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Inside dentist offices in times of COVID-19 shows a new reality to keep patients safe

Still worried about going to the dentist office for an appointment? A national survey shows just how much our attitudes have changed as the coronavirus pandemic grinds on. 

In an initial survey commissioned by the North American Dental Group, which released findings in April, 71% of respondents said they felt “uncomfortable” visiting their dentists during the COVID-19 pandemic. Similarly, 77% of respondents cited their own personal health and safety as a concern due to the pandemic, while only 42% of participants were confident in their dentist’s ability to reduce or prevent the spread of the novel coronavirus in the office.

But a follow-up survey in July showed significantly shifting attitudes, thanks in part to education efforts from dentists and groups representing the profession. Compared to the April findings, 60% of respondents said they were comfortable now with visiting a dentist for a routine cleaning or check-up.

In a report from the Dentist trade publication "Dental IQ," Dr. Frank Nia attributes the shift to the trust people have put in their dentist.  

“Dentists have not taken lightly the immense responsibility we have to our patients during this current crisis,” added Nia, who works at the McDonough Center for Family Dentistry in Georgia.

Findings from the July survey also found that 64% of respondents believed their dentists knew how to prevent the spread of COVID-19, up from 42% in April. Similarly, 65% of respondents were planning to schedule a visit with a dentist within the next six months.

How did dentists make offices safe?

As more people learned about coronavirus, and after Gov. Andrew Cuomo announced that dental offices could reopen June 1, employees at Victor Dental Care have seen a return to normal, according to Eileene Trace, office manager for the practice.

However, it did take some time to adjust to the new procedures to control possible infectious spread of the novel coronavirus.

Dr. Linda Rasubala and Dental Assistant Olga Kushch treat a patient in Eastman Dental’s Howitt Urgent Dental Care clinic.

Once the practice received the news that it could reopen, “It was really a kind of wild weekend,” Trace said. While the New York State Dental Association said patients could be received on May 30, announcements that went back-and-forth between Cuomo’s office and the association meant it took some time before things became more clear, with announcements being made that practices could open June 1. Practices could see patients as early as June 2.

But that didn’t mean the practice would be ready to accept any patients yet, Trace said. “It’s hard to be nimble and see a group of patients that fast.”

So instead, all staff at the practice began working on implementing a reopening plan which had been developed in Zoom meetings for six to eight weeks before reopening. Staff were broken up into groups, which would handle different aspects of the reopening process, according to Trace. These groups included infection control, social media messaging and an innovation team which would be responsible for developing new workflows to reduce possible infection.

“By bringing the team together like that,” the dental practice was “prepared for the day we would actually reopen.”

Trace also emphasized how, much like everywhere else, there was a learning curve for staff.

“In the beginning, it was hard because we didn’t walk through it or have the practice. But now it’s kind of routine.”

Patients who come to the office now must fill out an eight-question electronic form, which asks if they’ve exhibited any of the common COVID-19 symptoms, including a fever, shortness of breath, or flu-like symptoms, which is in accordance with recommendations from the American Dental Association. Patients also must fill out a form on whether they’ve traveled to one of the states which has a higher infection rate for COVID-19, which could affect the date of their appointment. Trace also said staff can make calls to patients if they don’t fill out the electronic screening in advance or are unable to before their appointment. 

When a patient arrives, Trace said they typically like to call in advance to make sure they’re the only ones aside from staff in the office, although the waiting room is now spaced out and can only be seated at half capacity.

The dental assistant working at the front desk also works as a concierge, greeting patients and giving them hand sanitizer before escorting them to the treatment room for their appointment. Clinical staff working on a patient are dressed in two different kinds of face masks, along with face shields and washable gowns. HEPA filtration units have also been installed in each room.

“We’re just trying to create less touch points, so to speak,” Trace said, adding how the office has also reorganized the flow of patients so they can exit through the employee entrance without having to backtrack.

So far, Trace says that patients have been accommodating with all the changes.

“For the most part our patients are great, very understanding for the most part.”

However, while extensive precautions have been set up, there are older patients who haven’t made the visit yet, Trace said.

“I think we find it more in the older population: 'We haven’t gone anywhere, we’re not going anywhere. Or my kids won’t let me go anywhere.' ”

Dental clinic steps in for emergencies

While private practices are up and running again, that hasn’t necessarily slowed down the Eastman Institute of Oral Health in Rochester, which has seen a massive increase in the number of patients, according to Courtney Speers, associate quality and compliance Officer at the institute.

