Dentists forced to adjust operations amid COVID-19

Danielle Starkey / Tahoe Daily Tribune

A trip to the dentist can raise questions you wish you didn’t have, such as, you found a new problem? And, will this go away on its own? 

Dental appointments can pose some degree of threat to everyone in the room, as is apparent in the precautions dentists and hygienists take in case you (or they) might be sick.

COVID-19 is ushering in a host of new practices, some of which will take a bit of getting used to, said dentist Robert Rutner, owner of Sierra Tahoe Dental. 

“Certainly, the style of dental offices is going to change,” he said.

Waiting rooms; treatment rooms; indoor ventilation systems; even the laundering habits of staff will change. These changes are bound to affect dentistry in profound ways, and more than a few teeth will be lost as care gets more expensive and treatments are postponed, Rutner predicted.

Rutner’s South Lake Tahoe office has remained open throughout the pandemic but only for dental emergencies — not to put in fillings or do cleanings or cosmetic work. In the meantime, he’s brought in new safety devices and taken out a  few things.

In the waiting room, the small creature comforts such as coloring books and toys and magazines have disappeared. 

“We don’t want people touching anything,” said Rutner. “The goal now is the virtual waiting room, which is your car. When you get here, you text us and staff will let you know when it’s your turn to enter the office. We are extending some walls more to the ceiling (to restrict the movement of airborne particles). 

One of their two bathrooms is being stripped and a washing machine and dryer will be added. 

“That’s so scrubs and outer gowns can be washed here instead of at home,” he said. 

The office will have a fogger. 

“It looks like a vacuum cleaner but blows a mist (containing hydrochloric acid) to spray the chairs after each patient,” he said. “They use it in food service a lot to disinfect fruit.” 

Before the pandemic, patients might have been alarmed to see someone walking into the exam room in a face shield, mask, goggles, shoe covers, a hair bonnet and a long gown.

“Now, you better look like you’re an astronaut when you walk into the room,” said Rutner. Even then, some patients will remain anxious about contracting COVID-19 and will put off dealing with minor dental problems before they develop into major ones. 

With a kind of — can we call it wistfulness? — Rutner recalls how different things were when he was in dental school.

“I’m 62; I’ve been a dentist for 35 years,” he said. “When I was in school, we didn’t use gloves or masks or anything. We didn’t sterilize the drills (between patients). We wiped things down, but didn’t put them in a sterilizer. The thing that changed all that was HIV (in the 1980s,). Before, a plain surgical mask was deemed fine.”

Now, a mask that can capture smaller airborne particles, such as the N95 mask, is needed. But these masks and other supplies are in high demand, according to Dr. Jason Henderson, owner of Kings Beach Dental. That’s made the supplies more expensive and supply lines less reliable, said Henderson.

“The same box of 30 masks that cost $30 before now costs $140 a box,” he said, and that’s if you can get one. “Now, (the suppliers) are saying they’re back ordered until August, September. We used to get our dental supplies in 24 to 48 hours.” 

Henderson said that he, too, has placed orders for a variety of new products, including a ‘wand’ that will use ultra-violet rays to zap your credit card, check or cash to kill any viruses clinging to them. He’s also ordered a device that goes over the head of patients to trap aerosols; a medical-grade air purifier and a ‘sneeze shield’ to protect front desk staff.

“It looks like a hospital ward,” he said of his office. 

Henderson said he’s had to cut staff and doesn’t know yet when he’ll be able to bring them back on. 

“People may be too scared to come for dental work,” he said. “A lot of people are rescheduling their appointments to July and August, but who knows what’s going to happen in July and August?” 

Facing a slew of new rules that will sharply reduce the number of patients per day they can see, some dentists, especially those who have been in practice a long time or whose building can’t easily be modified, may well decide it’s not worth it to continue, Rutner said. 

“It wouldn’t shock me if 20% to 30% of dental offices close (in the Lake Tahoe region),” he said. “Let’s say you’re 65, and you have a really old office. Do you want to spend a bunch of money retooling? Many likely will quit.” 

To bring down costs, he and five other dentists have pooled $15,000 for masks, gowns, face shields, booties, and hair coverings. Prices on some of these items have doubled, Rutner said. 

“Insurance companies are balking at factoring in these increased costs,” he added. 

As more people lose their job and the dental insurance that goes with it, or if they can’t afford insurance anymore, they’re likely to postpone treatment. 

“People will become more episodic in their care,” Rutner said. “They’ll only come in when it hurts.”

Hygienists have their own set of concerns, said Rutner. 

“I don’t think they are saying, ‘Oh my god, I need a different career,’ but I do read on blogs that some are asking for assistance.”

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