How is COVID-19 affecting dentistry? In SO many ways! For the past few weeks, every dentist I know has been scrambling. We have had to completely pivot our lives in terms of our practice. We have shut our doors, let go of our teams, taken out loans, and learned new ways to protect ourselves. Every week it seems like something new, a new layer that is revealed.

I think that we have finally hit a plateau and we will cruise right here for some time. If this is not going to go away, we have to learn how to live with it. 

How Is COVID-19 Affecting Dentistry in My Endo Practice?

Let me show you! I want to share what I am doing in my practice to protect my patients, my team, and myself. You may be taking these steps in your practice too, but in case you are not, feel free to adopt anything from here into your lives. My goal has always been to share best practices with my readers.

Treating emergencies only

Like most of you, I am only treating endodontic emergencies in my practice. 

But as an endodontist, I am not sure exactly what that means! (Click here to view my Emergency Pain Scale.) Emergencies are my life, so this is a hard one. According to my residency attending, it’s not an emergency unless you have two heads (from swelling) or mayonnaise pouring out of your face. (Ew, gross, but I admit it made me chuckle!) 

When someone finds out they have an infection, they feel the need to be treated right away. So, I am making sure that I let people know that yes, they need treatment, but some of them can actually wait until this passes. 

So watching how I present things to my patients is step one. We need to be careful how we are speaking to our patients right now in order to help manage their anxiety.

Explaining the situation to patients

I am finding that most patients don’t understand why dentists are closed right now. Patients definitely aren’t wondering, “How is COVID-19 affecting dentistry?” They feel that a pain level of any kind should warrant treatment. They don’t understand the risks associated with being at the dentist right now. 

I have had to spend some time letting them know about those risks. Now is the time to educate them, but in a way that won’t scare them from going back to the dentist in the near future! Remind them that their safety is our number one concern, and when we feel that it is safe to re-open as normal, they will be the first ones to get care. Until then, find something to tide them over.

As we quickly approach the peak of the spread of the virus in this country, luckily more and more people are beginning to understand it’s best to just stay home.

Using analgesics and antibiotics as treatment

I don’t really like to use analgesics and antibiotics as a form of treatment, but now calls for some changes to the norm.

I usually say treatment trumps drugs, so I always prefer to treat. But right now, this does not hold true, and you may need to medicate your patients for some time.

Perhaps you have to do that for a quarantine period that lasts about 14 days. After that, it’s probably safe to treat them with the proper PPE.

Asking the patient important questions

Make sure that you are asking the proper questions before you agree to see a patient for treatment.

  • Have they travelled within the past 21 days?
  • Have they been in contact with any patients that have tested positive for COVID-19?
  • Are they experiencing any flu-like symptoms?
  • Have they been practicing proper social distancing?

Hopefully, you will get truthful answers! Once the patient arrives at your office, make sure that you take their temperature. Within the first two days that we started this process, we found that 4 patients had a temperature of over 100 degrees and had no clue. We postponed their treatment for 3 weeks and asked them to self-isolate in order for us to treat them in a timely manner.

What’s your temperature cut-off?  We used 100 degrees initially, but you may want to consider 99.7, just in case there are variations with your thermometer.  

Social distancing within your practice

How is COVID-19 affecting dentistry? Maybe the most obvious is the fact that we are practicing social distancing in our office. There’s skeleton team in order to minimize the number of people in the building. 

We also ask that our patients come alone to their appointment. If we feel there are too many people in the practice, we will have the patient use their car as their waiting room and we call them when it is safe for them to come in.

We have also successfully implemented teledentistry, so that we can triage from the safety of our homes. This has been a game changer!

Using proper PPE

By now, you are probably aware that the N95 mask is recommended. We just got ours this past week. 

Let me just start by saying, now I see why this mask has not been mandated in the past.  It is impossible to breathe in. I really hope this is not our new normal! In the meantime, we all just have to live with it and hope that we get used to it. 

I even tried a P100 mask , but it does not fit me right and it is not sealed. So I am not sure how useful it actually is.  A matter of fact, the N95 isn’t sealed either! 

I truly wish we had more guidance on all of this stuff, but for now, I will be putting my traditional mask over an N95 mask, and I will wear a shower cap and a disposable surgical gown every day that I am in the office.

Wiping down frequently-touched surfaces

We make sure that the patients wipe down their phones before they come in.  That thing is a cesspool!

As soon as our patients come into the office, we have them wash their hands for a full 30 seconds. We even have a timer so that there is no cheating. They are then asked to rinse with 1.5% hydrogen peroxide for a minute, and we use a saliva ejector to dispose of the rinse.  

We also wipe down our front desk after each and every patient visits.

Using rubber dams and OpalDam

Today and everyday I am so grateful for my rubber dam and for my OpalDam. Maybe during this time, more people will adopt the use of a rubber dam! I really hope so because it could be the one thing that saves you right now, considering how many aerosols it can protect you from.

Once my patient rinses with the hydrogen peroxide, I put the rubber dam on. When this is in place, I take a cotton pellet soaked in sodium hypochlorite and make sure I wipe down that tooth.

After I do that, I use my OpalDam to seal all the little openings in the rubber dam that could leak out any oral fluids. Once I am confident that I have a good seal, I let that tooth soak in either more sodium hypochlorite or hydrogen peroxide for another minute. Now I am ready to pick up my drill.

This is such a small little detail that I think goes a long way.  I always say that endo is all in the details!!

Completing root canals in one visit

In my opinion, a root canal is probably the safest dental procedure that can be performed right now. It’s totally up to you if you want to complete the root canal in one visit or not. Personally, I would want to complete it.  But, if you feel like you just want to get in the tooth and get the patient out of pain and be done, you can do that too. It’s totally up to you.

Taking good care of myself

This is nothing new, but it’s more important now than ever. 

I drink warm lemon/ginger water every morning and take a shot of apple cider vinegar. It’s all delicious! Every day, I take vitamin D, vitamin C, a probiotic, and zinc every day to boost my immune system.

I am constantly washing my hands, trying not to touch my face, and taking a shower as soon as I come home from work. Plus, I am working out regularly and spending time in nature for some extra vitamin D.

How is COVID-19 affecting dentistry? In many ways, but you can protect yourself and your patients.

It will be interesting to see what comes of all of this. I am sure this is what dentists felt like in the 1980s when HIV first came on the scene. Back then, wearing gloves for the first time was probably a huge adaptation for many, but now we would never think of doing it any other way!

Let’s see what happens, but in the meantime, stay happy and healthy. I would love to hear what you are doing in quarantine.  Please leave a comment on how you are handling all of this.

-Sonia

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