We’ve reached an inflection point with the COVID19 crisis … when and how do we end the quarantine period and get back to work. We still don’t have all the medical answers, and a vaccine will be many months before it would be ready.

The dental profession is caught up in the controversy … to open or not to open …. That is the question! 

If we were only concerned about our personal health, we would lock our doors and just stay home. But that really isn’t the case is it? We have sworn an oath to serve the oral health needs of the public. So how do we reconcile our dilemma, and move forward?

What we must do during such an uncertain period is to step back and understand / weigh the competing risks, then forge a path forward.  Seems to me there are three “health risks” we must assess and balance:

 1. Dental Health of our patients and the community we serve (our oath as providers)  

 2. Team Health (our oath to each other)

 3. Office Health (source of our jobs)

You can think of these things like the heart, brain, and lungs of our professional life.  When all 3 are healthy and in alignment, life is good.  When one is suffering, the whole body suffers.  If one dies, they all die.  And this is the part we need to remember, it does not matter how healthy you keep two of the parts if you let one part die, all 3 die.

So, let’s suspend a focus on either the hygienist or the dentist, and instead look at each part of the overall system we are all part of.

The Health of The Patient

We took an oath as dental professionals to take care of the oral health of our patients.  Dentists generally treat the teeth, and hygienists are specialists in the periodontal health.  We are both a part of the system to care for the patient.  Are we not failing our patients right now? 

Yes, many dentists are still taking care of emergencies, but dental disease just gets exponentially worse. Insidious germs in the mouth take hold and build toward more significant problems.  

With hygiene, especially perio, there are two possibilities:

A)      Perio treatments can wait months, and therefore have as minimal importance as we fear patients believe, or conversely

B)      We realize treatment of periodontal disease is highly important to preserving the overall health of the patient, and dentistry cannot keep waiting

What about the oral-medical connection with diabetes, heart disease, Alzheimer’s, cancer, etc.?   Head/neck cancer is not being diagnosed.

Can we really stop caring for our patients any longer?  Can we really let oral health issues cause more infections and a weakened immune system?  Are we not the “first responders” for the mouth?

The Health of the Team

This is the concern of many of the hygienists and other team members.  Obviously, we all want to be safe.  Let’s think about a few points:  

1)       Don’t we already have the highest infection control standards outside of a hospital OR?

2)       Because of our already high standards, OSHA/CDC have not yet seen the need to increase their standards for dentistry. 

3)       We have been exposed to other respiratory viruses with the same exact transmission pathway as COVID-19 for a century.  Have dental offices ever been known to become hot spots for other viruses?

No one in the office wants to get sick.  However, this virus is not going anywhere.  Vaccines are a year away.  Experts all expect a majority of the population to get infected regardless of what we do.  Flattening the curve is about slowing down the spread, it was never about elimination of the virus.

Aren’t we safer in our own offices, with the incredible level of infection control, than we are at Walmart?  Or the open nail/hair salons?  Or the restaurant where we pick up our food?

Health of the Office

Finally, we need to remember the third component, the entity that provides us all a place to work and earn a living.  This part is currently on life support. 

This recent quarantine period has severely impacted most dental offices. Revenue has all but dried up. It takes a sufficient number of patients to generate sufficient income to pay for the many fixed expenses that a small business generates. While payroll costs are certainly less, the expenses for building leases, utilities, bank loans, insurance, maintenance and other bills have not stopped. The longer the period where a small business is not generating income, the closer it can come to defaulting, and for some, heading toward bankruptcy. It is not healthy to the community when small businesses go “out of business” and employees lose jobs.

The longer mandatory closures remain in place, the more likely this part will die, taking down everything with it. 

We also have to realize that in times of recession like we are in, demand for dentistry is going to be down.  When we do open again, revenue collections for the office are going to be down.

In order to preserve the business part of our system, many owners face hard choices in the short run such as reducing less critical services, cutting team members, or lowering team compensation or bonuses.  No member of the team is irreplaceable.  Some dentists are exploring models for offices without hygienists at all (Comfort Dental) due to costs or hygienists that don’t want to return.  Most dentists love their hygienists, but there are compromises that need to be considered in times of struggle. 

We need to make sure we are working together and coming up with solutions that work for the total system, even though that may require sacrifice from individual parts.

Balance the Risk

Given the inter-relationship among all three parts, we must balance out the risks to allow each part to survive.  There is no perfect answer.  Staying closed for months is not an option.  In order for the whole to survive, we need to make some difficult choices with the understanding that compromises have to be made.

We must appreciate the team we have, which means communicating with them regularly.  We need the voice of both dentists and hygienists. 

Dentists need to realize that many of our hygienists are distressed and fearful from all the news, much of which is overly dramatic.  They need to hear your voice, reaching out with more calm, logical information. 

Hygienists need to realize that many dentists are not good at starting difficult conversations.  This is an opportunity for you to work WITH your dentist to get team fears out on the table and come up with ideas and solutions.  Both sides should reach out and communicate with each other.

During that communication, we should be planning ahead what we can do to be as safe as possible when we reopen.  Maybe add some inexpensive safety protocols such as screening patients, keeping patients out of the waiting rooms, having air purifiers, etc.  Maybe we modify our procedures like going back towards hand scaling instead of ultrasonics.  Each office is going to find a unique plan that works for them, but the only plan that works involves the team input.

Some team members are still going to be uncomfortable going back to work.  This is okay, as long as you communicate with the team and realize that the health of all three parts of the equation need to be maintained.  The office still needs to function and see patients.  Delaying opening is not an option anymore.

Some team members may realize that this virus is not going away for an extended period and dentistry may no longer be the career path for them, this is okay too.  With the potential short-term decline in demand for dentistry and the overall recession, jobs are likely to be scarcer for a time anyway. 

What I suggest for everyone is:

Do not join the chorus of naysayers.  We need to advocate responsibly for our patients and our profession as a whole. 

Spend your social media time to reaching out to patients, be a voice of compassion and reason, because right now most are only getting fear.  Solidify those patient relationships.

Focus on reading/watching content that is positive and uplifting, instead of media and political negativity.

THIS is the time that we should be coming together as a team, communicating, working on solutions.  Find positive ways to help and maintain a balance in all three parts of our life!