Several States Allowing Expansion to Non-Emergency Services
Several states have reopened or will soon allow dental offices to reopen. AGD reached out to members in many of these states to gauge their feelings on reopening while the pandemic continues and what precautions they’ve taken to protect their patients and staff members.
Q: When will your office reopen?
Jeremy Suess, DDS, FAGD (Clackamas, Oregon): Dental offices in Oregon can reopen May 1 pending our ability to meet requirements that are still expected from the Oregon Health Authority.
Darren Greenwell, DMD, MAGD (Ratcliffe, Kentucky): In Kentucky, dental offices have already opened if they are prepared with the appropriate personal protective equipment (PPE). Obviously, with the new guidelines, the pace of treatment is much slower. This means fewer patients in the office at one time.
Peter Vayanos, DMD (Belgrade, Maine): According to our governor’s orders and four gradual stages of reopening, as long as a business facility can protect public health and safety, we can reopen May 1 to treat emergency patients only because phased opening outlined.
Aparna Sadineni, DDS, AAACD, MAGD (Dublin, Ohio): Our governor gave us the greenlight to open May 1.
Douglas W. Bogan, DDS, FAGD (Houston, Texas): The date we are allowed to open was moved up from May 9 to May 1, and we are planning to fully reopen with dentists and hygienists May 11. Between now and then, we will continue to take care of emergencies and possibly expand into some less urgent needs.
Deanna H. Snitzer, DDS (Lakewood, Colorado): We had a soft opening April 27 to get back into the swing of things and will have a full opening May 4.
Steve D. Wegner, DDS, MAGD (Omaha, Nebraska): We are starting May 4. We had a staff meeting April 29 to discuss which protocols will be different, and everybody is excited to get going again. One staff member is not returning right now — she has some underlying heart issues, and her doctor recommended she not come back to the office.
Q: How are you handling personal protective equipment (PPE)?
Suess (Oregon): In March, Oregon dentists donated their PPE to frontline critical-care responders. But that now leaves us with limited resources, and our suppliers don’t have them, either. I believe I have enough to start, but this won’t last long. I’m hoping the state can help us access higher-level PPE (such as N95 masks and disposable gowns), but, if the state or our suppliers can’t help, dentists will have to make tough decisions about continuing to treat patients or to suspending operation again. We would stop treatment.
Greenwell (Kentucky): I was able to source enough PPE to get started, but the price has been significant. I hope, as inventory increases, we will see a decrease in cost. We are currently using N95 masks, face shields, gowns and head covers.
Vayanos (Maine): Our biggest challenge is getting N95 masks, and we are currently on a waiting list. Moving forward, we will be using N95 masks, gowns, face shields, rubber dams for all operative procedures, hair nets and scrubs that we can leave at the office.
Sadineni (Ohio): Yes, I ordered from several companies over the last few months, and the equipment has arrived. We incorporated N95 masks, face shields, disposable gowns, and head caps for all clinical team members.
Bogan (Texas): We will begin using N95 and KN95 masks during aerosol-producing procedures, and we are working to procure those masks. We are also researching available options to ensure safe air quality in the treatment rooms, including vacuum and air purification devices.
Wegner (Nebraska): The N95 masks are pretty elusive. We have a few, but not enough to go very long. We’ve decided to start using scrubs for ease of use.
Q: How are you addressing patient questions regarding their safety during appointments in your office?
Suess (Oregon): Communication is necessary to show patients what engineering controls we have in place to enhance their safety. Dentistry has always been keenly aware of universal precautions, disinfection and cross-contamination considerations. This is our time to shine, and we will only benefit by being transparent with all the steps we implement as we routinely follow regulations.
Vayanos (Maine): Patients will go through a pre-appointment phone screening. Extra time will be allowed in the schedule for each patient to fill out a specific prescreening COVID-19 questionnaire. We have also purchased noncontact forehead thermometers to use prior to initiating a dental procedure. Finally, we are looking into test kits for COVID-19 that might become available in the near future that will specifically test IgM/IgG levels. This will confirm within minutes if the patient has been exposed to the virus and is now safe to treat or is currently infected.
Bogan (Texas): Our screening protocol includes a phone questionnaire during the appointment-making process. When patients arrive at the office, their temperature is taken, and the questionnaire will be reviewed. All patients will do a preprocedure rinse.
