Virtual waiting rooms. Patient and staff temperature checks. Workers outfitted with gowns, gloves, masks, and hairnets. Glass partitions at the front desk. More time between patients, while employees sanitize treatment areas.
Those are just a few of the safeguards being planned by dentists around the state amid the pandemic, before the May 18 date designated by the Massachusetts Dental Society as the target for practices to resume offering elective and non-urgent care, in addition to emergency procedures that have continued during the health crisis.
And dentists who spoke to the Globe said that as they begin the process of reopening, they want patients to come in for routine procedures to prevent problems with their teeth from becoming more severe.
"We don’t want dental infections to worsen if [patients] are not coming into our office,” said Dr. James Lee, who practices in Malden.
Providers said they are taking precautions to prevent the spread of the coronavirus.
“From an infection control point of view, I think dentists are going to do an excellent job," said Dr. Jeffrey Harrison, a dentist and state-certified prosthodontist specializing in aesthetic restoration and replacement of teeth at Metro West Dental in Wellesley. “Dentists are going to be taking a lot of precautions, not that they weren’t before.”
To aid social distancing, Harrison said, his patients will check in by e-mail or text in the parking lot on the day of their appointment and wait for an alert to tell them it’s time to enter the building.
After they get in the office, they’ll be asked to wash their hands and do a pre-treatment mouth rinse. And like his staff, he said, patients will have their temperatures taken as part of a pre-screening that will include a brief questionnaire about social distancing and possible exposure to the virus. Patients will be asked to reschedule appointments if necessary.
Harrison said his staff will be split into two shifts, a cleaning company will disinfect the office nightly, and air purifiers will be on to further reduce the risk of contamination.
“Most dental offices are going above and beyond what we call standard precaution,” said Harrison, who has taught at Boston University and Tufts dental schools and consulted for the Veterans Administration.
Harrison said his office in February purchased additional personal protective equipment, or PPE, “to keep us stocked up," and the office has always used a laundry service to disinfect scrub tops and other gear.
“I think we’re going to be ready to go,” Harrison said. “By the time we do our soft opening, I think there will be enough production [of PPE] to get our hands on supply.”
The state Dental Society has advised members to take “added infection control mechanisms” including pre-operative mouthwash for patients; strict adherence to OSHA materials guidelines; and strict adherence to proper hand hygiene and protocols for clinical gown and personal protective equipment use.
Regarding PPE, the dental society said in an April 30 advisory posted to its website that the group is communicating “daily with the major PPE suppliers and continues to explore options for members regarding the shortage.”
In addition, the site says, the society urges dentists to “reach out to your PPE suppliers to determine their inventory status and if they are fulfilling orders at this time. If you are able to order any PPE (e.g., masks, face shields, goggles, gloves, etc.) at this point, we recommend that you do so to start preparing your inventory in anticipation of your practice’s reopening.”
Some dentists who spoke to the Globe said obtaining enough gear is a top priority.
“Obviously the shortage of PPE, that is one of the biggest concerns,” said Dr. Sathish G. Palayam, a dentist with offices in Lexington and New Bedford who served on a state task force on reopening dental practices.
Palayam said he was able to order 200 N95 masks from one supplier Monday for his staff, and the Massachusetts Emergency Management Agency has been “very supportive” in supplying dental offices with “basic required PPE.” At the start of the pandemic, Palayam said, dentists around the state “donated a lot of PPE to them,” and now the agency is working to “return the favor.”
“We are getting more and more” protective gear, Palayam added. “We are hearing from our suppliers that there is more and more coming in.” He said dental offices even in normal times meet or go “way above” infection prevention protocols put out by public health authorities.
And Lee, the Malden dentist, said he and his colleagues are working to obtain gear such as masks and face shields, as well as plexi-glass to separate front desk staff from patients.
“We’ve been able to acquire some, but . . . I think that the pipeline of PPE needs to be increased in order to help our offices reopen safely,” Lee said.
Providers will take steps, he said, to reduce the amount of foot traffic in their offices to enforce social distancing.
The dental society, meanwhile, is urging members to only purchase PPE from reputable sources. The group says on its website that it’s warning dentists “against ordering PPE from unknown sources, including the growing number of international vendors that claim to have proven and effective PPE supplies.”
According to the dental society, the protective gear being sold by such “gray market” vendors hasn’t been tested or verified, so its effectiveness cannot be guaranteed.
“Do not put yourself, your staff, or your patients at risk with ineffective PPE,” the society says on its website.