Reopening of Quebec dental clinics stymied
Confusion, fear, lack of protective gear leave profession on sidelines for now
Confusing directives on how to safely treat patients and a lack of protective equipment are preventing dentists from taking care of thousands of clients and hampering their return to regular practice, Quebec dentists say.
The work of dentists, dental surgeons and orthodontists in the midst of a viral pandemic is akin to “looking down the barrel of a cannon,” said Barry Dolman, a past president of the Quebec Order of Dentists who at age 70 still runs a private practice in Côtedes-neiges.
“We are front-line health-care providers, yet we can’t get the protective medical equipment that other health-care workers are getting,” he said. “There’s a large segment of dentists who are anxious, and nobody really knows what to do.”
At the same time, dentists eager to return to work are being told by health authorities they may have to wait four hours between patients to ensure no traces of the virus are lingering, and to limit the use of equipment like drills, ultrasonic cleaners or X-rays to prevent aerosol infection, making it nearly impossible to run their practices. Trained to protect themselves from AIDS, tuberculosis and hepatitis C for more than three decades, dentists are well-versed in hygienic standards, and many argue government directives are overly draconian.
Dentists were ordered as of March 15 to stop all non-essential treatments and to provide only emergency care for acute infections causing swelling, fractured teeth, prolonged bleeding or extreme pain. Dentists without proper safety equipment were told to refer their patients to designated dental clinics or, if they were possibly COVID -19 positive, to designated hospitals.
Katie Mitchell found out this was not as easy as it was made to sound when her 23-year-old son’s face became swollen and painful on Sunday, April 26. Over the space of a week they visited the hospital in Hawkesbury, Ont., close to their home in Hudson, which prescribed painkillers, and called their dentist, who prescribed antibiotics. When the swelling and pain worsened, they went to the Lakeshore Hospital and her son was given intravenous antibiotics and a CT scan and sent home. When it persisted, they went to the Montreal General Hospital where they were first denied entry, then given antibiotics and sent home.
He was finally admitted to the Montreal General on May 4, where doctors diagnosed an infected tooth and inserted a shunt through his neck to drain the pus from his face. He has to be hospitalized for up to four days.
“He looked like he had 30 grapes in one cheek. Because of the swelling down his throat, he could hardly swallow his medicine, nor eat or drink,” Mitchell said. “All because they didn’t fix the abscess right away . ... Dentists are essential care workers.”
The question of when dentists will be allowed to see patients is becoming crucial, said Guy Lafrance, president of the Quebec Order of Dentists. After nearly eight weeks of postponing treatments and the coming of bicycle season, which brings more fractured teeth, a return to regular dental care is becoming increasingly urgent, he said. Recent large shipments of protective equipment to Quebec should solve the shortage problems, he said.
In a letter to the order’s members published Thursday, Lafrance said that media reports suggesting dentists will be able to resume elective treatments as of May 25 were incorrect. Final directives allowing a return to work require approval from public health authorities, which has not happened yet.
Quebec’s Health Ministry is preparing a return-to-work protocol, led by a diverse working group of 15 dentists, microbiologists, association presidents and dental school deans and professors, Lafrance said. But dentists such as Dolman complain the committee lacks a sufficient number of private-practice dentists who understand the realities involved in operating a clinic.
The level of uncertainty surrounding COVID-19 is spurring proposals that have little bearing in science, said Montreal orthodontist Paul Korne, including that all patients wear hazmat suits or dentists spend tens of thousands of dollars on air-purifying systems or negative pressure rooms. Meanwhile, shoppers are allowed to walk unprotected through stores.
“This could backfire in so many ways,” Korne said. “It would force dentists to invest for no reason and pass that cost on to patients, and the public would be justifiably scared to go to dentists for care they desperately need.”
Montreal West dentist Jane Lee said she’s having trouble finding safety equipment like visors, gowns, masks and Plexiglas barriers to protect herself and her staff, and is frustrated by a lack of information from the government and dental associations. She doesn’t expect dentists will be allowed back to work before June 1. Meanwhile, they are concerned about the health of their patients, as well as their own financial and psychological well-being.
“It’s the mental part that’s difficult,” Lee said. “Most of my colleagues have told me they’re having a hard time sleeping. There’s a lot of sleepless nights.”