It’s one thing to put off getting a haircut. But what about a visit to the dentist?
In the age of the coronavirus, the idea of having someone else’s fingers in your mouth — even if that someone is wearing gloves and a face mask — can feel unsettling. And not just for patients.
Dentists are among the workers at highest risk of contracting the virus — even more so than emergency medical technicians and paramedics, according to an analysis of federal labor department data by The New York Times. At the top of the list are dental hygienists.
Now, after months of limiting treatments to emergencies, Rhode Island dentists have started to resume cleanings and other routine care.
In Rhode Island, as in Massachusetts and Connecticut, there are lots of guidelines but few mandates about how to practice dentistry during the pandemic. But one thing is clear: If the dentist is doing things right, your next visit should feel anything but routine.
At my dentist’s office on Providence’s East Side, receptionists are the first-line of defense against the coronavirus. Before you enter the office, you have to answer screening questions on the phone.
The receptionists sit behind plexiglass wearing plastic face shields on top of surgical masks. Their clothes are covered with black gowns; their hands encased in rubber gloves. Gone are people sitting in the waiting room; patients are instructed to wait in their cars until the receptionist calls them.
For dentists and dental hygienists, high-speed drills and ultrasonic teeth cleaning tools pose the biggest risk of infection, because they produce aerosolized water droplets, which mix with a patient’s saliva, and are released into the air, said Sarah Gilkenson, president of the Rhode Island Dental Hygiene Association. “So it’s kind of a perfect storm,’’ she said.
In Connecticut, dental hygienists protested Gov. Ned Lamont’s phase one reopening plan last May, which allowed dentists to resume routine procedures. Lamont subsequently stipulated that dental practices unable to meet the “best practices” standards for infection control should hold off providing services beyond urgent care.
In Rhode Island, the local chapter of the American Dental Association, an industry trade group, took the lead in setting guidelines for dental practices. When Gov. Gina M. Raimondo announced phase one of the reopening in late April, her plan was to include “strict new regulations” for dentists offices. But state health officials walked back the statement in a May 4 advisory, saying they would not be issuing any new regulations for dental practices. “Rather than issuing a list of what dentists can and can’t do,’’ Joseph Wendelken, a Health Department spokesman said in an email, “we are allowing them to use their professional judgment.”
The Rhode Island Dental Association guidelines, like the CDC’s, recommend “if possible” practitioners hand-scale teeth rather than use tools that produce an aerosol. They also advise using “enhanced evacuation systems” to mitigate aerosoles.
Dr. Gary D. Light and his partner, Dr. Jason Conforti, bought a High Volume Evacuation machine with a HEPA filter and ultraviolet light designed to capture and kill aerosolized droplets. The machine, Light said, allows them to safely use high-speed drills and cleaning tools.
The dental association also advises providers to follow the CDC guidelines for leaving the treatment room empty for at least 15 minutes after each patient, to allow any particles in the air to settle before cleaning. The guidelines say that disinfecting between patients is not necessary unless a patient has tested positive for COVID-19, the disease caused by the coronavirus. Light says at his office they disinfect treatment rooms after every patient. He and his partner also installed ultraviolet lights in the office’s air duct system, based on research that ultraviolet light may be effective in killing the virus. (The CDC, however, does not recommend use of UV lights in dental offices, saying that not enough is known about their effectiveness.) Light said their office also purchased hospital-grade HEPA filters to clean the air.
The total cost of the pandemic prevention work, Light said, was “well over $50,000.”
“We really have gone above and beyond what is really, I think, necessary or indicated,’’ Light said, “but there’s a comfort level there and reassurance on an emotional level.”
For Light, 60, that comfort level alone is worth the price. In 2010, his wife, Jeanine, died after contracting a virus that he says was eerily similar to COVID-19, resulting in acute respiratory failure. She was 50.
Not all dental practices have the resources to invest in unproven strategies. At the Blackstone Valley Community Health Center, dental patients are treated on the second-floor of their offices in Central Falls, among the communities hardest-hit by the virus. And their office never closed. The dental clinic is often the “last stop” for keeping patients out of the emergency room, which is “not a good place to be right now,’’ said Dr. Pedro Ochoa, the dental clinic’s 35-year-old director. His wife, a pediatric dentist, is pregnant and also has continued to work at her office through the pandemic.
At the Central Falls dental clinic, patients are screened as they enter the building by a medical assistant in full Personal Protective Equipment (PPE). Patients are then allowed into the waiting room, where chairs are spaced 10-feet apart. But the dental clinic, Ochoa said, has not yet resumed routine care because they don’t have enough space. The center is upgrading its ventilation system in their Pawtucket office, he said, so they can reopen that office, hopefully by the end of the month.
It remains to be seen what, if any, changes are required for dental offices to safely resume use of high-speed drills and cleaning tools, said Dr. Steven Brown, a dentist and member of the Rhode Island Dental Association’s COVID-19 Task Force. “Every dental office is different, “ Brown said. “Every ventilation system is different. And science isn’t there yet for dentists to go out and spend a lot of money on something that might not work.”
If a dentist is taking all the recommended precautions for infection control and for preventing the spread of coronavirus, “the risk of acquiring COVID-19 from the dental office is really low,’’ said Dr. Phililp A. Chan, an infectious control specialist at Brown University. “I would be more worried about getting COVID-19, frankly, from going to a grocery store than if I went to a dentist office.”
So far, about 30 oral health care providers in Rhode Island have tested positive for the coronavirus, Wendelken, the department’s spokesman, said in an email. None of those cases, he said, have been linked to any dental practices.
Dr. Samuel Zwetchkenbaum, the department’s dental director, recommends that patients ask their dentist what type of precautions they are taking. Are they screening patients before they even come into the office? Are they able to do a cleaning that doesn’t create an aerosol?
One way to help consumers, Zwetchkenbaum said, would be to create some type of certification or “seal of approval” for dentists who have completed a set of requirements or checklist. That way, he said, “you can feel confident because they’re following this checklist. “ However, he added, “I don’t think we’re at that point.”
— Lynn Arditi, health reporter at The Public’s Radio, can be reached at larditi@thepublicsradio.org.