Snitzer (Colorado): We are being open and honest about our procedures and policies. I have been sharing my best practices document with patients if requested, but the majority of my patients are confident that I will do what needs to be done to keep them safe.
Wegner (Nebraska): We’re preparing a handout to give them information. Patients want to know what we’re doing differently. When we’re calling patients, before we even have a chance to ask prescreening questions, they ask if we’re going to ask them. Everyone seems to be ready to roll. They get it. They know what’s going to happen.
Q: What changes did you make to your practice?
Suess (Oregon): I added engineering controls, including air filtration, overnight fogging and aerosol scavenging systems (HEPA filtration, hypochlorous acid fogging and IsoDry). I’ve also put in some new administrative controls to screen patients and team members, enforce source control (masks and rinses) and reduce unnecessary visitors.
I don’t like spending unnecessary money, but this is an investment in being able to reopen safely. We don’t have the luxury of waiting for controlled studies of the effectiveness of each of these interventions before reopening, so it’s time to take the steps that we see as reasonably helpful now and make changes as we go along. For me, I didn’t see any choice; we have to do this for patients and employees.
Greenwell (Kentucky): I have placed plastic sheets over all operatories and many more barriers over the equipment. We have also removed all materials from the operatories. Staff has been reduced slightly, primarily due to their own childcare needs. Every patient has their temperature taken and fills out a questionnaire specific to COVID-19.
Vayanos (Maine): For front desk personnel, we have installed custom-made plexiglass partitions to eliminate exposure. Freestanding hand sanitizer dispensers have been placed in the waiting room. Automatic soap and hand sanitizers have been installed outside the hygiene and doctor’s operatories. Multiple face shields will be used throughout the day by each doctor, hygienist and assistant who will be treating patients. This will allow enough time to disinfect and rotate the face shields appropriately. Portable air purifiers will be placed throughout the office with true HEPA filters able to remove 99.97% of particles down to .1 microns. Furthermore, an in-duct air purifier system will be installed in our existing central air system. This unit will be able to produce hydrogen peroxide plasma that is distributed through the air handler, through the duct system and into the conditioned living space. The dual ionizers will kill up to 99% of bacteria and viruses.
Sadineni (Ohio): We made several scheduling changes so we can allow more time for proper team infection control protocols and to avoid too many patients checking in and out at the same time. We modified office protocols based on Centers for Disease Control and Prevention and American Dental Association guidelines for the safety of our patients and team members.
Snitzer (Colorado): We do a 24-hour confirmation screen prior to each appointment. The patients stay in their cars and let us know they have arrived, and a provider goes to the car for temperature screening. We are using N95/KN95 masks for higher risk procedures along with gowns and hair covers.
Wegner (Nebraska): We have face shields, which we’ve rarely used before. We’ve put up acrylic sneeze guards for the front desk area based on state recommendations. We’re verbally prescreening patients for COVID-19, and we’ll ask them the same questions and take their temperature again when they walk in the door. We took out half the reception room chairs and spread the rest out, and we took out the magazines and kids’ toys.
Q: Any last thoughts?
Suess (Oregon): The only thing I can promise is that I will take extraordinary action to do right by my patients and employees while I struggle back toward business viability.
Greenwell (Kentucky): I believe we will continue with enhanced infection control for several months. Hopefully, once testing becomes more available, dentists can screen patients more thoroughly. Also, if a vaccine becomes available, then dentists can help with the administration.
Wegner (Nebraska): The bottom line is that patients and dental team members alike should feel confident in the fact that dental offices are and have always been committed to providing a safe and comfortable environment for their personnel and patients. Dentists are taking even more precautions now in light of the unknowns associated with COVID-19, and those may change as we discover more about the virus. These changes may be temporary or permanent, but we should all feel comfortable in the knowledge that dentistry is always at the forefront of infection control and in protecting our team members and patients.
Vayanos (Maine): I anticipate some anxiety; however, we have hope as we have started to see the flattening of the curve. It is our responsibility to prove and explain to our patients that we have taken every measure possible to keep them safe. I can foresee that it will be a slow transition as guidelines will continue to change.
Each office needs to make a responsible decision and truly believe that they can safely treat patients and protect their staff. Before opening, I would ask myself: “Would I feel safe bringing my own family or elderly parents to my dental facility?” My next advice would be having appropriate PPE supplies prior to reopening. If you can answer yes and follow through on the above statements, I would have no hesitation opening your dental office.
