Pandemic Practice Strategies – Taking the Field without a Playbook

By Thomas Sklut, M.A.

There was no playbook when the COVID-19 pan-demic caused dental practices across the United States to close down. It was sudden, unexpected, and impossible to ignore.

We contacted a cross-section of alumni to see how the pandemic affected their planning and re-opening pro-cesses, and to see how things are going for them now.

Length of Closure and Initial Recovery
Our respondents’ practices were closed from 7 to 12 weeks. According to the American Dental Association (ADA) Health Policy Institute (HPI), nearly all dental practices across the country were closed in March and April 2020.

According to ADA and HPI statistics, 90% of practices were open by the week of June 1 but more than 70% of those reported lower patient volumes than usual.

“Our offices were closed from March 17 to May 11 to elective procedures and re-call visits, in compliance with the Centers for Disease Control and Prevention (CDC), ADA and Arizona State recommendations. We remained available for emergency care during the closure.” said David Ho, D.D.S. ’06, who runs a practice in Flagstaff, Ariz. with wife Amy Ho, ’05, R.D.H., ’05, B.S.

At the beginning of November 2020, (the most recent HPI data available) around 98% of practices were open. Our interviewees reported that they were at 70% to 120% of pre-pandemic levels. However, several mentioned difficulties with staffing. Mario Tomei, D.D.S., ’92, Livonia, Mich., mentioned that “practice productivity had recovered nicely but hygiene is slowing down because six-month recalls from May don’t exist.”

Greatest Challenges to Reopening
Many responded with the same challenges to reopening. The greatest challenges to reopening were recruiting qualified staff, obtaining adequate and appropriate PPE, staff training and finding the best evidence-based practice and patient communications.

Several practices enhanced communication with their patients by using online platforms, including new software designed to confirm appointments via voice and text messaging.

“Communication with our patients was considered paramount in our practice. Thankfully, we invested in systems pre-pandemic – website, blog and social media accounts functioned as intended – to keep our patients in the loop. Website/blog metrics were helpful in providing information to verify the effectiveness of this type of communication. We also implemented an after-hours “live operator” concierge system, giving our current and prospective patients the opportunity to be in contact with a responsive human,” said William Hustzi, D.D.S. ’92, who runs a practice in Milford, Mich, with wife, Anna Chong-Huszti, D.D.S. ’92 .

Physical Changes
Early in the history of the virus, it was difficult to determine which factors were most likely to cause transmission of COVID-19. As time went on, it became clear that the virus is mainly spread person-to-person through respiratory droplets produced when an infected person coughs or sneezes. This discovery triggered many of the physical changes brought about in dental practices.

When asked about physical changes made in their facilities, the most common included requiring face masks, the installation of HEPA-quality air purifiers and clear plastic barriers. Also mentioned were lim-iting the number of patients allowed in the waiting area, extended patient appointment times, temper-ature checks and frequent cleaning of operatories and high-touch surfaces.

One practice required patients to rinse their mouths with hydrogen peroxide and wash hands prior to treatment.

Malik Hider, D.D.S. ’04, Garden City, Mich., used the time of the shutdown to enhance and recon-figure his facilities in another way altogether: “I used the time to add six operatories to my practice and separate the dental treatment side from the dental hygiene side. Now there are six treatment areas for each.”

Huszti and Chong-Huszti challenged themselves to improve the effectiveness of teledentistry within their practice. They also produced videos that could be helpful to their patients (check out the Huszti Dental Care channel on YouTube).

Taking Care of the CareGiver
A feeling of anxiety was common among those interviewed. Ruchika Khetarpal, D.D.S., ’07, Cincinnati, Ohio, said “being the dentist, practice cheerleader, and financial supporter of the whole organization is a daily challenge. But during this time, it was especially difficult to keep a positive attitude with so many unknowns. I wanted to make sure that my team felt safe coming back. I run a transparent organization with my team and show vulnerability at times, but, during this period, I had to keep my emotions secondary and think about how we were going to safely move forward and keep our livelihoods intact.”

How Will the Now Affect the Future?
In 1989, there was no playbook when the dental world was affected by the unknowns of HIV and Hepatitis C. Some were shocked and dismayed at the directive to enact “universal precautions,” now called “standard precautions,” including face masks and gloves. Today, it is very difficult to imagine a time when dental procedures were performed with-out the protection of masks and gloves.

In 2019, the world was assaulted by the unknowns represented by COVID-19. In the short-run, dental professionals have made significant adjustments to our practice of dentistry. Only time will tell which of these adjustments will become the “standard precautions” of the future.

Afterward

Clinical Associate Professor Sanjay Chand, M.D., outlined many ways for oral healthcare professionals to deal with various emotional stresses within their practices.

“Dentistry is a highly detail-oriented profession where the provider seeks perfection.

A pandemic such as COVID-19 brings additional stress to the practice in multiple ways. Not only is there a constant worry about transmission from patients to healthcare providers but there is also the concern about providers bringing the virus home to their families and loved ones. This combination can become a dangerous recipe for mental health issues.

Healthcare professionals should consider taking small breaks, a walk perhaps. They should be sure to involve themselves in non-dental activities, outside of and away from their practice. And take time to associate with like-minded individuals with whom they can share positive experiences.”