The coronavirus pandemic has been difficult for everyone, but it has been particularly tough on the dental industry. In mid-April of this year, for instance, almost 95% of dental practices reported being either closed completely or open only for emergency patients, according to an American Dental Association (ADA) survey. Most practices reported that their practice volumes were less than 5% of usual, and collections were also down dramatically.
While the pandemic continues, many practices have been able to reopen successfully. And their patients are returning. But reopening hasn’t been without its struggles.
Dr. Ray R. Rodig, DDS, owner of the Vintage Dental practice in Modesto, California, talks about the process of reopening, some of the challenges — both expected and unexpected — and offers some tips and best practices for others in the same situation.
For how long was your practice closed?
Almost 11 weeks.
When did you reopen?
May 26, 2020.
Why did you decide upon that date?
We had done all of our research into what would keep our patients and team members healthy and safe at the office. We had a couple of “practice runs” the week before to work out our new patient flow to make sure it was workable, safe, complete and comfortable for patients and team alike. While hard to get, we had all the PPE we needed, our air purifiers and sneeze guards were in place — we were ready to go back to work, and the ADA said it was safe.
What challenges did you face initially?
The fear and uncertainty of both patients and team members — some patients are still not comfortable returning and have appointed out into November and December. There’s also a balancing act with moving our patients through the office, making sure there’s no “traffic jams” — no one coming in contact with each other in the office. And finding and ordering PPE was very difficult. Thank goodness for our local Stanislaus Dental Society! They really helped and kept us in the loop.
Which was the most difficult to address?
Some people — very few — are just put off by having to wear masks. We explain that they’ll only need them entering and leaving the office and that we’ll even provide them, but some folks just don’t want to accept this. We’re patient and understand completely, but we just need to keep everyone safe. No exceptions.
Did you encounter any challenges that you weren’t expecting or that surprised you?
The heat and stress of wearing the extra PPE really surprised us. Just breathing takes so much more energy — learning to breathe with N95s, wearing both scrubs and full-length gowns together. It creates a lot of heat and stress that we didn’t even think about before we started back.
Which challenges have been resolved and which are ongoing?
The biggest challenge we seem to have is letting our operatories sit empty for five minutes. We need a bit more time to turn over the operatories now, which creates a scheduling issue. We’ve resolved this by revamping the schedule, but it continues to evolve daily, as no day is ever the same, and turning over the operatories and taking the extra time to complete a thorough sterilization is a challenge.
I’d also say closing our reception area has been a real process. It’s yet another scheduling issue involving the flow through the office, but our patients understand what we’re doing and why, so it’s really become a non-issue.
And we’re getting used to the hot PPE, but I’m sure hoping this doesn’t become the “new normal.” It’s sure hard to visit with our patients now.
How did your staff react to returning to work? Did any refuse?
Thankfully, our team was ready to come back to work — not one person refused. Some voiced safety concerns in our team Zoom calls prior to reopening, but we answered their concerns, and everyone came back.
What additional precautions have you had to take in your office?
We closed our reception area, and our patients must call and wait in their cars for their appointments — this was very odd for us since we like to visit with our patients, but they seem to understand. We also don’t allow extra persons to come with them unless they have appointments, too. All patients need to answer a series of questions, sanitize their hands and have their temperature taken before we’ll take them to their operatory. Temperatures of all team members are taken as they enter and as they leave each day.
Our team members in the back office wear two masks (one being an N95), a face shield, scrubs and a full-length surgical gown, and most like to wear bouffant caps. Before COVID, we only wore level 3 masks, face shields and lab coats.
We have limited the use of the cavitron, and have external vacuum machines to help suction any aerosols away while in treatment or hygiene; we use Isolites as well.
Our front team wears masks and are stationed behind large sneeze guards, and they’re constantly sanitizing all pens, files, countertops, etc. There’s hand sanitizer everywhere. The office is fogged daily, and we have air purifiers in every operatory.
