After closing for an extended period this spring, most dental practices in Rhode Island have resumed routine care. But the experience is anything but routine for most patients.
Like other health care professionals, dentists are following new safety protocols designed to protect staff and patients, created by the Rhode Island Dental Association and public health officials.
A 23-page document published by the R.I. Department of Health outlines how dental professionals can resume routine, preventative and postponed dental care, and spells out the steps intended to protect personnel and patients.
Most patients can expect to wait initially for their appointment in the parking lot, have a phone-based health screening before stepping into the office, and get their temperature checked. But most dentists are not requiring a test for the new coronavirus prior to an appointment because the lag time in test results has made that impractical, said Dr. Steven Brown, an oral surgeon who is the state’s delegate to the American Dental Association.
“Initially, when we started opening in earnest, in the middle of May, the health department set up a website where dentists could order testing,” Brown said. “That was extremely helpful at the time. Of course, the problem now is that tests are taking too long. So it’s not predictable now. If you don’t get the test results until a week to almost 10 days later, that test is almost useless.” R.I. Department of Health documents indicate that the state, along with the state chapter of the dental association, has requested approval from the U.S. Department of Health and Human Services for on-site rapid tests for dentists, much like the state’s hospitals use for patients scheduled for surgery.
Brown, who also is on staff at Rhode Island Hospital for trauma-based dentistry, said in his own practice he had patients with wisdom teeth extractions take the COVID-19 tests as a precaution. It initially worked well, he said.
Barring tests, dental professionals are gearing up with personal protective equipment, which has been distributed several times through the state, but getting enough equipment has been hampered by supply-chain issues.
Initially, about 800 N95 face masks were distributed to dental offices in Rhode Island, followed by a distribution of about 9,000 masks. A third shipment included several thousand more.
But the availability is inconsistent, Brown conceded. Under current guidelines, dentists do not have to replace their N95 after each patient visit, which allows them to extend their use.
“It’s not one mask, one patient,” Brown said. “Because our suppliers are still not able to get those for us. Sometimes something will trickle in, but it’s not enough.”
One longtime dentist has adapted to the new standards, but he said the effect has been that he’s seeing only about half as many patients in a day.
Dr. Wayne Mollohan, a dentist for the past 40 years, closed his practice on March 17, under state direction, and reopened about 10 weeks later.
The new routines include having patients stay in the parking lot initially, where they are screened by a staff member using the checklist for symptoms of COVID-19.
“The new waiting room is the car,” Mollohan said. “Everything is locked.”
To some extent, the protective practices used in the office are similar to what dentists have been using since the AIDS epidemic, he said, when they first started donning gloves, masks and other protective equipment to prevent transmission of blood-borne diseases.
The difference now, Mollohan said, is the mask he uses is the N95, which filters viral particles. He tops it with a lighter mask to prolong its use.
The use of equipment in the office has also changed.
Mollohan said he has more time between appointments, and uses an ultraviolet light to kill infectious particles. Everything is cleaned after every examination.
Partly because of the new protocols, he said he sees only about 40% fewer patients daily. And purchasing the protective equipment has been expensive, he said.
Mollohan, who is 66, said he wouldn’t be surprised if many established dentists decide to retire because of a combination of the risk that COVID-19 presents to older people and because of the expense of following safety protocols. Insurance does not fully reimburse dentists in Rhode Island for their services, he said.
Because of the nature of dental work, a microscopic spray of blood or saliva can be generated by drills or teeth-cleaning devices. Dentists and hygienists are changing some of the equipment they use, to reduce the potential for that spray. Hygienists have stopped using a device called a Cavitron, according to Brown, and instead are cleaning teeth with hand instruments.
If someone has tested positive for COVID-19 and requires emergency dental care, that patient should be seen by a dentist at a hospital where procedures can be done in specialized rooms, Brown said.
Most dentists seem to have adjusted to the new screening requirements. “Now that we’re into this, I think dentists feel confident that their prescreening procedures and our PPE have gotten us this far,” Brown said.
No COVID-19 infections have been traced back to a dental practice, as far as Brown knows.
“I would have heard about it,’ he said. “The dental association would have heard about it.”
Mary MacDonald is a PBN staff writer. Contact her at Macdonald@PBN.com.
