All kinds of elective medical procedures are currently on hold as a result of the pandemic. And that’s a hardship for hundreds of thousands of dentist in the country — as well as for many of their patients in need of care.
Dr. Jeffrey Lowenstein, who runs small orthodontic practices in Wellesley and Framingham, said that when he first heard about the virus, he thought the steps dentists routinely take to prevent the spread of infection should be enough.
“And then, as we did more and more of the research, we found that this coronavirus was unlike any other virus we have ever come into contact with,” Lowenstein said.
In particular, dentists’ drills, called handpieces, can actually aerosolize the virus, making it easy to inhale.
“So [with] the combination of the handpiece and the high-speed evacuation system, we’re able to remove most of the aerosol,” he said. “We're just not able to remove all of the aerosol.”
And that puts everyone in the dentist’s office at risk. So in mid March, the American Dental Association made a recommendation to its members.
“We were one of the first health care associations to publicly request that all of our dentists only practice emergency dentistry or urgent care dentistry and to postpone all elective procedures,” said Dr. Kathleen O’Loughlin, the group's executive director.
Nationally, O'Loughlin said, about 80 percent of dental care is performed in small, private practices. Most of those offices have now shut down and laid off staff.
Winchester dentist Dr. Janis Moriarty said they surveyed their members on the financial impact of all this.
“People were reporting that they were going to need anywhere from $150,000 to $300,000 just to get to the other side of this and be able to reopen,” said Moriarty, who is also the head of the Massachusetts Dental Society.
The shutdown has been a real burden for pediatric dentist Dr. Lindi Ezekowitz in Newburyport, she said.
“We have fixed costs in our office that don't go away — rent and loan payments and utilities,” Ezekowitz said. “And those happen every month.”
Ezekowitz’s husband is also a dentist, adding to the financial stress.
“Besides my office expenses, we have personal expenses, too, just like everybody else,” she said. “And so all of a sudden, we found ourselves in a very odd situation where we're both unemployed.”
Ezekowitz has business interruption insurance, but that doesn’t cover pandemics. The dental societies in Massachusetts and other states are pressing for state legislation that would compel insurance companies to cover this. And dentists across the country are applying for small business loans to get them through.
Ezekowitz’s office isn’t totally closed. She still needs to take care of emergency patients.
“I'm definitely nervous when I see a patient,” Ezekowitz said. “And I'm also nervous about the parent [of a patient], you know, giving me something as well. I try to keep the parents at a distance.”
Dentists are taking added precautions when treating emergency patients. Dr. Jill Tanzi said she now wears a mask, face shield and disposable gown in her Hopkinton practice.
“You can hardly breathe under these masks,” Tanzi said. “It was a warm day yesterday, so I was sweating. And it actually wasn't a patient of mine that I was seeing. It was another dental office’s patient that had shut down. And I'm assuming they don't have the correct gear, but they're not seeing emergencies.”
Dr. Judy McIntyre is an endodontist in Hopkinton. That basically means she’s a root canal specialist — so almost all of her patients are emergency cases. And she said her family isn’t thrilled about the risk of her working right now.
“It's definitely a tricky situation to balance my commitment to my family and then the innate commitment that I have as a health care provider,” McIntyre said.
Of course, dental offices shutting down isn’t just hard for the dentists. Some patients can’t get care because their problems don’t rise to level of emergency.
Suzanne Sege of Sudbury is in a lot of pain, but isn't going to the dentist for now.
“Tylenol — extra strength Tylenol — has not touched it,” Sege said. "And it's been 24 hours a day."
Her dentist says Sege probably has an abscessed tooth, which would qualify as an emergency. But a couple weeks ago, Sege had a fever, and she’s worried that may have been a symptom of COVID-19.
“I did not want to expose anyone to what potentially could be someone who might have had the virus,” she said. “Or, necessarily, that I wanted to be exposed.”
With many patients staying away, dentists worry when they reopen, they’ll face a huge backlog of patients, many of whom will be in pretty bad shape. That’s if they can keep their dental practices alive until then.
