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Coronavirus in Austin: Changes underway as dentists reopen for routine care

Nicole Villalpando,
Hygienist Juli Rabadan cleans the teeth of Cliff Heiss at Walden Dental in Northwest Austin. Dental offices are in the process of reopening with new guidelines related to COVID-19. Some of the new requirements include N-95 masks, gowns and antibacterial mouthwash. [Stephen Spillman/for Statesman]

As dentist offices begin to return to providing routine care this month, their patients will notice some changes in what happens during a visit.

Dentists had to stop routine treatments March 22 when Gov. Greg Abbott prohibited nonemergency surgeries to conserve personal protective equipment supplies and hospital capacities. This order filtered down to dentists’ offices, some of which stayed open for emergency procedures.

On April 17, the governor issued an order that allowed for some nonemergency surgeries beginning April 24, and on April 28, he allowed licensed health care professionals to continue their practices as long as Texas has adequate supplies of personal protective equipment and as long as practices are following the rules of their licensing agencies for safe practices during this time.

For dentists that means following the State Board of Dental Examiners’ rules, which include new COVID-19 provisions:

• Scheduling time between patients to avoid interaction between fellow patients.

• Limiting patient guests unless in the case of a minor or someone with a disability.

• Prescreening for COVID-19 symptoms by telephone before the appointment.

• Doing an in-office screening of all patients including a temperature check.

• Screening all staff, including twice-daily temperature checks.

• Removing all things that could be touched by many people, such as magazines and toys.

• Placing signs that remind patients to maintain social distance.

• Giving patients an oral rinse before a procedure to cut down on infection.

• Staff should use hand instruments and low-speed polishing tools for dental hygiene instead of ultrasonic scalers.

• Staff needs to wear personal protective equipment, including N-95 respirator masks or KN-95 masks, if they will be within 6 feet of a procedure that is likely to have elements that aerosolize (such as particles flying). The federal Centers for Disease Control and Prevention recommends gowns, gloves and face shields as well.

• Staff should finish working on one patient before doing treatment on another patient, and in between patients their personal protective equipment has to be taken off and new equipment put on.

• If a dentist has to use a procedure in which aerosolizing could occur, they have to use an isolation technique.

• Patients should be told to contact the office afterward if they have COVID-19 symptoms within 14 days of their appointment.

• The staff has to change from scrubs and personal protective equipment at the office into personal clothing before returning home to avoid contaminated items coming home with them.

What does this mean for patients’ experiences? They should expect their dentist’s office to call them in advance to ask some questions.

Dr. Robert Benavides of Austin Modern Dentistry and Orthodontics said he’s using telemedicine to meet patients before they come to the office. He can assess what needs to be done before patients arrive, which allows them to spend less time in the office.

Many dentists offices are also asking patients to wait in their cars until called to come in. They also have them check out in the room with the hygienist instead of in the waiting room.

If a patient’s regular cleanings included using an ultrasonic scaler to get a deeper clean, expect dentists to use hand tools again.

Dr. David Frank of Walden Dental said he and other dentists are working to get portable suction units that prop up on a patient’s face to collect aerosolized particles, but those have been difficult to get because of the demand. Those units will allow them to do more treatments in a way that is safer for staff.

One thing that dentists are figuring out is how many patients they can serve in a day and how those patients need to be staggered.

It takes about 10 minutes to 15 minutes to clean a room and doff old protective equipment and put on new protective equipment for the next patient, Benavides said.

Right now, he estimates his office is at 25 percent capacity and will increase slowly. His office might be open longer and on more days to spread out patients.

It’s unclear how much of these new requirements will stay around after the pandemic is over, but the changes that dentists are going through now are not unlike the changes the profession saw during the AIDS crisis in the 1980s. Before, wearing gloves was not routine. Now dentists wouldn’t think about not having gloves on. The same might prove true with some of the protective gear dentists are now using.

While patients might think they should wait for routine care, Frank encourages people to get back on their six-month wellness check schedule “so things that are small do not turn into big things,” he said.

Those big things can include infections that begin to affect the airway or gum disease that can lead to heart disease and strokes.