Prevention, hygiene and self-care—mantras of dentistry—are also the tenets of COVID-19 mitigation. But stay-at-home orders issued by Gov. Tom Wolf and the Pennsylvania Department of Health have backed dentists into an uncomfortable corner in recent months. With other healthcare sectors deemed essential industries, they’ve been forced to close their practices for anything but emergencies—and those can be difficult to define, with pain being the best barometer.
COVID-19’s contagiousness gives patients a new reason to avoid dental care, so the effects of the pandemic on the field may be long lasting. Unlike other medical specialties, work can’t be done while patients wear masks. How will dentists protect themselves, their hygienists and their patients?
Health departments here and in other states have left that issue largely unanswered. Consumed by the crisis, officials are focused on saving lives and avoiding infections. This coronavirus is, by definition, a new disease. While the dearth of data on COVID-19 will invariably be filled by clinical research, getting fact-based results could take months, if not years.
“The longer dental practices remain closed to preventive care and treatment for early forms of dental disease, the more likely that patients’ untreated disease will progress, increasing the complexity and cost for treatment down the road.”
The American Dental Association has recognized the urgency of getting dentists back to work. “The longer dental practices remain closed to preventive care and treatment for early forms of dental disease, the more likely that patients’ untreated disease will progress, increasing the complexity and cost for treatment down the road,” said an ADA representative in a written statement.
The obvious solution is to have dentists, hygienists and dental assistants wear personal protective equipment. But to acquire scarce PPE, they’d have to resume their proper place in the medical hierarchy. The ADA is currently communicating with the Federal Emergency Management Agency, “other federal agencies and relevant organizations to advocate that dentists, as essential healthcare workers, are prioritized for PPE,” according to the statement.
Meanwhile, the ADA has assembled its own COVID-19 crisis team, the Advisory Task Force on Dental Practice Recovery, which has created a toolkit distributed to dentists across the United States. It includes pre-appointment screening guidance, in-office patient registration procedures, reception area preparation strategies, a chair-side checklist, staff protection strategies and a supply list. “The challenge we faced when formulating this document was balancing the introduction of new protocols addressing this specific COVID-19 virus with existing infection-control measures members have used for decades to safely deliver dental care to their patients,” says Dr. Kirk Norbo, a Virginia-based dentist, co-chair of the task force and a member of the ADA Council on Ethics, Bylaws and Judicial Affairs. “This document is intended to augment current infection-control practices to address the COVID-19 virus on an interim basis.”
The ADA’s new guidelines were welcomed news for Dr. Preetha Thilak, the resident dentist at La Comunidad Hispana. Located in West Grove, LCH provides low- or no-cost care to Chester County residents who qualify for services. “Most of our patients are mushroom farm workers, predominately Spanish speaking and living below the poverty line,” says Thilak. “Very few have medical or dental insurance. We charge according to income. If they can’t pay, we never turn away a patient.”
LCH’s clinic serves adults and children, many of whom have never had dental care. Thilak, her hygienist and two dental assistants often see patients in their 30s who’ve never had a professional cleaning, let alone X-rays or fillings. “Often, there’s a lot of work to be done,” Thilak says. “We start with gums, because a lot of our patients have serious gum disease and lost a lot of bone.”
LCH’s clinic had been seeing about 22 patients a day when Thilak shuttered the practice to comply with stay-at-home orders. While dentistry wasn’t deemed an essential industry, agriculture was. “The migrant farm workers didn’t have medical-grade masks,” says Thilak. “The few people who did have them were given disposable masks and told to wash them in Clorox.”
From their homes, Thilak and her neighbors in Media assembled materials and made masks, following guidelines from the Centers for Disease Control and Prevention. Within a few weeks, they’d produced more than 200 masks, which they safely distributed to migrant farmers through LCH. Though not medical grade, the masks provide some protection.
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Thilak has made plans to reopen LCH’s dental clinic, amassing PPE supplies that include N-95 masks and face shields to go with the gowns and gloves they already use. Thilak also uses loupes with sight shields, and she’s temporarily reducing drill operation until there’s a way to reduce its spray.
Thilak believes she’s taken the proper precautions, but she also knows that reopening too early would be a mistake for many dentists without PPE. States must first issue clear, comprehensive, universal rules that ensure the safety of patients and dental staff. “I’ve spent a lot of time thinking about what dentistry will look like for the next year or so,” says Thilak. “There’s not a lot of research, but there is a lot of conflicting information.”
To share information and strive for a consistent protocol, Thilak formed a group with other dentists, including her fellow alumni from the University of Pennsylvania School of Dental Medicine. “When the state says we can resume treating our patients, we’ll be ready,” she says.