Sun Sentinel Palm Beach Edition
Changing the face of dental care
Challenges lie ahead for clinics that are taking measures to keep patients healthy
The days of packed waiting rooms, magazines scattered on coffee tables and toys to calm nervous kids may be long gone as dental clinics begin to reopen in South Florida.
Though dentists still were able to treat emergencies during the pandemic, some practitioners decided to close their offices altogether after Gov. Ron DeSantis issued an executive order March 20 halting all non-emergency procedures in an effort to preserve limited medical supplies.
That order expired Friday, allowing elective procedures to resume and dental offices to reopen with increased safety measures for staff and patients. But challenges lie ahead for dentists to secure personal protective equipment for the long term, welcome back skeptical patients and ensure hygienists and assistants are comfortable returning to work.
Answering coronavirus-related questions, having temperatures taken, washing hands frequently, socially distancing from other patients in the office and sometimes being the only patient in the office are all things patients can expect when visiting their dentist during the pandemic.
Dr. Rudy Liddell, president of the Florida Dental Association and member of DeSantis’ Reopen Florida Task Force, said having an open line of communication about available medical supplies and following new procedures in order for staff to feel safe at work is as important as providing equipment. His priority was ensuring his employees were comfortable coming back to the office.
“Where I see some doctors or
providers running into problems is when they’re mandating that people come back, and they don’t have those conversations of ‘What’s it going to take to make you feel safe?’” Liddell said.
Patients can expect to answer coronavirus-related questions before their appointment, Liddell said. At his office in Brandon, dentists now use touchless thermometers to take temperatures before appointments and allow people to wait in their cars until the appointment time.
In candid conversations with his hygienist and assistants, Liddell asked his staff what they would need to feel comfortable returning to work. The answers centered largely around personal protective equipment.
In a letter to DeSantis from April 27 signed by Liddell, it in part says, “dentists and their staff are at very high risk of infection, since many dental procedures produce aerosols in the normal course of treatment.”
Personal protective equipment is delivered to healthcare professionals around the country by distributors working with FEMA. Hospitals, medical centers and first responders were prioritized to receive supplies, Liddell said.
The letter asked DeSantis for an equitable amount of the N95 masks to be delegated to dentists. Liddell said he did not get a response.
Data from the American Dental Association’s Health Policy Institute shows that, in Florida, over 57% of dentists have zero to seven days’ worth of N95 and KN95 masks, over 31% have zero to seven days’ worth of face shields and over 44% have zero to seven days’ worth of gowns.
Mike Graham, the American Dental Association’s senior vice president of government affairs, said the American Dental Association is working with FEMA to distribute masks to dentists and that dentistry is on the list of priority recipients for personal protective equipment.
Ramping up precautions
For Dr. Beatriz Terry, a
Miami periodontist for nearly 30 years, a majority of her existing patients are thankful that her office has reopened, albeit with slower turnaround of rooms and the staff wearing both face shields and masks.
She and her four employees at Miami Implant Perio reopened to patients Wednesday after having a two-day staff training on the offices’ protocol changes at the beginning of last week. The American Dental Association created a toolkit to advise dentists on strategies and procedures to help protect staff and patients from coronavirus, which Terry has implemented.
Terry said anyone with an appointment will have to have their temperature taken, answer screening questions over the phone regarding COVID-19 symptoms and wear a mask.
Patients also must rinse with a hydrogen peroxide solution before being treated. Employees clean the room with disinfectant wipes and peel plastic covers off of headlamps and headrests after each patient leaves.
“With regards to patients, I have heard some that say, ‘I’m not ready to come back right away. I want to be sure. I want to wait a little bit,’” Terry said, “and we’re OK with that.”
Dental offices have been attuned to the need for gloves and masks, so that change wasn’t a dramatic one, Terry said. Adjusting to what she called “a new normal” could prove to be the difficult part.
“I think perhaps public opinion or recognizing we are a safe place because people are fearful of wherever they go, that may be a challenge,” Terry said. “Making sure that staff feels safe also, that may be a challenge. It’s what they call the new normal.”
Seeing more patients
In Florida, nearly 80% of dental offices said they were closed but seeing only emergency patients, according to an American Dental Association Health Policy Institute poll conducted the week of April 20. Over 80% of the responding offices said their total patient volume was less than 5% of their typical volume.
Dr. Melisande Wolff’s Presidential Dental Center in West Palm Beach was one South Florida office that stayed open for emergencies, but the changes made at her office have not affected her flow of business, Wolff said. Only one patient is in her office at a time.
Wolff said this one-onone model could be something used more often going forward.
“I do believe that the number of patients and the amount of time that they’re committing per patient post COVID-19 is going to be increased time, seeing less patients,” Wolff said.
Though Wolff’s office also has enough personal protective equipment, obtaining it for the long term is one hurdle Wolff is anticipating. Another is the number of people who lost jobs and their dental insurance, which may make people hesitant to seek treatment.
“Therefore they’ll wait until there is severe pain, and it’ll be mostly emergencies we’ll be seeing in the future as opposed to preventive care, which is what I advocate and work on with my patients,” Wolff said.