Digital screenings, PPE and no waiting rooms — how COVID-19 is changing dentistry

Dentistry clinics, like many businesses, shut down operations in mid-March when the coronavirus pandemic took hold of Canada.

Two months later, they are wrestling with how to reopen and stay safe — Natalie Archer included.

“It’s going to be a gamechanger for dentistry,” said the Toronto-based dentist. “Everything is going to be slow. A slow, steady, deliberate approach.”

Being health-care professionals, the move to shut down clinics concerned some dentists. Many continued to perform emergency procedures, but the vast majority of services were halted.

“There’s no social distancing in dentistry,” Archer said, especially when the virus spreads easily from mouths and noses.

But with reopening somewhere on the horizon in Ontario, accessing the safety equipment needed is the newest challenge.

The shortage of personal protective equipment (PPE) has been a battle in Canada. It forced health-care workers to ration equipment, resanitize items for reuse and, in some cases, depend on homemade items.

When the fight first ramped up, dentists were some of the first to donate their stock of PPE to those on the front line, Archer said. Now, as reopening plans gradually unfold, dentists are facing a shortage of their own.

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“So many dentists gave a lot, if not all, of their stuff. Now, we can’t replenish them. And if we can, we’re paying huge, enormous fees. Not only that, now there’s a risk of it being defective.”

Pre-pandemic, Archer served more than 7,000 patients across three clinics in Toronto. She wants to open back up, but safely, so she took the PPE issue into her own hands.

In partnership with Myant, a Toronto-based textile computing company, Archer has come up with an anti-viral mask that is custom-fitted for the type of protection dentists require. It’s also sustainable, she said, so “nothing goes in the garbage.”

“You can imagine if you’re seeing someone for a five-minute visit, that mask is going in the trash after,” she said.

The masks use copper and silver yarn fabric, which have known antiviral properties. They will be reusable and washable, while also providing comfort and practicality for dental professionals, said Ilaria Varoli, Myant’s executive vice-president.

The technology behind the fabric is something Myant had already been perfecting. The company began making medical-grade masks using the fabric when the pandemic took hold and it is currently in a testing stage. The one being designed for Archer is iterating on that version.

“As COVID-19 ramped up, we started making better and better masks,” said Varoli. “It was Natalie who said, ‘What about us?’ The dentistry world is a huge risk right now. The design will have her input as a dentist, what she needs to operate freely, and give protection to patients and staff.”

Archer and Varoli hope the masks will be ready for use by early July. Until then, there are still major changes to office visits and protocol that her clinics — and others across Canada — will have to undergo.

In New Brunswick, one of the first provinces to relax lockdown restrictions, dental offices have reopened. In Calgary, dentists began providing urgent care, in addition to emergency care, as of May 4. British Columbia‘s dental services are allowed to restart on May 19. There’s still no clear timeline on when services will resume in other provinces, Ontario included.

The practices that have reopened in Canada have done so at reduced capacity, with one clinic in New Brunswick asking patients to wait in their cars until it’s time for their appointment.

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“The notion of sitting in the waiting room these days is largely done,” said Dr. Aaron Burry of the Canadian Dental Association, who is heading the organization’s work on COVID-19.

“To maintain social distancing, dentists are having to rethink what things look like. It’s a reduction. Some have removed chairs from their waiting rooms. It’s changed how we think about how staff and patients flow through an office.”

Many dentists have already cut back on in-person procedures by doing pre-screenings on the phone, he said. Teledentistry has held up a considerable amount of dental care during this pandemic so far and it will likely continue.

“Patient safety now includes more than just a visit to the dentist. It’s everything that happens from the time the patient leaves their home to the time they arrive in your office to when they go home,” he said. “Having that kind of pre-planning and discussions is going to be a larger part of dentistry now than it was previously.”

Part of the retrofitting of clinics and visits will depend on individual offices, Burry added.

Archer is lucky her offices are designed where patients can come in through one door and leave out of another. Otherwise, the doors stay locked until it’s time for a patient to come in.

She’s convinced she’ll be able to find an alternative for a front-desk attendant, to eliminate person-to-person contact for employees and patients. Aerosol procedures — classified as very high-risk during the respiratory illness outbreak — will be reduced, when possible.

She also expects she’ll have to expand her hours to seven days a week just to catch up on months of uncleaned and unchecked teeth. The quintessential magazine stack in dental offices is a thing of the past, she added.

“We’re going to be seeing fewer people in small spaces,” Archer said. “It’s not going to look the same. It will be very different.”

For Archer, one thing is for sure. The dental industry will have a new reliance on digital technology to keep up heightened safety standards that, she believes, will become the new norm for years to come.

A “virtual assistant” on her clinic’s website has played a starring role in her practice during the pandemic.

“Teledentistry is here to stay,” she said.