By Dr. Stephanie McGann, DMD FAGD, Columnist, The Times

As we dip our toes into the “new normal” of the world of the COVID-19 pandemic we have a lot to consider. Every single person has had their lives and or livelihoods affected in some way.  As a dentist and what some would call a “quasi-essential” healthcare provider we have a very complicated web of concerns to address.  I thought I would share a peek behind the curtain of what most dental practices are doing under these new circumstances.

Dentistry is complicated. No, not the tooth fixing part, the keeping everyone as safe as humanly possible is the complicated part.  The good thing is that dental professionals have worked under difficult conditions before. Our patients cannot wear a mask during treatment, We cannot effectively treat most things with teledentistry nor can we socially distance in the treatment arena.  Every study has listed dental hygienists, dental assistants and dentists as among the riskiest occupations for healthcare providers. (3 out of the top 5).

So what exactly do we do?

First, it’s patients first. The better we screen and protect our patients the better we are protecting everyone in the office. To be fair, every office, every practice is different and most of the rules were written with enough flexibility to be adapted to meet the needs of providers, practice owners, employees and patients.  That’s good, but also complicated.  Group dental practices owned by corporations have had teams of lawyers reviewing documents, negotiating with vendors, creditors and lenders.  Small private practices have had to navigate all of these waters on their own, all while trying to provide urgent or emergent care designed to keep dental patients out of hospital emergency rooms.  As a small business owner, solo practitioner, it’s been well, my word of the day – complicated.

So – in the new normal this is what it looks for me and my team.  First, paperwork such as registration and privacy forms are completed online away from the office.  Covid screening questions are online with a link with a text message sent a few hours before the appointment. The questions are reviewed again in the office.  Temperatures of the patients and team members are taken and recorded each day.  No extra people come to the appointment, our reception room is socially distanced. (half the chairs are gone).  In my practice we used to offer coffee or tea to those waiting, in the new normal those services are gone, so are the magazines and toys for kids to play with while they wait.  Surfaces are clean and clear and wiped with disinfectant regularly throughout the day.

Treatment rooms are a bit different as well.  Each room in my practices has been fitted with a sterilizing air purification system using HEPA filters and UV lights to process the air in the treatment room every 15 minutes, eliminating airborne particles.  During treatment as always we use high volume suction but now we have added an extraoral suction machine for procedures that are most likely to cause an aerosol. We are still limiting elective and some high risk procedures such as ultrasonic scaling and some tooth polishings.  Each evening the treatment rooms are bathed in 60 minutes of UVC radiation to kill any surface particles that may have escaped disinfecting or be on a surface like curtains or other surface. All of these changes are implemented to keep patients and team members safe.

We have heard a lot about PPE and what it means. Personal protective equipment is what your team wears to protect themselves from exposure to potentially hazardous viral or bacterial particles.  Yes, we always wore some, masks, gloves and eye protection are hardly new.  The difference is that Covid-19 is a tenacious respiratory virus, easily transmitted. HIV, hepatitis, influenza etc all are harder to catch and transmit and have effective treatments.  Your dental team has been immunized for Hep-B  if a blood borne exposure happens we have protocols and treatments for that too.  Covid-19 – well not so much.  So in today’s new normal, masks have been replaced with N95, KN95 respirators or a Level 3 mask. Team members are undergoing OSHA fit testing to be sure their mask is working for them. Face shields are worn for everything that uses a handpiece, Gowns are used to cover the clothing and protect it from splatter.  Gowns are removed before entering “clean areas” to eat or drink.  There are many types of PPE from disposables, to reusables with disinfection, to linen services etc.  Each practice will determine their level and needs.

In a perfect world, a practice could order their supplies and protective equipment and keep everyone safe.

But guess what?  We don’t live in a perfect world.  Counterfeit masks are popping up everywhere, manufacturers that were on an approved list at the time items are ordered, (at crazy high prices) are off the list by the time the order arrives.  A normal box of masks that used to cost $7 is now 5-10 times that or more.  So yes, just to keep everyone safe, the costs have gone up.

Alot.

Then guess what, under the socially distancing guidelines, and limitations on some procedures, fewer patients are seen each day.  That means, lower incomes for practices and every business that is required to operate  at a lower capacity.  For many businesses, they can raise prices, use less employees and find a way to get by. In the healthcare arena, that doesn’t really work. It takes the same team to see one patient per hour that it does to see two.  The supplies costs have gone up and thanks to network pricing costs are fixed.

What does this mean? Well, back to the  “it’s complicated”  part of the program.  Some larger corporate offices have restructured, closed some locations and consolidated their teams. Many solo practitioners who were nearing retirement, just threw in the towel and quit.  Others have chosen to drop out of networks.

Me? Well for now we have elected to follow the recommendation of the ADA and insurance networks and charge a per visit PPE fee that we can adjust as the times change.  The world of small business, healthcare and everything else feels like it’s on quicksand. Each day new recommendations, regulations, or requirements pop up that add a level of complication to providing safe care for patients, and protecting team members. We do this because we love what we do and know that one day we will return to a more normal routine. In the meantime we need your help.

What to do we ask in return?  5 simple requests.

1. Be truthful on the covid screening questions. We are not authorized to treat infected or potentially infected patients in private settings. Help us keep team members and other patients healthy.
2. Play by the rules, wear a mask in the reception area, use the hand sanitizer and don’t bring people to your appointment (exceptions for parents of minor children or the mentally challenged)
3. Be on time. Can’t stress this enough. One late person can back up the schedule for the day causing a social distancing problem.
4. Do not be a No-Show. Call with enough time to allow the schedule to be filled with someone who is waiting for an appointment. When we only schedule one patient at a time, it’s very noticeable when we are left with an empty chair.
5. Just be kind. We are all in this together and everyone is doing their best to work together to keep everyone safe and healthy.

We will get through this, we will find a treatment or vaccine to make covid-19 less of a risk for everyone.  Until then, stay safe, wear a mask and most of all – be nice – everyone is in this together.

Dr. Stephanie McGann, who has more than two decades of dental practice experience, is a resident of the Unionville area and owns and practices at Rainbow Valley Dental, in Valley. She is a past President of the Chester/Delaware Dental Society and she is a Fellow of the Academy of General Dentistry.

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