For more information on COVID-19, visit agd.org/coronavirus.
Q: When will your office reopen?
Jeremy Suess, DDS, FAGD (Clackamas, Oregon): Dental offices in Oregon can reopen May 1 pending our ability to meet requirements that are still expected from the Oregon Health Authority.
Darren Greenwell, DMD, MAGD (Ratcliffe, Kentucky): In Kentucky, dental offices have already opened if they are prepared with the appropriate personal protective equipment (PPE). Obviously, with the new guidelines, the pace of treatment is much slower. This means fewer patients in the office at one time.
Peter Vayanos, DMD (Belgrade, Maine): According to our governor’s orders and four gradual stages of reopening, as long as a business facility can protect public health and safety, we can reopen May 1 to treat emergency patients only because phased opening outlined.
Aparna Sadineni, DDS, AAACD, MAGD (Dublin, Ohio): Our governor gave us the greenlight to open May 1.
Douglas W. Bogan, DDS, FAGD (Houston, Texas): The date we are allowed to open was moved up from May 9 to May 1, and we are planning to fully reopen with dentists and hygienists May 11. Between now and then, we will continue to take care of emergencies and possibly expand into some less urgent needs.
Deanna H. Snitzer, DDS (Lakewood, Colorado): We had a soft opening April 27 to get back into the swing of things and will have a full opening May 4.
Steve D. Wegner, DDS, MAGD (Omaha, Nebraska): We are starting May 4. We had a staff meeting April 29 to discuss which protocols will be different, and everybody is excited to get going again. One staff member is not returning right now — she has some underlying heart issues, and her doctor recommended she not come back to the office.
Q: How are you handling personal protective equipment (PPE)?
Suess (Oregon): In March, Oregon dentists donated their PPE to frontline critical-care responders. But that now leaves us with limited resources, and our suppliers don’t have them, either. I believe I have enough to start, but this won’t last long. I’m hoping the state can help us access higher-level PPE (such as N95 masks and disposable gowns), but, if the state or our suppliers can’t help, dentists will have to make tough decisions about continuing to treat patients or to suspending operation again. We would stop treatment.
Greenwell (Kentucky): I was able to source enough PPE to get started, but the price has been significant. I hope, as inventory increases, we will see a decrease in cost. We are currently using N95 masks, face shields, gowns and head covers.
Vayanos (Maine): Our biggest challenge is getting N95 masks, and we are currently on a waiting list. Moving forward, we will be using N95 masks, gowns, face shields, rubber dams for all operative procedures, hair nets and scrubs that we can leave at the office.
Sadineni (Ohio): Yes, I ordered from several companies over the last few months, and the equipment has arrived. We incorporated N95 masks, face shields, disposable gowns, and head caps for all clinical team members.
Bogan (Texas): We will begin using N95 and KN95 masks during aerosol-producing procedures, and we are working to procure those masks. We are also researching available options to ensure safe air quality in the treatment rooms, including vacuum and air purification devices.
Wegner (Nebraska): The N95 masks are pretty elusive. We have a few, but not enough to go very long. We’ve decided to start using scrubs for ease of use.
Q: How are you addressing patient questions regarding their safety during appointments in your office?
Suess (Oregon): Communication is necessary to show patients what engineering controls we have in place to enhance their safety. Dentistry has always been keenly aware of universal precautions, disinfection and cross-contamination considerations. This is our time to shine, and we will only benefit by being transparent with all the steps we implement as we routinely follow regulations.
Vayanos (Maine): Patients will go through a pre-appointment phone screening. Extra time will be allowed in the schedule for each patient to fill out a specific prescreening COVID-19 questionnaire. We have also purchased noncontact forehead thermometers to use prior to initiating a dental procedure. Finally, we are looking into test kits for COVID-19 that might become available in the near future that will specifically test IgM/IgG levels. This will confirm within minutes if the patient has been exposed to the virus and is now safe to treat or is currently infected.
Bogan (Texas): Our screening protocol includes a phone questionnaire during the appointment-making process. When patients arrive at the office, their temperature is taken, and the questionnaire will be reviewed. All patients will do a preprocedure rinse.
Snitzer (Colorado): We are being open and honest about our procedures and policies. I have been sharing my best practices document with patients if requested, but the majority of my patients are confident that I will do what needs to be done to keep them safe.
