Dental practices are adapting how they work in and around a patient’s mouth to account for this complicated reality. Dentists are screening patients for symptoms, limiting the number of appointments in a day, implementing stringent sanitation protocols and wearing more protective equipment to guard against the respiratory disease.
The Centers for Disease Control and Prevention and the World Health Organization suggest that respiratory droplets expelled when an infected person coughs, sneezes, talks or breathes are the primary way the virus spreads. But the CDC reports there’s “no data available to assess the risk of SARS-CoV-2 transmission during dental practice.”
The Washington Post has been fielding thousands of reader questions about life during the coronavirus pandemic and many have asked whether they should go to upcoming dentist appointments. Dentists and public-health experts are concerned that Americans are putting off routine cleanings, which could compound health issues in the months or years to come.
“Dentistry is not an elective procedure,” said Purnima Kumar, a professor of periodontology at Ohio State University. “They’re important to your mouth health, as well as to the health of the rest of your body.”
In March, the CDC recommended that dentists conduct only emergency procedures for patients who’d otherwise end up in overworked emergency rooms. Since then, states across the country have largely lifted stay-at-home restrictions, businesses are starting to reopen and dentists are taking regular check-ins. The American Dental Association and the CDC are providing practical guidance on how practices should proceed with dental procedures while limiting face-to-face interactions.
Bill Miller, an epidemiologist and physician at OSU, said it’s important to remember that going to the dentist isn’t the same as going to a barber or hair salon.
“Dentists are accustomed to be thinking about infectious-disease risk,” Miller said. “They’re already taking precautions.”
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Talk to your practitioner, find out how appointments have changed.
Even before you walk through the door to see the dentist, you’ll notice some changes.
Dental offices are calling patients two or three days before their appointment to ask whether they’re experiencing any common covid-19 symptoms, such as a fever, cough or muscle aches.
Of course, a fever can also be a common symptom for an oral health issue like an abscess, a tooth infection caused by an untreated cavity. In those cases, Kumar said, patients will also notice swelling and acute pain in their mouth. Kumar said she would then prescribe an antibiotic to help the fever drop before having the patient come in for an appointment.
Anything that can be done over the phone or email, from payments to health questionnaires, should be done. Kumar said she has even been on FaceTime with patients to physically see what the problem may be.
“My phone’s constantly blowing up with text messages from patients,” Kumar said.
The ADA recommends that patients sit outside in their cars, rather than in waiting rooms, before any appointment. Dentists are asking patients to come to their appointments alone, if possible, to limit the number of people in the office.
Once inside, patients will need to wear a mask and have their temperature taken in a second series of health-screening steps. You may want to also bring your own pen, in case you have to sign any documents.
Bridgett Anderson, executive director of the Minnesota Board of Dentistry, said appointments will “take a little longer” than normal to keep patients and staff safe.
After an exam is done, the staff will disinfect the room and equipment. Some practices are buying air purifiers to place in the office. Charlie Doring, a dentist at a private practice in Rockville, Md., said he has gone from seeing eight to 10 patients a day to only five or six to provide enough time between appointments.
The more that dental offices can stagger schedules and reconfigure their spaces to ensure “there’s as few unmasked people in one space as possible,” the better, said Emily Sickbert-Bennett, the director of infection prevention at UNC Hospitals.
And if you’re not feeling well, Sickbert-Bennett said, you should cancel your appointment.
“You don’t want to put yourself in a situation where you’re around other people when you’re not feeling well,” Sickbert-Bennett said. “That, I think, cannot be stated enough.”
Cleaning your teeth will take longer.
The devices used in dental procedures often vibrate, spin and spray the spit from a patient’s mouth into tiny water droplets, or aerosols, that can stay in the air for a while.
A growing number of studies shows that the coronavirus can remain suspended in these aerosols. When possible, dental hygienists are switching to hand instruments that have a lower chance of creating these small clouds of droplets, said JoAnn Gurenlian, a professor in the department of dental hygiene at Idaho State University.
Dentists say they’re also depending more on suction devices that hook around your mouth to vacuum any potential aerosols at the source.
But there’s no avoiding the inherent risk of working next to the respiratory system, and the CDC recommends that dental workers wear an N95 mask, or another respirator, when conducting any “aerosol-generating procedures” on a patient.
“All of us are aware that when we came back to practice, we were not coming back to a covid-free world,” Kumar said. “So we’re trying to compensate and — maybe — a little bit overcompensate, too.”
There are findings published about covid-19 each week, Gurenlian said. It’s a new virus, and dental practices are operating cautiously to guard against any potential spread.
Dentists are donning new or disinfected personal protective equipment, or PPE, like face-shields, gloves, gowns and masks with each scheduled appointment. To date, there haven’t been any reports of covid-19 cases clustered in dental offices, according to the CDC.
“Whatever dentistry is doing today is based on an abundance of caution,” Kumar said.
Meanwhile, brush and floss your teeth
Now more than ever, dental health experts say people should be diligent about their personal health at home — whether it’s focusing on their diet, exercise or oral health.
“The health of your mouth is also impacting your heart, your lungs, your kidneys, your brain, everything,” Gurenlian said. “These are good, positive steps to fight any infection in our body.”
Take the time to properly brush and floss your teeth twice a day in case you have to push off an appointment for some reason. And, if there’s a day when your teeth feel funny or you can’t eat a scoop of ice cream because it’s too cold, contact your dentist, Kumar said. Be vigilant and ask questions.
“If you’re in doubt, when in doubt, just pick up the phone and call the dentist,” Kumar said. “Let the professional be the judge of: Do you need to come in right now or can you wait for longer?”
As the number of reported covid-19 cases rises and falls in different parts of the country, some communities are going to be at a higher risk than others. Dental health experts and epidemiologists say that people should monitor the number of cases from their public health department before scheduling an appointment with their dentist. What’s safe and when might depend on where you live.
“If you’re living in a county that has rapidly increasing cases over the last three weeks, you should behave differently than if you’re in a county where you’ve not seen any cases for a couple of months,” Miller said.