Having worked in this position for three years, with additional experience as a nurse, Speers has always been focused on patient safety and complaints, something which changed dramatically with COVID-19. 

“With COVID, there’s been a fast switch,” she said, describing how the reaction meant the institute “wanted to make sure everything was in place,” to prevent possible spread.

Once all the private practices were closed due to COVID-19 concerns in the spring, “we started to see a lot of emergency patients,” Speers said, with people coming from out of the county and across the state in some cases.

“We’ve seen over 5,000 patients over 48 counties,” Speers said, with daily totals at about 100 patients a day, in addition to their regular patients.

“Now we’re kind of in a crisis mode, in a sense, to make sure people feel safe.”

With a number of locations patients can visit, including the main site next to Strong Memorial Hospital, education around COVID-19 happens across all sites, Speers said. Mask-wearing for patients is a must, and if someone doesn’t have one, they receive one from a staff member.

“That’s where that education component comes from, being able to talk to them. We see so many people. We want to make sure we talk to them and educate them.”

The Institute has also implemented temperature checks and screening tables for patients to answer questions. At the main site a tent has been set up to create an outdoor waiting room for patients, along with pre-appointment mouthwash. Staff also have extensive protections in place, Speers said, with employees wearing PPE, including medical gowns, masks, face shields and gloves, along with adjustable glasses, which are also worn by a patient on occasion. If there’s a patient with a suspected or confirmed case of COVID-19, staff can wear fitted N95 masks. HEPA filters are also in place for each exam room, along with an increase in cleaning procedures.

The result? No viral spread, according to Speers, with staff and patients continuing to be safe.

“There was that fear at the beginning, but we’ve really been able to decrease that.”

With winter on its way, Speers said the institute is planning how to accommodate patients while continuing to make use of outdoor, well-ventilated spaces. Two plans are being developed, with the first one involving a heated waiting room, while the second will be space to serve patients. 

“If we don’t have enough room in the building, we’ll have enough space by setting that up."

Infection control past and present

Given the nature of the novel coronavirus and how it’s transmitted, the virus had a “significant impact on dental practices, not just nationally, but worldwide,” according to Dr. YanFang Ren. As a dentist, professor and clinical chief of the institute’s Howitt Urgent Dental Care clinic in Rochester, Ren found that, as the American Dental Association issued guidance on halting elective dental care between March and June, it severely impacted patients all over, including New York.

Dr. YanFang Ren of the Eastman Institute for Oral Health says dentists are uniquely equipped to treat patients during the COVID-19 pandemic, noting that they've frequently been "at the forefront of infection control measures,” originating during the HIV/AIDS epidemic.

“With no cleaning for a long period of time, two and a half months in New York, that was a major disruption of dental care, as most dental offices were closed.”

The result of not making regular appointments or being able to see their usual dentist is what led to an increase in patients for Ren’s clinic and the Eastman Institute as a whole. While the number has gone down, Ren admits that they’re still seeing double the number of patients they saw from before the pandemic, due to missing or not making regular check-ups.

“They did not get preventative care, so now there’s an increase.” 

And while people may still have concerns about going to the dentist, Ren believes the profession is uniquely suited to handling the pandemic.

“This is one of the things that a dentist can do very well in terms of infection control,” he said, noting that certain procedures in place before the pandemic were originally pioneered during the height of the AIDS epidemic.

“There were a lot of unknowns there as well, working with people and their saliva. There’s a lot of blood.”

As a result, Ren said, dentist offices around the world in the 1980s started to implement specific infection-control measures to reduce the likelihood of transmission.

“Before the 1980s, dentists didn’t wear gloves. A lot of people used to not wear masks either,” Ren said, although following concerns around how HIV and AIDS were spread, the profession started to implement stricter use of masks, surgical gloves, plastic goggles and gowns.

“That started in the 1980s. That has proven really effective to use in a dental setting,” Ren said, adding that hand-washing and sterilizing dental instruments also went into effect.

“Compared to other health care settings, dentists have been at the forefront of infection control measures.”

Now with the implementation of HEPA filters in offices to increase air filtration and ventilation, Ren believes dentists will be able to continue reducing and preventing infection from COVID-19, and that more people will feel comfortable going to the dentist for regular check-ups and cleaning appointments.

“Dental health is very important, preventative care is very important. Brush your teeth and go to the dentist as much as you can. If you delay preventative measures, you might end up in pain and in emergency."