If you haven’t set foot inside a dentist’s office this year due to anxiety about COVID-19, you’re not alone.
Many of Dr. Frederic Barnett’s patients haven’t scheduled an appointment since the pandemic began, either. The chairman of the Maxwell S. Fogel Department of Dental Medicine at Einstein Medical Center Philadelphia is concerned.
“Most dental disease develops without any symptoms and without any signs. And then, when finally something does begin to hurt a patient, it needs more extensive management and, of course, it’s always more expensive as well,” he said.
Many Jewish dentists like Barnett have seen their practices change in significant ways since the pandemic began, from fluctuating demand to stringent cleaning protocols to increased cases of certain dental problems. Dentists in Pennsylvania faced intense restrictions on their practices in the early days of the stay-at-home order, and were forced to close for nearly three months with the exception of emergency procedures.
Barnett said his clinic stayed open during the shutdown to help patients with dental emergencies and prevent them from relying on overburdened emergency rooms.
Dr. Louis Rossman’s practice, Rossman Endodontics, was also only open for emergencies. Rossman specializes in root canal treatment, and he treats infections created by diseased tissue inside teeth, which can be life-threatening.
Like many businesses, dental offices also struggled to find enough personal protective equipment during the spring shortages. Rossman said many continue to face price gouging while buying items to protect themselves and their staff. He saw the writing on the wall in February and put in an order of personal protective equipment then, so he was able to keep his practice equipped during the worst of the shortage. He said dentistry as a field was able to use cleaning practices and patient protection techniques from an earlier era.
“We took practices that were very clean, very sterile and made them even more so. Dentistry learned a lot during HIV about putting in layers of protection for the patient,” he said.
His safety precautions are already designed to protect him from aerosols produced by working with open mouths.
“As an endodontist, I put a latex drape around the tooth that I work on. And then I wipe the tooth with sodium hypochlorite, which is a Clorox-type product. So that destroys bacteria and viruses,” he said.
Now that the office is open again, Rossman arrives at 6:15 a.m. and wipes down every surface that may have been touched the night before. He had air handlers installed to circulate air five times per hour. Patients are not allowed to come into contact with each other and must come into the office one at a time.
Even when stay-at-home orders were lifted, Rossman and Barnett both said appointments remained low due to patients’ fears about being in medical settings, especially ones where uncovered mouths and noses were present.
Other dentists have reported being busier due to pent-up demand. Dr. Ernest Dellheim was surprised to find the hygiene schedule at his practice, Main Line Center for Dental Excellence, booked solid when the office was allowed to open again.
“Everyone wants to get their teeth cleaned, which is great. That’s the way it should be,” he said. “Gum disease, gum inflammation or tooth decay does affect your dental health so it’s nice to see that patients appreciate that.”
Barnett, Rossman and Dellheim also have noticed an increase in a specific type of dental damage this year: tooth fractures.
“I wouldn’t say it’s an epidemic, but we’re certainly noticing more teeth that have chips and cracks, and most of it is stress related,” Barnett said. Rossman and Dellheim agreed that the stress of the pandemic, along with the recent election, is causing more people to clench and grind their teeth, a condition known as bruxism. The pressure from this behavior can lead to jaw discomfort, headaches and tooth damage. Barnett said the pain can sometimes mimic that of a root canal, but it can be treated with the use of a mouth guard.
Accessing dental care this year is especially complicated for seniors, who must weigh the increased health risk of virus exposure with the risk of untreated dental problems. Barnett is planning to sign up his department for volunteer work with the Alpha Omega- Henry Schein Cares Holocaust Survivors Oral Health Program, which provides pro bono dental care to Holocaust survivors.
This program was created in 2015 in response to then-Vice President Joe Biden’s advocacy for public-private partnerships to meet the needs of Holocaust survivors. A spokesperson for the program said staff at the health care products and services company Henry Schein, Inc. learned that many Holocaust survivors were living in poverty, contending with serious pain and unable to speak or eat due to severe dental issues and lack of access to dental care. They worked with Alpha Omega International Dental Society, a Jewish dental fraternity, to start the program in nine North American cities, including Philadelphia. They have since expanded to 22 cities.
The spokesperson also said the program has provided care for nearly 1,600 patients and delivered care valued at more than $3.5 million since its inception. It has continued to serve these patients this year, although numbers are down slightly from previous years due to the pandemic. One dentist even saw a patient in her kitchen because she couldn’t leave her house. Dellheim has treated patients through the initiative for three years.
“It’s been an incredible program. People’s stories, as you can imagine, like any Holocaust survivor, are amazing and, by virtue of what they’ve been through, their dental condition is horrific — badly broken down, many missing teeth or all their teeth missing from all those years when they had no care. So it is amazing and it’s really gratifying to treat them, and they’re a delight to treat,” he said.
Having seen the impact of stress and neglect on patients’ teeth this year, Barnett hopes that dental care will be viewed differently if more shutdowns are needed during the pandemic.
“This time around, we’ll be considered — or we really should be considered — essential,” he said.
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