Safety in the dentist’s chair

Mark West was munching on almonds during Memorial Day weekend when he broke a tooth. His initial response was trepidation about having to visit a dentist in the midst of a pandemic.

“I was really kind of frightened about going,” he recalls. “There was this sense that you don’t know who’s carrying the illness.”

But the tooth was bothering him and he knew he had to do something about it, so he finally called West Asheville Family Dentistry and made an appointment.

“They asked a lot of screening questions,” he says. “And when I went, everyone wore a mask, and the dentist and assistant wore face shields. … They got me in and out as quickly as possible, and they also took care of a couple other issues.”

Ann Beggs tells a similar story. She and her husband, Jim, both of whom are older and therefore at higher risk for complications from COVID-19, had dental appointments on the same day.

“I was concerned,” Ann Beggs says. “I think that’s normal.”

But Dr. Thomas Morton’s office put her fears to rest, she says. Employees asked screening questions, gave both patients the option of waiting in their car till they could be escorted straight into the treatment rooms, and everyone was masked.

“I felt safe,” says Beggs. “They did a good job.”

Face to face

While many physicians are now seeing patients online or in their cars, dentists must see people in person, in the office, in order to do their work, explains Natalie Raper, administrative director of MAHEC Dental Health. The practice’s two clinics (in Asheville and Columbus) are both fully open, though they’re seeing fewer patients — 40-45 a day, versus 45-60 before the pandemic — because they’re cleaning even more thoroughly after each patient and changing into fresh gowns, gloves, masks and face shields.

“Everyone went through a daylong training on procedures before we opened back up,” says Raper.

According to the federal Centers for Disease Control and Prevention, the risk is higher for dental workers than for those in most other professions because of the way the virus is transmitted. Dental practitioners use rotary instruments such as drills, ultrasonic scalers and air-water syringes, which create a spray that can contain particle droplets of water, saliva, blood, microorganisms and other debris. And while masks protect the mucous membranes of the mouth and nose from droplet spatter, they don’t provide complete protection against inhaling airborne infectious agents.

No data is yet available concerning the risk of COVID-19 transmission during dental work. To date in the United States, clusters of health care personnel who have tested positive for the disease have been found in hospitals and long-term care facilities, but none have been reported in dental settings or among dental health care practitioners.

For the first two months of the pandemic, dental offices in North Carolina were closed to all but emergency patients, but they reopened for elective procedures on May 8 under Gov. Roy Cooper’s phase 2 guidelines.

“We’re taking precautions in line with both the CDC and the American Dental Association, whichever is more stringent,” notes Raper.

Strict precautions

Dr. Mark Knollman says he finds the current procedures both familiar and reassuring.

“I was in dental school when the AIDS epidemic began,” he explains. “That was scarier, in my mind.” Early on in that epidemic, researchers hadn’t identified the retrovirus that causes the disease, and no one was certain how it was transmitted.

“We know more about this one, so we can be more assured that what we’re doing will work,” says Knollman. “You know, the term ‘universal precautions’ didn’t even exist before 1985. It means we treat all patients as though they might have something contagious. Now it’s how we practice.”

At the office of Dr. Timothy Gillespie, patients and staff follow a strict protocol, says Hailey Wallace, hygiene coordinator for the practice:

• Before patients come in, they’re asked to review and sign two forms electronically through the website: a COVID-19 consent form and an updated health history. This helps determine whether they should keep their current appointment or reschedule. It also ensures that the office has the most recent medical information on patients.
• Patients call the office from the parking lot to let staff know they’ve arrived and what vehicle they’re in; the waiting room is not an option during the pandemic. Patients also are asked to come alone unless they can’t drive themselves.
• Once the patient has called in, a dental hygienist or dental assistant greets them at their car and takes their temperature.
• Patients must wear a mask or other face covering when inside the building. They use hand sanitizer or are asked to wash their hands on entering the treatment room. The practice has one-way traffic in its hallways to improve social distancing.
• Once in the treatment room, patients are asked to swish with an antimicrobial mouth rinse for 30 seconds while the clinical staff members wash their hands. The clinician then closes the door, after which patients can remove their masks.
• Every surface is cleaned before and after each patient — both in clinical rooms and at the front desk.
• Appointments are staggered to reduce the number of people entering and leaving the office at the same time.
• Clinical staff members all wear proper personal protective equipment, and administrative staff wear face masks.
• All staff members has their temperatures taken and are prescreened before starting the workday.

Reassuring patients

Knollman says his office follows similar protocols. “I’ve had patients tell me they feel safer here than in a grocery store,” he says. His worst fear, notes Knollman, is that if he got sick, his office would have to close and his staff would be out of work.

“North Carolina has some of the strictest rules governing dental practices,” he points out. “If the dentist is not in the building, no one can do any procedures on any patients, and that includes cleaning and X-rays.”

Meanwhile, the N.C. Board of Dental Examiners has left it up to individual practices, which are considered essential businesses, to decide whether to open and, if so, whether they should accept nonemergency patients.

“We’re encouraging patients who have dental issues to come in, because waiting can make things much worse,” says Knollman. “A $300 problem can become a $3,000 problem pretty quickly. We want you to feel comfortable coming in, and we assure patients that we’re following the safety protocols.”