As Iowa’s dental offices began resuming elective procedures this week, dentists and their staff must meet a specific set of guidelines before they can see more patients.
But achieving these new protocols, as well as the additional steps practitioners are taking to stop the spread of the novel coronavirus, will take a large financial investment from dental offices — an amount posing an additional expense to those already grappling with the loss of patients because of the pandemic.
The Iowa Dental Board issued requirements for dentists to see nonemergent patients, allowed as of May 8 under a recent proclamation from Gov. Kim Reynolds to reopen parts of the state’s economy, that included personal protective equipment, or PPE, during all clinical visits and patient screening, among others.
The Iowa Dental Association estimates the majority of the state’s dentists have not ramped up patient visits, but instead spent the past week training staff on new protocols, building up their supply of necessary PPE and purchasing additional infection-control supplies and equipment.
In particular, finding additional PPE for all dental staff — including the face shields, gowns and gloves required by state officials — has been a challenge for dentists to meet given the ongoing pandemic.
Dr. Sara Stuefen, who owns a dental practice in Vinton, said N95 masks especially are expensive and “almost impossible to find” because of the strained supply chain across the country.
If the supply chain doesn’t ease, Stuefen fears her office may have to halt patient visits.
“I’ve definitely had some sleepless nights worrying about that,” she said. “Anxiety is pretty high worrying about PPE inventory, which is pretty strange because it’s something we’ve never had to worry about before.”
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Local dentists say Iowans’ next stop for a cleaning or a cavity fill will look much different from how it did before the pandemic.
Not only will patients be required to wear masks and be screened twice before their appointment, but many offices also are asking patients to wait in their cars until they can go into the exam room.
The Iowa Dental Board also stated in its guidelines for dentists transitioning back to practice that it requires offices to clean thoroughly between patients and for staff to practice frequent hand washing.
Because of this, there will be a slower tempo between patient visits to his Iowa City-based practice, said Dr. Bren O’Connor, who plans to resume normal operations by Tuesday.
“We’re staggering patients, so there’s not a lot of them in the waiting room,” he said.
Reopening their offices isn’t as easy as turning on the lights, said Laurie Traetow, executive director of the Iowa Dental Association.
Many dental offices are taking the extra step of adding new air-filtering machines and other engineering controls to help reduce the number of aerosols in the air. COVID-19 is spread through aerosols as fine liquid droplets in the air that are generated through dental procedures — meaning dental professionals in particular are at high risk for becoming infected by the virus.
These engineering controls cost somewhere between $20,000 to $30,000 to install, Traetow said. In addition, PPE costs approximately $24 for each patient visit.
And that’s on top of the fact that nearly 92 percent of dentists in Iowa were at less than 5 percent of their total patient volume on May 4 compared to a year ago, Iowa Dental Association data showed.
“You’re talking about shutting down the business altogether,” Traetow said.
Between additional staffing, PPE and installing air purifiers, “it cost an excess of $30,000” for Dr. Ryan Stuntz, the president of the Iowa Dental Association, to reopen his dental office in Farley, a town in Dubuque County. He intends to reopen Monday.
“These are things you can do to take a step further to improve your infection control, so most dentists are following this,” he said. “With so much of this being unknown, they want to err on the side of caution.”
As a result, Stuntz warned Iowans may see an increase in the cost of their dental care.
“The reality, as the costs go up, that’s something the patients should be aware of,” he said.
Unlike hospitals and many physicians’ clinics, most dental offices are independently owned by the dentists working in them, so they also handle the business side of the practice including hiring staff and purchasing equipment.
Dealing with the additional expense COVID-19 mitigation efforts pose may be particularly hard on new dentists, some officials say.
Stuefen, who serves on the American Dental Association’s New Dentists Committee, said it’s uncommon for dentists who are within 10 years of graduation to own their practice. However, she said many young dentists worry about the effect the pandemic may have on their career and their ability to pay back student loans.
On average, dentists graduate from dental school with around $280,000 in debt, Stuefen said. In some cases, she’s heard of as much as $500,000 in student loan debt.
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“And for dental students about to graduate, they worry about whether they’re going to be able to get a job,” she said.
Since mid-March, dental offices have been limited to performing dental services only in cases of emergency, which could include pain and facial swelling. As a result, dentists have had only a few cases a week since pandemic mitigation policies went into effect.
As practices began increasing their caseload this week, many dentists said they prioritized patients based on the urgency of their case.
“We’re at a point where we’re seeing more and more emergencies that could have been handled sooner and could have been prevented, which we couldn’t have done before,” Stuntz said.
“Before, the patient needed to be experiencing pain ... . Our goal is to get to that before that happens.”
Even a simple cavity, if left unattended too long, worsens until the patient needs a crown or even a root canal, Stuntz said. In a worst-case scenario, it could develop into a tooth abscess, caused by a bacterial infection, for something “that could have been solved with a $150 filling.”
“We don’t want that to be a model for how people get treated,” Stuntz said.
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