Wegner (Nebraska): We’re preparing a handout to give them information. Patients want to know what we’re doing differently. When we’re calling patients, before we even have a chance to ask prescreening questions, they ask if we’re going to ask them. Everyone seems to be ready to roll. They get it. They know what’s going to happen.
Q: What changes did you make to your practice?
Suess (Oregon): I added engineering controls, including air filtration, overnight fogging and aerosol scavenging systems (HEPA filtration, hypochlorous acid fogging and IsoDry). I’ve also put in some new administrative controls to screen patients and team members, enforce source control (masks and rinses) and reduce unnecessary visitors.
I don’t like spending unnecessary money, but this is an investment in being able to reopen safely. We don’t have the luxury of waiting for controlled studies of the effectiveness of each of these interventions before reopening, so it’s time to take the steps that we see as reasonably helpful now and make changes as we go along. For me, I didn’t see any choice; we have to do this for patients and employees.
Greenwell (Kentucky): I have placed plastic sheets over all operatories and many more barriers over the equipment. We have also removed all materials from the operatories. Staff has been reduced slightly, primarily due to their own childcare needs. Every patient has their temperature taken and fills out a questionnaire specific to COVID-19.
Vayanos (Maine): For front desk personnel, we have installed custom-made plexiglass partitions to eliminate exposure. Freestanding hand sanitizer dispensers have been placed in the waiting room. Automatic soap and hand sanitizers have been installed outside the hygiene and doctor’s operatories. Multiple face shields will be used throughout the day by each doctor, hygienist and assistant who will be treating patients. This will allow enough time to disinfect and rotate the face shields appropriately. Portable air purifiers will be placed throughout the office with true HEPA filters able to remove 99.97% of particles down to .1 microns. Furthermore, an in-duct air purifier system will be installed in our existing central air system. This unit will be able to produce hydrogen peroxide plasma that is distributed through the air handler, through the duct system and into the conditioned living space. The dual ionizers will kill up to 99% of bacteria and viruses.
Sadineni (Ohio): We made several scheduling changes so we can allow more time for proper team infection control protocols and to avoid too many patients checking in and out at the same time. We modified office protocols based on Centers for Disease Control and Prevention and American Dental Association guidelines for the safety of our patients and team members.
Snitzer (Colorado): We do a 24-hour confirmation screen prior to each appointment. The patients stay in their cars and let us know they have arrived, and a provider goes to the car for temperature screening. We are using N95/KN95 masks for higher risk procedures along with gowns and hair covers.
Wegner (Nebraska): We have face shields, which we’ve rarely used before. We’ve put up acrylic sneeze guards for the front desk area based on state recommendations. We’re verbally prescreening patients for COVID-19, and we’ll ask them the same questions and take their temperature again when they walk in the door. We took out half the reception room chairs and spread the rest out, and we took out the magazines and kids’ toys.
Q: Any last thoughts?
Suess (Oregon): The only thing I can promise is that I will take extraordinary action to do right by my patients and employees while I struggle back toward business viability.
Greenwell (Kentucky): I believe we will continue with enhanced infection control for several months. Hopefully, once testing becomes more available, dentists can screen patients more thoroughly. Also, if a vaccine becomes available, then dentists can help with the administration.
Wegner (Nebraska): The bottom line is that patients and dental team members alike should feel confident in the fact that dental offices are and have always been committed to providing a safe and comfortable environment for their personnel and patients. Dentists are taking even more precautions now in light of the unknowns associated with COVID-19, and those may change as we discover more about the virus. These changes may be temporary or permanent, but we should all feel comfortable in the knowledge that dentistry is always at the forefront of infection control and in protecting our team members and patients.
Vayanos (Maine): I anticipate some anxiety; however, we have hope as we have started to see the flattening of the curve. It is our responsibility to prove and explain to our patients that we have taken every measure possible to keep them safe. I can foresee that it will be a slow transition as guidelines will continue to change.
Each office needs to make a responsible decision and truly believe that they can safely treat patients and protect their staff. Before opening, I would ask myself: “Would I feel safe bringing my own family or elderly parents to my dental facility?” My next advice would be having appropriate PPE supplies prior to reopening. If you can answer yes and follow through on the above statements, I would have no hesitation opening your dental office.
For more information on COVID-19, visit agd.org/coronavirus.