices led record health care job losses in April, but are already bouncing back this month." CNBC. May 9, 2020

Coulthard, P. "Dentistry and coronavirus (COVID-19)—moral decision-making." Br Dent J 228, 503–505 (2020). https://doi.org/10.1038/s41415-020-1482-1

Peer, Tracey Amick. “Women hit hard by unemployment during pandemic.” https://www.11alive.com/article/news/health/coronavirus/women-unemployed-numbers/85-a5ec33a4-c91d-4df1-a2fd-d49d953af750. May 11, 2020.

 

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.

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