Dentists to open wider:
State makes room for particular procedures
Many Bay Area practices are expanding this month in an effort to save their businesses and help patients.
Many Bay Area dentists are expanding practices this month in an effort to save their businesses and help patients, even as personal protective equipment is scant and health guidelines are sometimes contradictory.
Dentists have been considered “essential” since shelterinplace orders were issued in midMarch, but routine appointments weren’t allowed. There is gray area now.
While the Centers for Disease Control and Prevention still encourages people to delay elective dental care at the federal level, California has opened doors to procedures that might relieve future oral problems. Each county in the state has its own guidelines, and dentists are being advised to follow the most restrictive policies.
“The biggest level of confusion is that currently the CDC is not recommending routine dental care,” said Dr. Lior Tamir, a cosmetic and reconstructive dentist at Bloom Dental Group in San Mateo. “We have made the decision that we are going to do our best to mitigate and evaluate the risk on a daytoday basis and have resumed our operation.”
Like Bloom, many Bay Area dentists are screening patients on the phone and again with temporal thermometers when they arrive at the office. Because the industry often demands ultrasonic cleaners and dental drills that create aerosol, supplementary safety is being heeded with highvolume evacuators, suctions and rubber dams. All seem to use tuberculocidal disinfectant. “We’ve layered on so many precautions that I really
believe dentistry is actually a safer place than being in some of the public places we go to and are considered essential,” said Dr. Natasha Lee, a private practice owner in San Francisco who was the former president of the California Dental Association and was appointed to Gov. Gavin Newsom’s jobs and recovery task force. “If patients don’t get certain levels of dental care, they end up in emergency rooms,” she added. “That costs taxpayers a lot more money, and an emergency room is not really the place you want to be right now. We’re concerned that, if you lose dental practices, it’s going to affect the overall health care network in the state.
“California is in a dire state for its budget. It’s bleak. It’s grim. We are very concerned with how it’s going to affect public health, especially when it comes to dentistry. It’s going to be rough.”
The dental association projects that 25% of practices are in danger of closing during a time of increased wrangling over PPE.
Dentists are buying N95 masks, which should be priced at less than $2, for six times that, according to Jim Wiggett. The interim CEO of the Dentists Supply Co., which serves 27,000 dentists in the state, says it has gotten way worse than price gouging and counterfeit PPE.
Wiggett said that he secured 1 million masks in March and sent them to his 85,000squarefoot distribution center in Reno. The day before he could start the distribution to dental offices, the state of California sent four trucks to take the masks on the federal government’s order.
“It’s a real paradox that comes from when this all went this into motion,” Wiggett said. “When the pandemic hit and everyone started responding, dentists were not made a priority. They just weren’t on the radar screen. “Why? I don’t know.” Orthodontic patients could see a relapse without continued treatment, according to Dr.
Afshin Rahimi of Pacific Heights Dental. He said that a tooth with a cavity that needed a filling in March could easily progress to a crown, root canal or extraction in a short time.
That’s part of the reason Tamir reopened last week.
Patients are screened and required to wear face masks and gloves. Hand sanitizer is provided, and a Plexiglas barrier has been added in the reception area. Patients aren’t allowed to arrive with companions.
In the procedure rooms, filters and oral suction units have been added to reduce aerosols during treatment. Patients are told to rinse with peroxide before appointments, and extensive infection control and sterilization are completed in the procedure rooms before and after each appointment.
“The show must go on,” Tamir said. “I’ve had several patients that had minor emergencies early on during the lockdown, and their problems turned into much greater dental issues that are more extensive and more expensive.
“Oral health is a very important part of overall health.”