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Dental practices begin process of reopening

  • Children's Dentistry of Dublin opened its doors this week to provide care for patients from age all the way up through high school. Staff photo by Tim Goodwin

  • Raynor Dental in Peterborough, which hosts a free dental day every year (above) reopened on Monday. Courtesy photo

Monadnock Ledger-Transcript
Published: 5/18/2020 4:51:52 PM

Dental practices around the region voluntarily closed down in mid-March for all treatments except in the case of emergency situations.

On May 8, Gov. Chris Sununu announced that dentist offices may resume operations for elective/non-emergent and orthodontic procedures as early as last Monday given they follow a list of guidelines and protocols outlined in Emergency Order 40.

But local practices are taking different approaches to reopen for regular business, waiting for everything to be in order before resuming for appointments.

Protocols

Sununu said dental providers may add elective/non-emergent and orthodontic procedures for patients when practices are able to fully comply with ADA interim guidance and align with OSHA guidance on Personal Protective Equipment while there is ongoing community transmission of COVID-19.

According to the American Dental Association, standard precautions include: hand hygiene, use of PPE, respiratory hygiene/etiquette, sharps safety, safe injection practices, sterile instruments and devices, clean and disinfected environmental surfaces. The ADA’s Interim Guidance for Minimizing Risk of COVID-19 Transmission includes “Wear a surgical mask and eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures likely to generate splashing or spattering (large droplets) of blood or other body fluids.”

Staff shall be provided training on the use of PPE and regular updates and training for employees about personal COVID-19 mitigation and practice safeguards based on ADA, CDC and OSHA guidelines, along with screening of staff prior to each shift. On May 12, the CDC said, “It is unknown at this time how COVID-19 may permanently change infection control practices in dental health care settings, but CDC continually assesses emerging scientific evidence for developing policies, guidelines, and recommendations. CDC is working to update its COVID-19 guidance for dental settings in preparation for resuming care. This is a rapidly evolving situation and CDC will release updates as information becomes available.”

Reopening

Raynor Dental owners Jay and Stephanie Raynor said on Sunday the Peterborough and Keene offices would be open on Monday, May 18.

Jay Raynor said the practices have spent the time since closing down to non-emergencies to develop a reopening plan, secure Personal Protective Equipment and last week brought all employees back to train on the protocols that have been put in place. The plan developed by Stephanie matched up with recent guidelines put out by the American Dental Association.

“It confirmed we are doing the right thing,” Jay said.

Zane Broome, owner of Monadnock Dental Associates in Jaffrey, said he plans to reopen sometime after Memorial Day and will release a video on Facebook when a date has been determined. Even though Sununu said offices could open on May 11, Broome said there wasn’t enough lead time for that to realistically happen, considering all the necessary steps that must be taken prior to opening.

Broome has been available for emergency situations and has seen patients in the office since closing for regular appointments, but “luckily there wasn’t a lot of true dental emergencies.”

John Collins, office manager of Children’s Dentistry of Dublin, said last week the practice would reopen on May 18 and there have slowly been appointments put on the schedule. Collins said they have seen a few emergencies and a few other patients from practices that completely shut down.

“We’re really hoping we can ramp it up,” Collins said. “We have the ability, we have the equipment, but at the same time we’re being really conservative.”

By no means is he pushing for a full schedule right off the bat – for obvious reasons.

“I don’t want to be ground zero for the next coronavirus uptick,” Collins said.

Jennifer Charland, owner of Signature Smiles Dental in Rindge, said she hopes to reopen in early June, but a firm date has not yet been established. Through her closure, Charland said she has seen about three emergency patients in the office per week, about half of the patients who have called.

Concerns

Every office said there is concern on the part of staff members, which is why they are going above and beyond to ensure everyone can feel as safe as possible.

“You have people on both ends of the spectrum,” Broome said.

Charland echoed that statement.

“I have staff members who are concerned,” she said. “But they know I’m doing everything I possibly can.”

Jay Raynor said every employee has a different comfort level about coming back.

“You have people who have some fear of coming back to the office,” he said.

PPE

Collins said the biggest hurdle has been securing the proper PPE to keep the practice’s patients and staff safe.

“It’s a matter of making a boat load of phone calls,” Collins said. “Because we’re all trying to get supplies from an extremely limited source.” Collins said they did secure some PPE from the state.

“You don’t get a lot, but you get something,” he said, but added they have secured a second round of PPE from the state and is hoping to get a little more this time.

Broome said he donated a lot of his PPE to the Jaffrey/Rindge Ambulance, and the Jaffrey Police and Jaffrey Fire departments and is now waiting for the last of his shipments of the required equipment to arrive at his office.

He said he is going above and beyond what he is requiring of his employees, and all will be required to wear N-95 masks, face shields and gowns. He has also invested in surgically clean air purifiers for each of his nine treatment rooms, as well as the front desk area, that will dramatically help clean the air throughout the day.

