Pandemic takes bite out of dental industry
Practices suffer 20%-30% losses as dentists adopt longer days, strict new protocols to keep offices open
With everyone wearing masks, shields and gowns, the waiting room closed and magazines nowhere in sight, your next trip to the dentist might be a little jarring.
Although many businesses have been hit hard by the coronavirus pandemic, dentists have faced some of the biggest challenges because numerous procedures routinely use instruments that can create droplets and aerosols, posing potential risks of transmission.
We spoke with Dr. Mandeep “Mona” Sidhu of Smile Line Dentistry in Antioch and Livermore about the challenges she and other dentists have faced in trying to make their offices and practices virus-free and assuring leery patients it’s safe to return.
QHow has the dentistry business been affected by COVID-19?
A“We were closed for 2 1/2 months, starting on March 16, the day the
shelter-in-place order came from the county and then we reopened on June 1 when the dental board cleared dental offices for regular patients. During the closure, we were seeing emergency cases only. Like once a week we’d go in and see two or three patients who were in pain; no treatment was being done to not have aerosols. It was whatever could be done without a handpiece or ultrasonic devices. There were no fillings, no treatment per se, or crowns — only for symptom relief. If something broke, we would put a flowable liquid cover on it just to cover it so the sharp edges were not sharp anymore and the area was not exposed, or put a temporary filling to close it but not actually do the restorative work.
When we did open, things were slow. Definitely patients were anxious about safety, so it has taken a lot of training of staff and then also reassuring patients of all the steps that were taken so that they feel safe to come in. Pre- COVID versus post- COVID, I would say we have lost 20% to 30% business.
Q What are the specific risks with dental procedures and how do you deal with them?
A Dental practices are considered high risk because most dental procedures involve aerosols and it is all coming from the mouth, which is the mode of transmission of the virus. How do we deal with them is we try to reduce the risk by reducing aerosols. We have switched to doing procedures via hand wherever possible, like even for cleanings doing a hand scaling versus an ultrasonic to reduce the aerosol there and similarly for any other procedure.
To reduce the risk of transmission, the steps that we have taken involved not only employee training to follow the most stringent guidelines of infection control. … (Before treatment), patients use a hydrogen peroxide mouth rinse and you have to rinse and swish it around for a minute. It reduces the viral load in the mouth. Even if there was someone who has been undiagnosed and maybe they had some virus in their mouth, we are clearing the area that we are going to be working in so there is no transmission in that aerosol again. While we are working on the patient, we have added more high-vacuum suction so all the aerosol that is being generated is eliminated at the source before it goes up in the air.
Each instrument set has always been sterilized and continues to be and there is no cross usage of anything. The whole room gets wiped down with an antiviral and antibacterial product. The lights, the handles, the countertops, chair, everything is wiped down with Cavicide (surface disinfectant). It kills both bacteria and viruses.
Q Do you use a HEPA filter to trap particles or an air-purifying machine to sanitize the air?
A We have HEPA (high-efficiency particulate air) filters, which were replaced throughout the office to a higher filtration level. We also installed air purifiers in the office and they are 24/7 continuously going, purifying the air in the office at all times. Whenever an aerosol is generated, we fog that operatory room with an antiviral product and let it settle for minutes before we bring another patient in.
Q What changes will patients notice in procedures for check-ins?
A We prescreen all patients 24 hours before their appointment. We do a phone screening to see if they have any symptoms, if there is a travel history or if they have been exposed to someone who could have been positive. Once the patient comes in, the patient has to wait in their car, there is no lobby or waiting room in use anymore; it is one patient getting checked in at a time. We taped the chairs with signs that say “please do not sit,” and there are no magazines or coffee.
When a patient reaches the office, they fill out a second screening form with the same questions as the telephone screening a day before. We review the screening questions once the patient is in the office and then they sanitize their hands, have a temperature check before they are taken to the back, and the patient has to keep their mask on this whole time.
We now have one-way entrance/exit so patients don’t have any interaction with any other patient and they must put their mask back on before they leave as they walk out. Even the signing of any paperwork, we ask patients to bring their own or we provide the pen and let them keep it. We don’t disinfect it and reuse it. The lobby also has a plexiglass shield to keep our employees protected.
Q How has COVID-19 affected your staff?
A It is a longer day for everybody with all the extra steps, wiping down and changing things that are needed between patients, and we have to be in gowns and double masks and face shields, which not only can get pretty hot but you’re not breathing as