While adjusting to the "new normal" since Gov. Kate Brown allowed dental offices to conditionally reopen has proved challenging, dentists in the Lake Oswego, West Linn and Wilsonville communities are excited to get back to work and provide an important service to their communities.
As of May 1, the governor lifted the ban on nonemergency medical services and allowed businesses like dental offices to reopen if they have a sufficient supply of Personal Protective Equipment — at least 14 days' worth of PPE like gloves, masks and gowns.
According to the American Dental Association, dental office employees are required to screen patients before their appointment and the day of their appointment. Screenings include questions relating to COVID-19 symptoms and exposure, and require patients to take their temperature at the start of their appointment. Staff also are being screened.
"We were happy and a little surprised, but caught off guard," said Dr. Jon Robinson, owner of Lake Oswego Dentistry with his business partner Laura Miller, about the governor's decision to allow offices to reopen.
Also, the state mandated that hand sanitation stations are available upon entry into the facility and staff must follow specific cleaning protocols to ensure the office stays clean all day. The dental offices that have decided to open up are doing so gradually.
"People I have seen are very happy," said Mike Lorio of Town Center Dental Group in Wilsonville. "For dental disease, it can be very uncomfortable not getting treatment."
Both Lake Oswego Family Dentistry and Lake Oswego Dentistry plan to see their emergency patients first, serving their priority patients before opening up for regular cleanings.
Robinson said the office took a few extra days to make sure staff understood the protocol and guidelines set forth by the ADA, Oregon Health Association and Centers for Disease Control and Prevention, before opening back up May 5.
Lisa Strauch, owner of Lake Oswego Family Dentistry with her business partner Carrie Laird, said they officially reopened May 4 and are seeing one patient at a time, with an hour in between for cleaning.
"I like to escort my patients out. I'm opening the door for them, and I have a sanitizing wipe in my hand," Strauch said.
Roane Family Dental in West Linn is taking similar precautions. Office staff member and patient care representative Angie Edson said the Roane office also is staggering appointment times to allow for more sanitization. Edson added that the office has implemented curbside check-in, where patients call or text the office when they arrive, but stay in their car until their appointment is about to start.
Some aspects Wilsonville Dental Group uses to safeguard patients include an air filtration system to provide "maximum air flow," surgical caps, face shields and an external suction unit that sucks up aerosols. Criscione Family Dental in Lake Oswego, meanwhile, is limiting the use of aerosols in its hygiene department and relying solely on the hand-scaling technique for cleaning appointments.
Various dental offices said they have taken additional safety precautions not required by governmental agencies, including ultraviolet light disinfection.
"It's a 'why not?' It can only help, it can't hurt," Robinson said.
The Roane office also eliminated all paper, which Edson called a breeding ground for bacteria, from the office, except at the front desk.
Strauch said she has implemented a unidirectional flow for patients with one entrance and one exit.
"We have windows open to allow more airflow, cell phones are left in the car, no food in the office (and) no water bottles in the office," Strauch said.
At Criscione Family Dental, patients are asked to wash their hands and rinse with an antibacterial before sitting down, then wash their hands again before leaving. A professional company also comes in once a week to "cold fog" the office in order to kill off bacteria and viruses.
Also from a safety component, Lorio pointed out that dentists have to go through yearly infection and federal Occupational Safety and Health Administration training.
"It's a little different, but in some respect every dental office is used to running with this sort of thing," he said.
When the Lake Oswego dental offices bring back their hygienists for regular teeth cleanings, it won't look the same. Hygienists will be required to use hand instruments instead of the ultrasonic instruments for safety reasons.
Maybe the biggest challenge for all businesses Pamplin Media Group chatted with was collecting enough PPE to keep staff and patients safe. Obtaining PPE was a challenge, but Robinson said he feels prepared to keep staff and patients safe.
"I started ordering stuff two weeks ago, including certified masks from overseas that are taking weeks to get here," said Robinson, adding that after they were ordered to turn in their PPE to hospitals at the start of the pandemic, they've had to restock and sometimes pay "top dollar" or make seven to eight calls to find a decent supplier. "It's been ugly; it's been a lot of scrambling."
Lorio felt similarly.
"We have a supply. The fear is no one has a huge stockpile of anything. We call our suppliers daily for whether we can get more," he said.
What's also been difficult, Strauch said, is calculating the equipment burn rate — how many masks, gowns, gloves and other supplies they go through each day and even each hour, and determining what equipment is reusable and what needs to be disposed of.
"It's actually kind of complicated," Strauch said.
Not every dental office had been closed prior to Brown's order. Wilsonville Dental Group provided emergency procedures, such as tooth removals or root canals, during the time when normal operations were closed and dentist Thomas Clark said the office actually gained more new customers during this time than normal. However, he said it might have been more profitable to close.
"I think we have a commitment to patients, to staff members who rely on us for their livelihood and the community, in general, to provide treatment for people in pain," Clark said. "It wasn't in our plan to totally close down. For financial reasons we could have done so, but felt like it was important for the community to be there for people and take care of their needs."
Clark said they're seeing about a 20% decrease in patients per day so far and estimated that about 60% of patients want to get procedures done now while 40% are more reticent and want to delay until the summer.
At Criscione Family Dental, which also stayed open throughout the crisis, business was generally slower, but dentists there noted that emergency procedures were more common than normal. Edson from West Linn's Roane Family Dental said the office went from seeing about 26 patients per day to five each week for the past month and a half.
"Most patients have felt confident and comfortable coming in to have their regular dental care. The patients that are precautious are the elderly," Edson said. "They are just choosing to wait a bit longer to come in for their elective care to see how things play out in the next month or so."
Edson said their office is still unsure about how the coming months will play out now that offices are back open for regular care.
Clark also said one staff member is staying home due to an underlying medical condition.
"I know we've had some staff members who have had some level of concern (about spreading the virus) and we've been able to talk through (that)," Clark said. "I personally feel safe. I feel we are doing way more things than the average dental office, way more things than any business that people go to and still use on a regular basis."
Lorio opened up shop for the first time in a month and a half recently. He said the time off was financially burdensome on the business and employees, and he is worried about expenses exceeding revenue moving forward.
"It's a fear as a business owner. Dentistry overhead is very high; staff wages are high. Paying staff, hopefully we make enough to pay people, get supplies — PPEs are expensive. It's uneasy, for sure, but I know all businesses feel the same way," Lorio said.
"It will be interesting in six months or a year (to see) how dental offices are operating in terms of their profitability," said Strauch of the decrease in dental procedures and the amount of time required for each procedure with added cleaning measures, social distancing and screening requirements.
And Lorio agreed with Brown's decision to reopen medical offices, a decision that was derided by some.
"One of the collateral things about this is people's health, and it can start to collapse in different ways. Dental treatment, medical treatment for (things like) heart disease, if that goes untreated it starts to pile up on a different end," Lorio said.
The uncertainty around the COVID-19 crisis and its longevity is palpable across industries including dental offices.
Strauch, for her part, said she's concerned about another resurgence of COVID-19 later this year.
"If people start losing their jobs and people start losing their dental coverage — dentistry is one of those things people tend to drop off earlier if they have job losses," Strauch said. "As we open back up and people start socializing or traveling, it's going to be an issue we have to deal with."
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