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Open for business: Dentists confront unique business challenges posed by a pandemic

Woman dentist smiling and standing at a window looking out while holding a mug
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Pre-appointment screenings. No handshakes or physical contact. Communal objects removed from waiting rooms. Hand sanitization stations. Temperature checks. Texts to patients in cars when it’s time to be seen. Walkie-talkies for communication between the front desk and the operatory.

This is the face of dentistry in the age of COVID-19, a global pandemic that has spread faster and killed more people in the U.S. than anywhere else on Earth: more than 2.5 million infections and more than 126,000 deaths at press time, according to Johns Hopkins University data. Yet as many industries are still reeling nearly four months after the outbreak, organized dentistry has already taken big steps to help practitioners resume a full working schedule.

One of those steps is the Return to Work Interim Guidance Toolkit. Published by the American Dental Association, the 22-page toolkit offers detailed instructions on in-office patient registration, reception area preparation strategies, chairside checklists, staff protection strategies, tips on how to make smart choices with personal protective equipment, how to spot a fake face mask and more. The toolkit has been downloaded more than 131,000 times since its 
April 27 release.

“Dentistry has always been at the forefront of infection control,” says Dr. Rudy Liddell, a Brandon, Florida-based general dentist who helped author the toolkit. “This isn’t the first time [dentistry] has faced a virus outbreak.”

Dr. Liddell points to examples of past outbreaks like severe acute respiratory syndrome (SARS) in 2003, bird flu in 2004, swine flu, the H1N1 virus in 2009 and Middle East respiratory syndrome (MERS) in 2012, and he notes that dentistry recovered every time, often much sooner than other industries. Yet, Dr. Liddell concedes the scope and severity of the current pandemic has strained the profession like never before. 

That’s what led ADA President Dr. Chad P. Gehani to appoint a seven-member task force to address the issue back in March. At that time, federal and state guidelines largely restricted dentistry to emergency care only. Since the toolkit’s release, dental offices have resumed performing restorative procedures, hygiene appointments and elective procedures.

The rebound was not always easy.

Dr. Kirk Norbo, a general dentist in Purcellville, Virginia, and task force member, furloughed nearly all of his 16 employees when the pandemic hit. He kept the practice afloat with revenue from unemployment insurance and the federal Paycheck Protection Program. All his employees have since returned to work, but Dr. Norbo says that state-wide school closings now make it hard for his staff to arrange child care.

Patient care has changed, too. In Dr. Norbo’s office, a staff member at a screening table takes every patient’s temperature and his or her medical history. Patients sign a consent form, then typically wait in their cars for a text message when it’s time to be seen. Magazines, the TV remote and other items have been removed from the waiting room to reduce the chance of transmission. Chairs are spaced six feet apart to enforce social distancing. Front-office staff communicate with staff in operatories via walkie-talkie. All of these changes are designed to reduce human contact.

Yet it’s just that kind of human interaction that Dr. Norbo says used to define his family practice. Gone are the leisurely chit-chats with patients and friends. When patients come in, Dr. Norbo gets right down to business.

“I’m one of the most long-winded people you will ever meet,” he says. “When patients come in, all they want to do is talk about their families. Now I tell them, ‘We need to keep this short and to the point.’”

Dr. Liddell, who runs 16 operatories in two offices, cut office hours by half in late March. The dental practice stopped all hygiene, restorative and elective procedures. By late May, his practice’s caseload rebounded to about three-quarters of pre-COVID-19 levels.

Drs. Norbo and Liddell agree that a big part of returning to normal is assuring the safety of patients and staff. Dentists have limited access to N95 respirator masks — the current shortage leaves them fourth in line behind hospitals, nursing homes and first responders — but they know that a level 3 surgical mask and face shield can be just as effective. As states relax restrictions on dental procedures, both say that patients need to feel confident that dentists can treat them while keeping them safe.

“A lot of [the recovery] is going to depend on the public’s perception of what’s going on,” Dr. Liddell says. “If what we do now doesn’t cause a second spike in the fall, we’ll know we’re on the right path.”

To make sure that happens, Drs. Liddell, Norbo and the rest of the task force released a new hazard assessment tool in late May. Available with the ADA’s Interim Return to Work Guidance Toolkit, the hazard assessment tool is designed to help regional dentists make smart choices about reopening. One feature, for example, offers COVID-19 infection rates by zip code. 

Dr. Norbo, who also worries about a recurrence of the virus, says a return to routine care is a big part of helping patients get back on their feet.

“We see a lot of patients coming out of hiding for appointments,” he says. “It’s almost like we’re enabling them to get back in society.”

Only when asked to predict when all this might end does Dr. Norbo’s confidence start to buckle. In the meantime, he says, “We’re open for business, and all procedures are on the table.”

About the author 

Author photo for David WeissmanDavid Weissman has been writing about dental issues for the American Dental Association and the American Student Dental Association for nearly 20 years.