Dental hygienist Victoria Laurin cleans a patient's teeth at Better Living Through Dentistry in San Francisco. Dentists are resuming routine care, now wearing more protective gear like N95 masks, face shields and hair covers. (Courtesy of Dr. Natasha Lee)
Going to a dental office during a global pandemic is a bit like playing a video game. Patients and office staff will muster their greatest patience and don new protective gear to overcome hurdles previously unseen. Once inside the office, they will navigate an intricate maze of socially distanced people, plexiglass sneeze guards and bottles of hand sanitizer before making it to their final destination: the dental chair.
Dental offices postponed routine and nonurgent care following the statewide stay-at-home order issued March 19. Dental visits slowed to a trickle of emergencies: a painful tooth, for example, broken tooth, or facial swelling.
As California entered Stage 2 of the state’s reopening in early May, when curbside pickup for some retail like flower shops and bookstores was permitted, the state also allowed routine dental care, such as cleanings and exams, to resume.
But like the loosening of other restrictions, the return to regular dental care varies based on permission from counties themselves. What's resulted is a patchwork of rules and regulations, and confusion for dentists and patients alike.
"The state was saying one thing and then you had counties saying different things," said dentist Dr. Natasha Lee, of the San Francisco-based private practice Better Living Through Dentistry. "Everyone was like, 'Well, who do I listen to?'"
The correct answer, says Lee, a former president of the California Dental Association, is whichever directive is more restrictive.
While the state announced in early May that dental offices could resume routine care, the soonest Lee could do so in San Francisco was on May 18, which she did.
And things in her office look a lot different.
Before patients even come in, staff will screen patients over the phone for symptoms of COVID-19 and ask whether they've traveled recently.
If they check out, they will head to their scheduled appointment. When they arrive, however, they won't open the door and enter the waiting room. They'll knock and be met by staff outside the clinic, where they go through the same screening again, plus a temperature check.
"Only then do we actually allow a patient to come into the practice," Lee said.
Office staff give patients a new surgical mask, even if they brought a mask from home. Patients will see a receptionist who is behind plexiglass sneeze guards, a setup Lee calls "an aquarium."
A staff member escorts patients to the treatment room, "to make sure that we're timing patient arrival and patient departure so we don't have anyone crossing paths in the hallway," Lee said.
In the treatment room, patients wash their hands and rinse with a peroxide-based mouthwash. Finally, they'll take their seat in the dental chair.
"When I come into the room, they say, 'Oh, Dr. Lee, it's so nice to see you,'" Lee said. "And then I realize they can't see me because I'm behind all this PPE now."
New personal protective gear for dentists includes an N95 face mask, a face shield, a hair covering and a fresh gown. The gowns are disposed of after each patient is seen, even if it's just for a brief exam.
It may be hard to hear Lee too, since she has four new HEPA air filters whirring in her office to increase air flow.
All of that is not without a cost. In Oakland, Dr. Sharon Albright, who was once my dentist, says she's spent more than $10,000 to prepare her office and outfit her staff to resume routine care next week.
While she isn't having trouble finding enough PPE, she said it has become much more expensive than it once was.
Despite the new financial costs, Albright said dentists are uniquely prepared for this kind of challenge, based on their training and experience.
"We've been dealing with a lot of things in dentistry. There was AIDS, there's always been hepatitis B, tuberculosis" Albright said. "We're no stranger to microbes."
When Albright's office does resume offering a full range of services, it'll see fewer patients.
So will the nonprofit Children's Dental Health Clinic in Long Beach. Before the pandemic, the large clinic saw roughly 100 young patients per day, said Executive Director Dr. John Blake, and still couldn't meet the demand. Now, Blake said they can see about half that many people in the same amount of time. He's considering seeing patients at night to accommodate more of them.
Other clinics are considering using teledentistry for things like evaluations before a procedure.
While getting close to another person feels precarious these days, Blake believes dental care is still safe. And the Centers for Disease Control and Prevention reports there have been no clusters of COVID-19 outbreaks in dental settings or among dental health care personnel.
Blake said he explains it to hesitant patients like this:
"The dental office, if they have the proper PPE, if they have the proper recommended protocols in place, is much safer than going to the supermarket."
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