Dr. Kim Hansen, president of the Ontario Dental Association.

Protective gear will be required for doctors, staff and patients to solve serious safety concerns

We have 10,000 dentists in this province. So when you think about any dental procedure, you have (personal protective equipment) required for the dentist, the assistant, the patient … And then the number of patients that we would see a day ... multiply that by 10,000.

Ontario’s 10,000 dentists are at a crossroads: They can’t get back soon enough, but they don’t want to come back too soon.

Given the nature of how the deadly coronavirus spreads — through moist droplets in our breath — dentists, hygienists and their patients will need a great deal of trust in each other and the protective equipment they’re wearing in order to get that cavity filled or that tooth capped.

“We have, obviously, intimate relationships with our patients,” says Dr. Kim Hansen, president of the Ontario Dental Association. “These viruses are being found in mucous membranes, so there is serious concern out there for safety.”

The dental industry remains largely closed except for emergency care. But it’s working on a plan to reopen, meaning the next time you visit your dentist, the experience will be very different.

For one, dentists and hygienists will likely be wearing personal protective equipment, like N95 respirators, face shields and other masks.

Social distancing — perhaps aided by plastic barriers — will be the norm at reception and in the waiting room.

And you’ll probably have to wear dental dams and the suction straw will be used more frequently, all in an attempt to reduce the number of droplets exiting your mouth. “No one knows for sure how many virus particles we need … to cause COVID-19 disease,” said Dasantila GolemiKotra, an associate biology professor at York University. “They suspect around 1,000. So if you’re breathing, you’re leaving about 50 droplets. So how many do you need to reach 1,000 virus particles?

“The mask that is provided is a huge barrier for those droplets to reach you.”

Golemi-Kotra, whose mother is a dentist, said dentists are well-educated about the dangers of respiratory viruses and well-schooled about protection. But nonetheless, she said patients should be vigilant when visiting one.

“The onus is on the dentist to protect the patient,” Golemi-Kotra said. “Is he touching your hand and then he’s touching the other equipment and then back to your head?”

If so, she said, it’s OK to ask the dentist to change gloves.

A handful of dentists have remained open, deemed essential to see patients requiring emergency care and keeping those patients away from hospital emergency rooms. But like so many other industries, dentistry largely shut down in mid-March.

Hansen says the Ontario Dental Association is working with the Royal College of Dental Surgeons of Ontario, the Ministry of Health, and other business partners a plan to get them back. The best practices of other dental associations across Canada and elsewhere are also being considered, Hansen said.

“Are there ways that we can make the air safer,” Hansen said. “We’re looking into all the possibilities to provide a safe environment for patients.”

The biggest issue is the shortage of personal protective equipment.

In the beginning, dentists who were not going into their office donated their equipment to the front lines, Hansen said. But that’s led to a lack of supply.

“We have 10,000 dentists in this province. So when you think about any dental procedure, you have PPE required for the dentist, the assistant, the patient. And then the rest of the staff who work to prepare the operatory and sterilize the instruments, and staff out at the front desk.

“So there is a lot of PPE per patient. And then the number of patients that we would see a day, and then multiply that by 10,000.”

Part of the desire to come back is to see patients who need dental work but might not qualify for emergency care.

“We also have a serious concern about delaying dental treatment for people, those with urgent issues and even preventative care, because we all know that small issues over time can turn into bigger issues and require more expensive treatment like root canals or extraction,” said Hansen.

“Poor dental health can lead to serious dental problems but you can also have serious medical conditions.”

And if your immune system is busy trying to fight gum disease, he said, it can “lower immune response to the pandemic.”