After nearly 30 years as a Charlotte-area pediatric dentist, focusing on children with severe heart defects and other complex conditions, Dr. Meg Lochary long ago accepted the extra risks that come with their care.
But she’s still trying to comprehend how, in the midst of a pandemic, she’s reduced to protecting her young patients and herself by wearing a painter’s face mask donated by a sympathetic neighbor.
The gold standard in her profession are N95 respirator masks, but those are so scarce that Lochary says she has enough to safely practice for only two more weeks. That raises the stakes for patients who often can’t wait for treatment.
Many of Lochary’s child patients can’t have medical procedures, such as cardiac catheterizations, until they first get dental care to avoid infecting their cardiac tissue with bacteria from their mouths.
Medically compromised children generally have higher risks of dental decay because of sugar-based medications they take several times a day, Lochary said. They often also have feeding issues that require that they eat more often or use calorie-boosting food that can be high in sugar.
Some of her patients can’t tolerate dental procedures in the office because nitrous oxide and dental anesthetics with epinephrine in them can’t be safely used. Lochary treats them under general anesthesia in an Atrium Health operating room.
Lochary also works with special-needs adults who pose high risks because they often live in group homes.
“I am on the front line of care for these children and special-needs adults. If I shut down, they will have nowhere to go,” she said this week. “I need help right now, but so do all of my dental colleagues. The dental industry is unable to practice within the current guidelines due to these severe shortages.”
Dentists and their staffs also face special risks with coronavirus raging. The compressed air that runs handpieces and air and water syringes turns everything in the mouth — including viral particles — into an airborne mist.
One of Lochary’s patients, John William Brakefield, 9, had his first heart surgery at 23 weeks, while his mom was still pregnant. Open-heart surgery followed days after his first birthday.
Because a bacterial infection in his mouth could quickly affect his severe heart disease, John, who lives in Rock Hill, S.C., has to have dental checkups every six months. If he develops an infection, like the abscessed tooth he had three years ago, treatment must be swift.
“There’s no waiting time for patients like John,” said his mother, Terisa Brakefield, who lives in Rock Hill, S.C. “It has to be done as soon as possible.”
Brakefield isn’t overly concerned about the coronavirus. But she’s quite worried about the prospect of Lochary running out of protective gear.
If Lochary can’t practice, she said, “we don’t have a place to go. It’s imperative that she be able to practice.”
The American Dental Association says it’s working on the PPE problem. As dental practices reopen under state-by-state orders, the ADA said in an April 22 article, “substantial inventory of personal protective equipment is currently diverted to medical operations on the front lines of the COVID-19 pandemic.”
The U.S. Department of Health and Human Services has designated hospitals, medical centers and first responders as essential categories for receiving personal protective equipment, the ADA said.
Dental supply distributors have estimated demand for some PPE to be at least ten times that of supply, the association reported, with masks, face shields and disposable gowns the hardest to find.
This month, the ADA urged the Centers for Disease Control and Prevention to “quickly provide guidance” on how to safely reopen dental practices as the outbreak stabilizes or declines in many areas.
Lochary’s group practice, which has offices in Matthews, Steele Creek and Wesley Chapel, includes four other dentists. It’s doing a slow reopening, with extra precautions, after three weeks of emergency-only care.
“I thought it would be three or four weeks,” time enough to find more protective equipment, she said. “Within two weeks, we had kids who were going to the ER if we didn’t see them.”
When dental suppliers couldn’t ship PPE, Lochary said her staff began spending hours a day on the phone, often ordering supplies only to find them back-ordered for two months or more.
A woman working in her office finally got 26 N95 masks through a woodworker friend of her dad. A neighbor contributed the painter’s mask Lochary is using this week.
“We’ve been mostly scouring garages, because that’s where a lot of them are hiding,” Lochary said.
The practice was able to buy 800 alternative masks, KN95s, which recently got federal approval for emergency use. Lochary said her practice will use those, along with secondary masks and face shields, once its supply of N95 masks runs out.
North Carolina dentists are using their professional judgment and following federal guidelines to minimize the potential risk of exposure, Dr. Alec Parker, executive director of the N.C. Dental Society, said by email. Some practices are asking patients to wait in their cars instead of indoors or screening for COVID-19 before admitting them.
“The good news (is) dentists are highly experienced in dealing with infection control and have been using PPE while treating patients for decades,” Parker said.
The society has bought N95 masks and face shields as a bridge supply for its members, and expects to receive them soon, he said, and Lochary hopes some will reach her practice. The society also expects a shipment soon of KN95 masks from the state emergency-management office and has deals with two health care apparel rental companies for the sanitary reuse of gowns.
Katie Webb, an 8-year-old patient of Lochary’s, was born with a cleft palate and a rare genetic disorder that affects her pituitary, the “master gland” that helps regulate the heart rate, thyroid, blood pressure and other functions. She was the 2016-17 Children’s Miracle Network Hospitals Champion Ambassador for North Carolina.
Because her daughter lacks the ability to generate a “fight-or-flight” response to acute stress, mom Leigh Ann Webb said, “We literally would have to triple her meds just to give her that fighting chance.”
Katie is scheduled for dental surgery in July, if the pandemic will allow it to be done safely.
“It’s really important for (dentists) to have that protective gear to be able to treat these kids safely. They’re so vulnerable,” Webb said. “They definitely don’t want to be exposed to things they don’t have to be.”