Since reopening in May, dental offices have had full schedules. Patients have been eager to get back on track with their routine dental care after many offices were closed during part of March and April due to the coronavirus pandemic.
“Even though you can’t have as many people (in at one time) because you have such a backlog from the time that we were closed and then new people, too, we’ve almost been busier than ever,” said Dr. Andrea Smith, of Berks Prosthodontics in Wyomissing.
Protecting patients and staff from viruses and other diseases by using protective equipment and adhering to a high standard of cleaning practices is a familiar task for dentists.
“Most dental procedures remain the same,” said Dr. Eric Angstadt, of Angstadt Family Dental in Wyomissing. “In a more practical sense, this viral pandemic has simply reminded us that we need to always be vigilant when it comes to disinfection and sterilization procedures performed in a dental office.”
The new normal
Dental offices have adjusted procedures to follow specific COVID-19 health and safety guidelines. For patients, this means a slightly new experience when visiting the dentist.
To practice social distancing guidelines, waiting rooms are closed in the dental offices. Patients instead remain in their vehicles and call the office to check in for their appointment. They then go through a COVID-19 screening process including a questionnaire about symptoms and any known exposures, and a temperature check. Depending on the practice, the questionnaire is done when the patient calls to schedule their appointment or upon arrival for the appointment.
A staff member will then take the patient directly into a treatment room. Unless the patient is receiving dental services in the treatment chair, the patient must be wearing a mask at all times.
Social distancing guidelines are followed as much as possible and hand sanitizer is made available to patients and staff throughout the office. Appointments are also further spaced out to allow time for additional cleaning between appointments and to prevent a number of people being in one area at the same time.
Just as patients have to wear a mask while in the office, dentists and their staff are also wearing additional personal protective equipment to help protect themselves and their patients.
“With dental offices, we’re really working in close contact with patients,” Smith said. “When we do drilling or anything like that inside patients’ mouths, that’s getting very close to where COVID-19 would (spread from). When you work on patients, of course they don’t have a mask, so we have to be extra careful to protect them (and ourselves).”
The additional PPE, depending on the practice, includes KN95 or N95 masks, protective eye wear, disposable gloves, hair bonnets, face shields and the changing of gowns or jackets between appointments.
“Other than that, we’re pretty much back to routine dentistry and our way of doing things,” said Dr. Jordan Hottenstein, of Central Berks Dental Center in Leesport.
Angstadt said even before the pandemic, dentists were taught to treat every patient as if they were high risk or could have some form of a communicable disease to ensure the proper level of protective equipment is used and cleaning procedures are followed.
A new look
At the start of the pandemic, dental offices were shut down rather quickly due to how the virus is spread and the nature of providing dental care.
“There was definitely a lot of evidence early on in the pandemic that people who work close to the head and neck, like dentists who can’t do our jobs unless we’re a foot or two away from a patient’s open mouth, that we had the potential to be super spreaders,” Hottenstein said.
While offices were closed, dentists worked on purchasing additional PPE, adjusting procedures and updating the reception area and treatment rooms in their offices with additional COVID-19 precautions.
Smith, Hottenstein and Angstadt all had air filters put in each of the rooms in their offices. The filters help clean aerosols produced by dental procedures. Appointments have to be scheduled to allow for additional disinfecting time between patients, which allows for more thorough cleaning and for the room to air out. Angstadt, for example, uses ultraviolet-C light flash sterilization protocols to kill surface-borne and airborne bacteria and pathogens.
“In our office, and I hope in all dental offices, we consider ourselves health care providers, so we try to follow all the strictest standards for everything being clean and taking care of our patients,” Smith said.
For procedures, Smith has her patients do a pre-treatment rinse as a precaution. In the treatment rooms, everything in the room has a protective covering including the tools she will be using for the appointment. Any other items not needed for that specific appointment are removed from the room.
Angstadt has made an effort to reduce dental aerosol production during procedures by using dental lasers, and high speed evacuation and specialty saliva ejectors. In the reception area, custom clear acrylic barriers were installed around the desks. Social distancing cues can been seen throughout the office including floor decals that Angstadt said patients are following very well.
“The things that we’ve added and done are to continue to make this a safe place for people to come to,” Angstadt said. “Not just because we take care of (patients) here, but we take care of ourselves and our families here, too.”
Bringing patients back
Dentists are glad to be back in their offices and caring for patients again.
“I felt there was definitely a social responsibility in the beginning,” Hottenstein said. “It was hard for me to have people calling me and not really being able to help them. For two months I didn’t really step foot in the office or help anybody at all.”
Hottenstein is thankful for the oral surgeons and endodontists who were able to stay open and take care of patients with dental emergencies while dental offices were closed.
While the dentists each have some patients who do not feel comfortable coming into the office for an appointment at this time, most of the patients were eager to get back in for their rescheduled appointments.
“I feel like most people want to come back,” Smith said. “I hope that it’s because they see dentists are taking precautions to keep everyone safe and that they feel safe in the office when they come here.”
Angstadt believes one of the reasons patients have been eager to resume their appointments is due to trust and the unique relationship between dentists and their patients. He and his staff also feel it is not more important than ever to go out of their way to ensure they do not lose the kind and compassionate care they show their patients.
“We treat everybody like they’re family,” he said. “When you have that kind of relationship, it’s not tough to bring people in. People want to come back in. They know that you’re doing everything.”
Dentists do require all patients to follow the current guidelines in place at their offices.
“At the end of the day we have to respect everybody that comes in,” Hottenstein said. “The safety and health of my staff and our patients is my number one priority. We’re going to follow the guidelines.”