Is visit to dentist now a treat? Apparently so in this COVID-19 world

By Mike De Felice, Special to Kitsap Daily News

A routine trip to the dentist’s office isn’t typically viewed as a fresh change of pace, but during these COVID-19 times, being able to return to some semblance of normalcy by seeing a dental hygienist for teeth cleaning or visiting the dentist to get a cavity filled qualifies as a lifestyle treat.

Patients in need of dental work are finally getting their chance after dental offices were given approval to reopen May 19 under Gov. Jay Inslee’s Proclamation 20-24.1, part of his Safe Start plan.

Here is a look at what it is like to go to the dentist in these COVID-19 times:

Basic procedures have not changed much but greater attention is being paid to sanitation issues for the protection of patients and staff. Dental staff wear more personal protective equipment (PPE) and patients have their temperature taken upon arrival at the office. Meanwhile, waiting rooms in many offices have undergone major changes.

“For the most part, patients are really glad to come in. It provides them a sense of normalcy,” said Dr. Paul Hutchinson, co-owner of South Kitsap Family Dentistry in Port Orchard.

“I have not seen a whole lot of apprehension. Patients have really been appreciative and happy they are able to do something for their health. I think they are also glad to be out of the house.”

The first difference a patient at Hutchinson’s office will notice is when they call for an appointment.

“Right off the bat, there is a COVID-19 questionnaire (Do you have a fever? Been in contact with anyone confirmed with COVID-19? Experienced any change in taste or smell?).

“Also, the parking lot has become the waiting room,” the dentist explained.

When patients drive to the office, they are directed to park out front, then call the front desk to say they have arrived. At the door, a staff member takes the patient’s temperature, provides hand sanitizer and a face mask.

The waiting room holds a limited number of patients for shorter times and has been revamped – fewer chairs, no more Highlights magazines or other publications, and the kids’ toy area has been removed. Acrylic sneeze guards have been installed at the receptionist desk.

Staff throughout the office now wear surgical masks throughout the day.

“Normally when I greet a patient, I would not be wearing a mask and would shake their hand,” Hutchinson said. “Now when I come in, I have a mask. That happened today with a new patient. It felt weird because he doesn’t exactly know what I look like.”

For some procedures that utilize a high-speed drill, Hutchinson will wear an N95 mask. Otherwise, he only wears a surgical face mask.

At the time the Stay-at-Home order was announced, there was growing concern that hospitals were running out of N95 masks.

Hutchinson’s office had some masks on hand and several patients offered up N95 masks they had at home. “My wife happens to be an ER nurse at St. Anthony’s Hospital in Gig Harbor, so I gave her most of the masks to take to work.”

However, when it came time to reopen the dental office, Hutchinson and his partner, Dr. Chris Bock DMD, had difficulty obtaining masks for their staff.

“When we donated our masks, I didn’t think it would impossible to get more later. We had to struggle to find them when we needed them. Fortunately, we got lucky and found a new supplier who had them on hand.”

Currently, the office has about a three-week supply.

“We are still looking for more. We never know if we’ll be in situation where we are scrambling to get them again.”

The extra PPE equipment dental professionals wear has increased costs at many dentist offices. Patients at South Kitsap Family Dentistry pay an extra $15 for PPE, according to staff members.

When the Stay-at-Home order was first imposed, Hutchinson and other dentists were limited to performing only emergency dental work. Routine teeth cleanings were put on hold.

“During the shutdown, business at the office went down 95 percent. We were open two half-days a week and only seeing emergencies. If someone had pain, say from a broken tooth, or infection, we could work on them,” he said.

“During that time, I have never seen people so glad to go to the dentist,” Hutchinson noted.

Teeth Cleanings

South Kitsap Family Dentistry has six hygienists performing teeth cleanings. Teeth cleanings involve removing plaque and tarter. This procedure can result in a patient’s saliva being sprayed about the room. The invisible floating liquid particles create what is called aerosol.

As a result of aerosol concerns, hygienists wear N95-style masks and a full plastic face shield.

“I was pretty nervous,” admits dental hygienist Erica Dickinson about returning to work at the Port Orchard office following the shutdown. “We have never worn some of this PPE. That is new.”

Dickinson uses one N95 mask all day but covers it with a surgical mask. A new surgical mask is used for each patient.

Teeth cleaning appointments are a bit longer these days – 70 minutes verses the usual 60 minutes – largely due to the extra time needed to screen for COVID-19 and for hygienists to put on and take off PPE, Dickinson explained.

To reduce aerosol build up in the room, the office installed a new HVAC system and upgraded the air filters to remove particles in the air, she said.

“We are still learning how COVID lingers in the air,” Dickinson noted.

To limit aerosol distribution, Dickinson no longer uses a cavitron, a devise that sprays vibrating high-pressure water on teeth to break up hard deposits.

“We have been trying to only use a metal scaler (pointed scraper) on teeth,” Dickinson said.

The coronavirus era has forced Dickinson to grapple with some personal issues.

She is a cancer survivor with a compromised immune system and a husband and a 5-year-old daughter at home.

“Has all of this has raised personal concerns? Absolutely,” she said

“I’m grateful I work in an office where they do care about me as a person and work to get us proper supplies,” Dickinson said.

With the pandemic, the dentistry profession has had to face stricter sanitization protocols, but Hutchinson points out the profession has always been focused on protective practices.

“Anyone coming in the door can be the source of a communicable disease, such as hepatitis C, the herpes virus and now the coronavirus,” he said.

“We haven’t had to change that much with the current crisis because of the infection control procedures we have always had. As an industry we are pretty well equipped to deal with it.”

Hutchinson indicated there is a bright side to the coronavirus outbreak. It has helped raise the public’s awareness of germs and bacteria, he said.

“Most people did not think about these things because they could not see them,” the dentist said.

“The risks are out there – whether its COVID, colds or the flu. It’s good people now have a better awareness of these things.”