‘No social distancing in dentistry’: How care has changed during coronavirus

Like many Canadians, Natalie Archer has been adjusting to her new life in the time of coronavirus.

For someone who has spent years sitting side-by-side with patients, whether to clean someone’s teeth or yank them out, new distancing protocols amid the pandemic have been particularly difficult.

“I think dentists, in general, feel helpless and frustrated,” Archer said.

“We are health professionals too. We’re extremely educated. We’re willing to help but, in a lot of ways, our hands are tied right now.”

Provinces and local governments have imposed increasingly tight controls to try and curtail the spread of COVID-19 and ultimately encourage as many people as possible to stay home. Quebec and Ontario, for example, have ordered all non-essential businesses to close, but it’s slightly different in each jurisdiction.

Those deemed essential are somewhat obvious — health-care workers, first responders, suppliers of critical goods like food and medicine, and utility workers.

Where does that leave dentists?

Ontario, Quebec and British Columbia have ordered a pause on “non-essential” dental services like teeth cleaning and cosmetic procedures. Only emergency care, like facial trauma or pain that can’t be managed with antibiotics or over-the-counter medications, can be performed. Dentists in other provinces, like Manitoba, have taken it upon themselves to do the same.

Even then, there are risks.

“We have to set a high bar for emergencies in dentistry because it’s such high risk. We’re one of the most at risk in this,” said Archer.

“We’re still learning about the virus, but we definitely know it’s spread through things like mucus and saliva. These are things that dentists are intimately connected with… There’s no social distancing when it comes to treating patients in dentistry.”

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The respiratory virus is spread mainly from person-to-person, either by close contact or “respiratory droplets.” So when an infected person coughs or sneezes, if the resulting droplets end up in the mouths or noses of people nearby, either by inhalation or contact, those people can become infected.

In health care, increased risk comes with increased protocols. In Ontario, for example, the Royal College of Dental Surgeons (RCDSO) has clamped down on what constitutes an emergency dental situation and has issued directives on screening procedures as well as which tools to use when.

But infection control in dentistry was already air-tight, according to Dr. Chris Swayze, the director of the University of Toronto’s continuing dental education program.

“The standards for dentistry are incredibly high. Personally, I think in healthcare, it’s one of the highest.”

It doesn’t negate the fact that close contact is usually needed to do the job, he said, but with health-care systems at risk of being overloaded with virus patients, dentists realize the need to keep their patients out of emergency rooms, too.

Between 2017 and 2018 there were over 93,000 dental visits at the University of Toronto’s Faculty of Dentistry, which allow students to treat patients. Of those, 4,000 were considered emergency dental visits, said Swayze.

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“It’s a large number of people that need these things in a year,” he said.

“The primary thing is to keep people safe and healthy but you also really have to keep them out of hospitals unless they absolutely need to be there — the system’s already facing a burden.”

Archer, who typically juggles three practices in Toronto, now only has one office in operation. Most of the service being provided right now is done digitally.

Patients can set up phone-call screening and counseling or FaceTime a dentist for certain inquiries. Part of this abides by the RCDSO’s new required safety practices, but part of it is to provide some level of comfort to those at home who need advice, said Archer.

“I think it makes patients realize what is a real emergency right now,” she said. “As a dentist, we have to assume that everybody we come into contact with has COVID-19. So that’s the level of care we take when we decide what’s an emergency.”

Digital screening is likely going to scale up across the country as the pandemic drags on, said Aaron Burry of the Canadian Dental Association (CDA), who is heading the organization’s work on COVID-19.

“It does exist and we are using it, it’s primarily been used for areas in the north where you’re trying to have discussions with patients before they have to travel,” he said.

“That’s one of the key advantages, especially now as we’re respecting requirements around social distancing.”

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For Archer, there’s been an unfortunate trade-off in that aspect.

Along with reconfiguring how to care for patients, she’s also been forced to lay off staff.

The shock of these changes is still fresh, she said, but dentists are still here to help if needed.

She was quick to point out a silver lining, though as she acknowledged, it might not be one everyone will like to hear.

“There’s a very good chance that you’re not going to get into a dental office for a check-up for quite some time, so this is the best opportunity to take care of ourselves from a preventative side,” she said.

“People always tell me they don’t have time to floss. Guess what? You’ve got time. You’ve got more time than you know what to do with. Now’s the time to floss.”

–With files from The Canadian Press