No routine cleanings, only emergencies: How a dentist runs his private practice during COVID-19

Since Gov. Gavin Newsom issued his stay-at-home order more than a month ago, the California Dental Association recommended all dentists  suspend in-person procedures unless they're emergencies.

Dr. Richard Nagy, president of the California Dental Association and a periodontist in Santa Barbara, defines emergencies: “Somebody with uncontrolled bleeding, somebody with significant pain and infection, a broken tooth or … [a tooth that] comes out of the mouth, or somebody who's had other trauma to their jaws where they're having a breathing problem.”

If you don’t have an emergency right now, but your tooth is bothering you, and you suspect it may get worse, Nagy advises you to call your dentist so they can triage your symptoms and determine whether you need to be seen now, in the near future, or after stay-at-home orders are lifted. This all depends on how much personal protective equipment (PPE) your dentist has. 

“Dentists have always been the safest place to go. We are quite well-versed in infection control and standard precautions. But that was for a blood-borne pathogen. Now it's an air-based pathogen. And so we're going to be gearing up with a lot more PPE to be protective,” he says.

Even with PPE, dentists have to be in close contact with patients, putting their fingers inside patients’ mouths. Nagy acknowledges there’s high risk here, but he says protocols are being created to help guide dentists on appropriate ways of handling patients in today's environment. 

“It starts now with when a patient calls for an appointment. When we open, the patient will be asked a multitude of questions to make sure they're not at high risk for having COVID-19 themself. And then once they come into the office, we will actually be taking their temperature, as they do in the hospital, to make sure there's no [high] temperature, no cough,” he says. 

“And then from there, we will be adding on extra PPE such as face shields, N95 masks if we can get them, or at least level three surgical masks, gowns, probably hats and booties. We'll be trying to minimize aerosol production to start. But if we need to, depends on when we schedule the patient, [we’ll be] using high-evacuation suction, everything we can to make sure it's safe for the patient.” 

In the early days of the AIDS crisis, dentists also wore extra gear. Nagy says it’s the same concept now, but since COVID-19 is air-based, the gear must be stepped up in terms of having a seal around the mask, plus a face shield to help with any splatter and virus adherence. 

“Right now, since it's new, there's a hype around it, just like the HIV crisis back in the 80s,” he adds. 

Dr. Richard Nagy says when dental offices open and the patient wants to make an appointment, they’ll have to answer questions so staff can make sure they’re not at high risk for COVID-19. Then they’ll have their temperature checked when they come into the office. Photo courtesy of Dr. Richard Nagy. 

Nagy runs a private practice, where he’s the sole practitioner. How’s he faring economically?

“All of my employees, as most dental offices, are furloughed right now since we're not working. And the employees are getting unemployment. Yes, we would all like our dental teams to get back to work. But if there's no patients to treat, there is no income coming in,” he says. 

Nagy still has to pay for rent, insurance and overhead expenses. “So this has been a very devastating big hit for dental offices since the majority of dentists are in a private practice,” he says.  

Nagy, like other dentists, have applied for loans from the federal government. 

He says long-term, the financial situation is concerning. 

“When we do go back to work, we're not going to be able to go back like we had in terms of 30-40 patients a day scheduled right after one another. We're going to have to space these patients out — to make sure we don't have a lot of people in the same area at the same time, letting a room air out prior to seeing the next patient,” he explains. 

“With our costs going up for PPE and our volume going down, I mean, that's a problem. And I believe until we get a vaccine and widespread testing, it's going to be more challenging probably for another year,” he continues. 

— Written by Amy Ta, produced by Brian Hardzinski