How COVID-19 will change North Carolina dental practices

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Your next dental appointment will look and feel very different. That’s if you even choose to schedule a dentist appointment.

The novel coronavirus pandemic has changed everything about daily life. But the nature of dentistry — probing in people’s mouths, the high volume of patients seen daily, the potential for spreading germs through the air and on surfaces — has impacted that industry to an extent that a routine cleaning and exam night never be the same again, according to the head of North Carolina’s dental society.

While dentistry was considered an essential business under N.C. Gov. Roy Cooper’s stay-at-home order, complications including the unprecedented demand for masks, face shields and gowns caused most dentists to cut services or close temporarily.

Figuring out how dentistry will look in the new normal worries some in the profession.

“We’re driving down a dark road and we don’t have any headlights,” said Dr. Alec Parker, executive director of the Cary-based North Carolina Dental Society . “That’s where we are right now.”

For instance, Charlotte dentist Haydn Jones said no one gets to sit in his waiting room anymore. Patients wait in their cars until they are called in.

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Charlotte dentist Dr. Haydn Jones says dentist appointments will be very different going forward due to COVID-19 precautions. Among other precautions, Jones is upgrading an air-filtration system in his procedure rooms and eliminating the ultrasonic method of teeth-cleaning, going back to hand-scaling. Photo courtesy Dr. Haydn Jones

He described some procedures more common to a hospital admission.

“We get (them) on the porch, take their temperature, ask them questions about who they’ve come in contact with,” Jones described. “We have them wear masks inside the building.”

‘Anybody’s guinea pig’

As Cooper’s stay-at-home order is phased out, there is a pent-up demand for all sorts of elective medical procedures.

But Parker, who was a dentist in the Asheville area for 28 years, believes a segment of Americans will delay that twice-a-year teeth cleaning and exam out of fear that could increase their chance of contracting COVID-19, the disease caused by the new coronavirus.

“We don’t know how many people are going to say, ‘I’m 2 1/2 months overdue, nothing is really bothering me, I think I’m going to let this settle down for a while before I go out there. I don’t want to be anybody’s guinea pig,’ ” Parker said.

Not all dentists anticipate widespread inhibition. Chris Martin, one of nine dentists at Raleigh-based Village Dentistry, says that practice stayed open for emergencies and will resume teeth-cleanings starting Friday. Their appointment schedule is already packed.

“Now we’re so busy you can’t get in. Fifteen (procedure) rooms all full,” Martin said. “We’re slammed.”

He said people shouldn’t fear COVID-19 to the extent they disregard other health risks. Martin cited a patient who put off having a cavity examined for four weeks. Now the problem has progressed to a point that patient will require a root canal and crown.

“I think we’re going to find a lot of people who didn’t seek care, who should have, out of concern over COVID,” Martin said. “That’s collateral damage.”

Martin has practiced since 1998. He said dentists understand guarding against disease after decades of HIV and hepatitis risks in treating patients.

He figures he has injected countless patients with needles without cross-injecting himself with a serious disease. Protective gear and precaution are nothing new.

“We put alcohol on our hands all day long,” long before the COVID threat, said Martin, whose practice uses misters to sanitize rooms between patient visits.

Village Dentistry overcame a hand-sanitizer shortage by partnering with Durham’s Mystic Farm and Distillery to produce it in volume.

New procedures, schedule

Parker projects dentists will inevitably have to schedule fewer patients each day to practice all the new safety and social-distancing procedures.

Dentists now review everything about their work environments. Jones is changing filtration systems so that each procedure room in his building gets a fresh air supply in 20-minute cycles.

Ultrasonic teeth cleaning, which uses an aerosol of water, will be replaced by the hand-scaling that was standard 30 years ago, he said. That’s to limit splattering of potential infection.

Dentists and dental hygienists always used various personal protective equipment. Now, they need more of it, replaced more frequently, at a time when the demand for masks, gowns and shields has skyrocketed.

N95 surgical masks, with a high degree of protection from airborne particles, are so scarce that Parker said they have risen in price by up to eight times what they were in January.

“It cost maybe 75 cents to a dollar in January of this year. They’re $8 to $9 (now), even in quantity. And it’s hard to even find them,” Parker said.

He spoke of a wholesale shipment he was called about recently.

Parker said the seller controlled a million N95 masks, and offered 300,000 of them for $500,000. But Parker said he had no way of quickly assembling that kind of money on behalf of the state’s dentists.

Buying power

Parker believes all this change in the dental industry likely favors the large, multi-dentist practices, if simply for their buying power for PPE.

He worries that some small, single-dentist practices could struggle to stay open between lost business, higher equipment costs and slowed patient schedules.

He says rising costs will inevitably be passed on to patients.

“Dental fees will have to go up to cover the additional cost,” Parker said. “It remains to be seen what (dental insurers) will do.”

Regardless of cost, all dentist visits will change, perhaps permanently, as a result of the pandemic.

“It’s going to be a lot more like going to the hospital,” Parker said. “Basically, we’ve been told it’s OK to go back to work — you’re going to see dentists opening back up — but it’s going to be totally different.”

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Rick Bonnell is a sportswriter/columnist for the Charlotte Observer. He has been in Charlotte since 1988, when the NBA arrived, and has covered the Hornets continuously. A former president of the Pro Basketball Writers Association, Bonnell also writes occasionally on the NFL and college sports.
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