Additionally, we started using a COVID-19 testing program weeks ago through Pathnostic. We have kits on hand, and if someone isn’t feeling well, has a cough or fever, or has come in contact with someone they think (or know) has been ill or had COVID-19, we have kits in the office that are simple to use, comfortable, and we get results back in a couple of days.
I highly recommend these for safety and peace of mind, and they’re not scary, painful tests. There’s no cost to the office or the person being tested. We’ve tested team members, family members, friends, patients — and everyone is surprised at how easy they are to do, and how fast we get the results back. It’s comforting to know we can find out quickly if there’s a problem.
Have you had to discontinue use of certain equipment or purchase new equipment?
We have limited the use of cavitrons — the hygienists have external suction machines to limit aerosols in addition to air purifiers in their operatories, so we leave it up to the hygienists to decide whether to use it. As far as equipment is concerned, we have really only purchased air purifiers for each operatory and a fogger we use daily at this point. Our office has always been very sterile and safe, so we didn’t have to change or add much.
What kinds of additional expenses have you faced as a result?
The professional installation of sneeze guards was a bit pricey but certainly necessary, and the cost of PPE went through the roof — that’s quite an expense right there.
How do ask your patients to prepare for a visit?
Our front office will call our patients the day prior to their appointment and ask all the same questions that we will ask when they arrive for their appointment. We don’t want them to show up and not be able to see them due to travel, or fever, or coming in contact with someone who may be sick. We ask that they wear a mask, arrive at the time of their appointment, call us from their car when they arrive, and we call them back to let them know when to come inside.
What do ask your patients to do when they arrive?
Our reception area is locked; when they call to let us know they’ve arrived, we let them know that we will call them back when they can enter. Once their assistant or hygienist is ready, we call and ask them to come on in. Our team opens the door, so patients don’t have to touch the door handle.
How have your patients responded?
Some have been a bit confused at first, but 99.99% of our patients are happy we’re working hard to keep them safe and healthy. The .01% that are unhappy about wearing masks are still appreciative of our efforts. Some are pretty amazed at all the precautions we take and have taken some of our ideas to implement in their homes.
Have your patients had any concerns? How have you addressed them?
Their concerns seem to center around safety. Once we walk them through the process over the phone, they understand that each patient is carefully screened and put through the same process they’re going through, as well as our team members. Most are confident by the time they get here and are definitely confident when they leave.
What is your current situation in terms of patient volume? Collections?
We were very surprised at how busy we were right from time we reopened and we’ve continued to stay busy — new patients, patients coming back for treatment diagnosed prior to closure, past patients with new treatment needs — people seem to be excited to be able to get back to keeping their teeth healthy. Our collections have exceeded our expectations, as has the patient attendance. We were pleasantly surprised.
How has this changed since you initially opened?
Our patient flow is much more of a rhythm now — at first it was disconcerting implementing all the new steps, but now it’s a habit and much easier. I’m also blessed with a great team and great patients.
What advice do you have for other dentists in a similar situation?
I’d say everything can be really overwhelming at first, but as the old saying goes, “How do you eat an elephant? One bite at a time.” Do your research, figure out what works best for you and your team, find out what is working for other professionals in your local dental community and emulate them.
We thought it would be very hard to reopen, and while it seemed very challenging at the beginning, it became easier sooner than we anticipated. And let your patients know what you’re doing to keep them safe — they’ll appreciate that.
Is there anything you’d caution other dentists about or recommend that they look out for?
I’d make sure that your team knows how important it is to everyone that they practice social distancing in the office.
We protect ourselves from our patients, but once the PPE comes off and we’re with our “office family” we can’t forget that we need to keep our distance from each other. This isn’t the easiest thing to do — we have staggered lunches, plenty of room in our breakroom and wear masks when not eating.
And remind your team about social distancing and wearing masks away from the office. We need to protect each other.