Getting patients to “open wide” after reopening presents new challenges for dentists and orthodontists.
Dr. Hal Cohen is good at a lot of things, but elementary school math isn’t one of them. “My daughter was in third grade, so I could do the work,” Cohen says. “But I won’t say that I enjoyed it.”
When COVID-19 closed schools, Cohen and his wife found themselves in the same homeschooling boat as many other parents. But as the owner and lead dentist at Downingtown Family Dentistry, Cohen had more than elementary school number crunching to worry about during the early days of the pandemic. Deemed nonessential services, practices like his were ordered by the state to close, and dentists were forced to furlough their staffs. Employees filed for unemployment, an unfortunate but necessary financial lifeline.
Available only for emergencies, dentists did their best to help patients. “If the situation could be delayed or managed with medication, that’s what we did,” says Cohen.
Managing orthodontia was a bit different. Care was minimal for patients with Invisalign aligners, but patients with traditional braces needed video consults. Dr. Catherine Foote and many of her colleagues used telemedicine platforms to consult with patients. “Those active wires need watching, and we can’t let patients go without being checked for so long,” says Foote, who has offices in Bryn Mawr and Wayne. “People were lobbying for orthodontics to be deemed essential so we could open, but that didn’t happen.”
Dental practices reopened in mid-June. By then, dentists had acquired the additional personal protective equipment needed to safeguard their staff and patients. Masks, gloves and protective eyewear were commonplace before COVID-19, but full face shields had to be ordered, and shipments were delayed. “There was so much demand that suppliers were backlogged,” says Foote.
Dentists also had to reassemble their staffs, which posed some challenges. “Fear of the virus has caused many employees—especially hygienists—to refuse to return,” says Exton Dental Health Group’s Dr. Jonathan Scharf. “Some dentists are being forced to reduce benefits resulting from the long-mandated closure.”
Scharf predicts that staffing issues will persist through the fall and winter. “Parents of young children not going back to school now need to stay home, and the $600 unemployment bonus has disincentivized a significant number of employees from returning,” he says.
But patients are returning, largely thanks to the safety measures instituted by dentists and their staffs. Scharf filmed a safety video and emailed all of his patients with a link to it. “We received great reviews, and I think that’s why our patients have felt pretty comfortable continuing and initiating treatment,” he says. “Believe me, I take this situation very seriously. I won’t receive an Academy Award for the performance, but it came from the heart.”
At Downingtown Family Dentistry, Cohen installed physical barriers around his front desk and instituted all of the American Dental Association’s recommended protocols. “Patients see the safety measures we’re taking, and most are OK to come in,” he says.
Dr. Annie Creato notes that dentists have a lot of experience dealing with respiratory viruses. “We wear N95 masks, face shields, gloves, protective gowns and everything OSHA recommends,” says Creato, who heads Kidsteeth Pediatric Dentistry in Swarthmore.
It’s the same at all dental practices. There are pre-appointment telephone screenings that check potential symptoms, and office procedures and waiting rooms have been revamped. At Kidsteeth, patients arrive with only one caregiver and no siblings. “They call us from their car,” Creato says. “Then they enter the office and sit for only a few moments in the waiting room.”
Foote’s orthodontic patients are also children, but they tend to be older and a bit more independent. She doesn’t allow parents or siblings in the operatories or in the waiting room. “If there’s a highly anxious kid, we accommodate,” Foote says. “Otherwise, parents wait in their cars while we treat their kids.”
Parents actually seem quite happy in the parking lot, enjoying a few moments of quiet, Foote reports. “The kids have been great and don’t mind wearing masks,” she says. “They’re generally excited to start braces or Invisalign and get their teeth straightened, and we don’t do drilling or even cleaning. So visiting us is less scary once we talk them through it.”
Creato says her young patients haven’t been unduly alarmed by the new procedures or added protective equipment. And she makes sure they get a token to use in the toy-vending machine. “All of them are individually wrapped, so kids get a clean toy to take home,” Creato says. “We think it’s important that they still get a prize, even with COVID-19.”