Dental practices, routine treatments on hold until emergency COVID-19 order lifted

Crain’s Detroit Business

Along with ear, nose and throat physicians, dentists must work much closer to patients and their airways where coronavirus could be present than other professions. In other words, the recommended 6 feet of social distancing is impossible.

“When we go back to work, we can wear N95 respirator masks, face shields, gloves and full gowns, but our patients can’t wear masks when we are working inside people’s mouths,” said one specialty dentist, who asked for anonymity.

The dental specialist said he and other dentists are concerned that some dentists and political leaders are pushing to reopen practices without sufficient testing and personal protective equipment. Coronavirus testing is at such low levels in some communities that treating patients requires additional PPE and an understanding whether a patient is positive or negative for COVID-19.

“If we have a positive patient in our chair, how do we safely treat them, and then the next person without being infected? We need to do much more cleaning and sterilization of our offices during the day and after we close,” the dentist said. “Do we spend $30,000 on a negative pressure room for COVID-19 positive patients?”

Another major question still to be answered is what will be the testing rules for patients and staff.

“I need a good test with an extremely low false negative rate,” said the specialist. “It needs to be rapidly done. I don’t want to rely on a piece of paper saying it was done and how do we know if it was accurate? I am concerned about my patients, my staff and potential liability.”

Gingrich acknowledged that many dentists are asking these questions. She also said there is a healthy debate within dentistry, with some wanting to reopen practices faster than others. The MDA’s task force report is intended to create guidelines for safely returning to work.

While future guidance for dental practices from the Centers for Disease Control and Prevention, dental associations and the state of Michigan are forthcoming, Doolin said his practice plans to exceed recommendations along with continuing virtual online dentistry consultations.

“Dentists have no more information than the general public at this point about what the new protocols will be in dental offices when the world gradually reopens,” Haddad said. “But we’re not waiting. We have already adopted additional health and safety best practices now that we believe will go beyond the anticipated new standard for patient-centered, progressive dentistry.”

Here are some changes Haddad and Doolin have made to their office once it reopens:

Office-wide air filtration system that captures microbial pollutants and toxins and kills airborne virusesTaking the temperature of all employees prior to their scheduled shiftTaking the temperature of all patients upon entering the practiceEnhanced cleaning, disinfection and sterilization protocols for the entire office

Gingrich said preventive measures to minimize coronavirus infections will be widespread across dentistry. She said COVID-19 will change the practice of dentistry, even more so than the HIV-AIDS crisis affected medical professionals in the 1980s.

“We are going to pay more attention to personal protective equipment than ever before. We have always wiped down rooms, but we may have patients rinse their mouths (with hydrogen peroxide) before treatment,” Gingrich said. “When we return to work there will be one standard of care.”

But that standard to practicing dentistry also depends on whether a vaccine, COVID-19 tests and serology antibody tests are readily available.

Once she is given the green light, Dawley said it will take several days to reopen her practice because staff and patient education will be required to practice safely.

“Our environment has completely changed. We will need to schedule people farther apart than we normally do,” she said. “Before, we had three providers in our office and three sets of patients. We won’t be able to do that again. Some people will be waiting longer for an appointment. Not because I don’t want to see them, just because we need to protect ourselves and our patients.”

Dawley said all providers will be wearing masks, face shields and additional protective coverings over scrubs.

“We will look a lot different to our patients,” she said. “Some patients will be OK with it. Others might back off and say, ‘Well, you know maybe I will wait a little longer before I get my dental work done.'”

Meraw said all the precautions dentists will take to keep staff and patients safe will increase operating costs. “It will be difficult for some to open because the revenue has been nonexistent. I have applied for a small $5,000 grant from the U.S. Chamber of Commerce,” he said.

Dawley said some dentists are talking about adding a charge on a patient’s bill for infection control to help pass along the additional costs. “They do this at hospitals for procedures. It’s not something that we’ve ever done, but it is an expense,” she said.

Gingrich said necessary testing for coronavirus in patients also will increase costs. “Our costs now are $22 to $30 per test. The state of Alaska has mandated that everybody be tested before they go to the dentist. The two tests cost $80,” she said. “We don’t know if we can pass that along to patients or if insurance will cover it.”

Meraw also said waiting rooms will change dramatically to prevent patients from coming into contact with each other.

“Pediatric patients will require their parents to come inside the office, but waiting rooms will be pretty much empty,” he said. “Elderly patients might need assistance. We are going to need to limit the number of people inside our offices and spread them out” in different rooms.

Gingrich said magazines in waiting rooms will be a thing of the past. “Patients will sit in their cars and wait for a text message to enter,” she said.

Dawley also expects patients with more severe dental conditions because they have waited for care. Some dental problems could lead to medical problems, including cardiovascular disease, diabetes, dementia and cancer.

Initially, “We’re gonna see more gingivitis (inflammation of the gums with a film of plaque, or bacteria, accumulates on the teeth) and more periodontitis (severe gum infection that can lead to tooth loss and other complications),” Dawley said.

“The key to not losing teeth to that particular dental disease is early intervention,” she said. “We aren’t having early intervention right now because people are at home. They should be brushing their teeth three times a day, after each meal. I know it is hard because sometimes I don’t follow my own advice, but it is important.”

Contact: [email protected]; (313) 446-0325; @jaybgreene

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