“I want to make sure patients are safe, my team is safe,” Broome said. “We want all our patients to be 100 percent safe when they come into our office.”

But securing the necessary protective equipment has been much harder than he anticipated.

Stephanie Raynor said she anticipated the need for PPE and began working almost immediately when the office closed to secure the necessary equipment to reopen.

“It’s been tough because a lot of the suppliers we use are rationing supplies,” she said.

Raynor Dental has received donations from local organizations and vendors, while also taking advantage of the state program for PPE. Occupational health officials from Cheshire Medical and Monadnock Community Hospital helped train staff in the proper use of PPE.

Charland said she has gloves and faceshields made by the makerspace in Nashua, but is in need of N95 masks and gowns. She applied for PPE through the state and was given a pickup date of May 20, but is unsure of what it will include. She has also been trying to secure the equipment through her distributors, but it has been challenging. She also invested in the surgically clean air purifiers.

“I will not open until I have everything,” Charland said. “Some of the things I’m getting are not required, but are recommended. I want to protect my staff, my community and myself.”

Training

Broome said that once all the necessary PPE is in place, there will be a few dedicated days to training his staff in the procedures that will be put in place.

“Just to make sure everyone is comfortable with the new protocols,” he said.

Charland said she will have her staff come in for a week of training and what that might look like is still being worked out. She will set up a mock treatment room so staff can practice and get comfortable with the new normal.

“So my staff can see what it’s like to be a patient,” she said. “It’s going to be a lot of trial and error to figure it out.”

Safety is of the utmost concern.

“I don’t want my office to be the source for an outbreak,” Charland said.

Patients

Broome said that patients cars will be the practice’s new waiting room and have eliminated the use of the area, getting rid of magazines and children’s toys.

Patients will be required to wear a mask when they enter and leave the building and will be escorted directly to the treatment room. There will be a pre-screening questionnaire to determine if a patient has been sick or showing possible symptoms of coronavirus and temperatures will be taken prior to entering the building.

Charland said there’s a good chance they won’t be able to see as many patients in a day that they would have before.

She said that patient arrivals will be staggered, temperatures will be taken and anyone coming in the building will be required to wear a mask. Charland said she likes to think her patients and staff will be as safe as possible when in the office, but “there’s always going to be a risk.”

Collins said they are fully prepared to see patients, but “if you’re not comfortable, I don’t want people to come in.”

Jay Raynor said they are adding time to all appointments where possible to avoid too many patients from being in the office at the same time.

“Every appointment is a little different,” he said. “But we are really spacing people out.”

Raynor said during confirmation calls, patients will go through a screening process and are required to take their temperature prior to leaving home. When checking in from their car, patients will be asked the same series of questions again and have their temperature taken upon arrival. Patients are also required to wear a face covering when going into the office.

“We are going to ask for patience from our patients,” he said.

Cancellations

With almost two months of appointment postponements, Broome said it will take some time to catch up.

His staff has created a triage list of patients that need to be seen first and expects it to take a month or two to cross all those names off the cancellation list.

“Just like eating an elephant, one bite at a time,” Broome said.

Since closing down operations, Broome has been in contact with patients to provide updates and check in.

Charland said a full catchup from cancellations might extend into next year, as she was already booking into October for herself and the hygienists had appointments going into the summer.

She said the practice averages about 25 patients per day, but it will be difficult to see those kinds of numbers with all the new protocols in place.

Jay Raynor said “it could be anywhere from three week to three months” before they catch up with all the cancellations. The plan is to start slow, but as everyone gets comfortable with the use of PPE, the discussions have been centered around extended hours and weekend appointment times.

Changes

In Sununu’s emergency order, it recommended that practices refrain from the resumption of elective cosmetic procedures or the use of ultrasonic scaling. Broome said not using the ultrasonic equipment for teeth cleaning is “like going back to the 90s.”

“You can still get a really good cleaning,” Jay Raynor said without the use of ultrasonic.

Broome said he has spent close to $70,000 in upgrades to be able to reopen. So included in the cost of a visit will be to institute an out of pocket PPE fee in the range of $20 per visit. He said he did that instead of raising fees for services and hopes that the new fee won’t last too long, but the cost of operation has increased exponentially.

“We pretty much exhausted all of our financial resources,” Broome said. “And that might not even cover everything.”

Broome said he furloughed all his employees early on because he didn’t know how long the office would be shut down and wanted them to be able to collect unemployment. He did receive a Payroll Protection Program loan, but won’t be able to use it as intended to maintain staff.

“Unfortunately it’s a loan I’m going to have to pay back,” he said.

Collins said he believes the future of dentistry will look different after all the changes being made to deal with the pandemic.

Charland said in order to reopen, “we have to create a new normal for ourselves.”

Jay Raynor said he’s confident they can treat patients very safely. Stephanie added that the longer they stay closed the more problems that could arise with not seeing patients.

“We took an oath to take care of our patients,” she said.


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