As dental offices start to reopen across the country, the guidelines vary from province to province but the concerns remain the same: having the right protocols and enough protective gear to safely see patients, and seeing enough of them so they can keep the office running.
“It is going to be a little slower,” said Dr. Ken Phillips, of Royal Centre Dental Group in downtown Vancouver.
“We have to be really careful that we don’t introduce another wave of this pandemic.”
Before seeing a patient with a broken tooth, Phillips and a colleague go through a meticulous routine of gearing up.
It includes one gown, two face masks, a face shield and goggles. He sanitizes his hands at the start and then again before he puts on his gloves.
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The patient is waiting in the empty mall, because the reception area in the office is closed off, to be replaced with a virtual waiting room app that will notify patients when it’s their turn.
When this patient is called in, she is asked if she has any COVID-19 symptoms, and her temperature is taken. It’s only when the thermometer reads 36.1 degrees that she is pointed toward the dental chair.
Aside from emergency services, most dental procedures were considered non-essential when provinces and territories implemented pandemic restrictions.
Before the closure, the office was seeing about 50 patients a day, but now they are seeing only a handful. Phillips’ office stayed open with just a few staff members, but many others were completely closed.
Dr. Sura Hadad was one of those who shut down her clinic. But her bills haven’t stopped.
She says rent in the Halifax strip mall where she is located is more than $10,000 a month, and she also has loan payments for some of the equipment in the office. On top of that, she has a mortgage and four children.
“Everybody is like, oh, you are a dentist, you have it easy,” she said.
“To run a dental office is very expensive, the overhead, the staff, everything.”
Hadad qualified for the federal government’s $40,000 business loan, but a dozen staff members have been laid off.
When she does reopen, restrictions mean she won’t be able to see the same number of patients, nor take in the same income.
“I don’t know if we are going to be able to bring all the staff back or what is going to happen,” she said.
“It is so hard.”
Hadad is waiting for direction on how and when her clinic can safely start to see patients, but in some other provinces guidelines have already been issued.
In B.C., where new daily cases of COVID-19 have remained low throughout May, recent guidelines from B.C.’s College of Dental Surgeons state that procedures should only be done when the benefits far outweigh the risk — a judgment call that has to be made by individual dentists.
They also suggest that patients who are at high risk, including those with diabetes and those over the age of 70, should have appointments deferred as long as possible.
However, Dr. Alastair Nicoll, the chair of the B.C. Dental Association’s “Back to Work task force,” says provincial experts have concluded if there is low prevalence of disease in the community, and patients do not show any signs of COVID-19, many procedures can be done without additional safety gear.
“Dentists have been dealing with infectious diseases and the risk of transmitting them to staff and patients in the dental office setting for decades,” said Nicoll.
“What we have been using for many, many years is the proper level of personal protective equipment [PPE] for most cases.”
Not enough PPE
But in Ontario, where hundreds of new COVID-19 infections are still being reported daily, dentists are scrambling to find enough personal protective equipment.
There are some 10,000 dentists and their staffs in the province, according to Dr. Kim Hansen, president of the Ontario Dental Association and a dentist in Prescott.
“Just imagine the amount of PPE that we are seeking.”
A survey conducted by the association found that in April, 40 per cent of its members were unable to provide emergency services and the primary reason was because of a lack of safety gear.
Hansen noted that back in March, many dentists donated some of their safety gear when shortages were reported among front-line workers.
New guidelines released on Monday by Ontario’s Royal College of Dental Surgeons outline the required PPE as well as rules around sealing off a room after aerosol-generating procedures like drilling or ultrasonic scaling and polishing.
The amount of time a room needs to be left vacant varies depending on the rate of air exchange in the building, which is why the dental association was encouraging its members to contact an HVAC specialist and get their ventilation systems evaluated.
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But for now, Ontario dentists can only see patients for essential care, including procedures that “relieve pain and suffering.”
The guidelines say they won’t be able to see patients for routine check-ups until community transmission of COVID-19 has been significantly mitigated.
Dr. Rob Eisen and his colleagues at North York Smile Centre in Toronto held a drive-thru check-in on the weekend, where patients could pull up and ask questions — and leave with the standard toothpaste and dental floss.
“I think part of reopening is really connecting with our patients still and making sure that they are comfortable,” said Eisen, who has been providing emergency care and consultation over the phone.
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