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In mid-July, for her first big post-quarantine outing, Margaret Abrams went to the dentist. Abrams, 31, was in desperate need of some dental TLC, but she was also wary of being in a medical facility during a pandemic, especially in Florida, where cases were skyrocketing. “There definitely was a moment of I’m about to have my mask off for an hour,” she says of her initial trepidation.
As soon as Abrams arrived at the office, however, all her fears were assuaged. From increased personal protective equipment to spit-minimizing dental tools and techniques, the entire visit had been modified with pandemic-specific safety in mind.
“This is the best time to go to see your dental hygienist — it couldn’t be safer,” says JoAnn Gurenlian, chair of the American Dental Hygienists’ Association Return to Work task force, which provides COVID-19 safety guidance for the field. “We have never been better than we are right now, because we are trying to make sure that we are providing every safety measure we possibly can.”
While many dental practices temporarily closed at the start of the pandemic, save for emergency care, every state has reopened in some capacity and now allows for elective procedures, in accordance with the Centers for Disease Control and Prevention’s guidelines on safe dentistry for the COVID era. Currently, no cases of COVID-19 have been traced to dental facilities. Still, with a virus that primarily spreads through an infected person’s saliva entering someone else’s eyes, nose or mouth, dentistry — where a patient lies down open-mouthed for an extended period of time — poses many risks.
In order to mitigate these risks, dental offices across the country have implemented stringent safety precautions to ensure a smooth visit for both patients and healthcare workers. “It’s not as simple as walking into the building on time for your appointment,” says Dr. Terri Tiersky, a dentist in Illinois and the president of the Chicago Dental Society. “While it is a more structured visit than before, patients and staff greatly appreciate the additional layers of protection.”
Here’s what to expect at your next trip to the dentist.
Expect a screener before your appointment
As with many pandemic-era health appointments, telehealth phone screeners are becoming commonplace to determine if patients may have been exposed to COVID-19. Expect the dentist’s office to give you a call the day before your visit to ask if you have any COVID-19 symptoms, such as cough, fever, breathing issues and loss of taste and smell, and if you’ve been exposed to anyone who’s contracted the virus.
If you have a particular concern you’d like to discuss with your dentist first, like a pain in your tooth, they might suggest a video call. Teledentistry helps dentists assess clients over video without in-person consultations. Through teledentistry, the doctor can weigh in on whether it makes more sense to postpone your visit (if you’re concerned about physically coming to the office) or to proceed with in-person care. “We absolutely can do teledentistry if a patient has a particular concern,” Gurenlian says. “But there are some times where we really don’t want you to wait, we want you to come in and we want you to understand this is a very safe time.”
No more waiting rooms
Thanks to COVID, waiting rooms are a thing of the past. When you arrive at the dentist’s office, wear a mask and wait outside or in your car until someone from the practice calls, texts or comes outside to escort you in. Once inside, you’ll need to sanitize your hands and get your temperature taken, and you’ll be asked again if you’re experiencing any symptoms of COVID-19. (If you are showing symptoms, you may be sent home and told to call your primary care provider.) Staff at the practice undergo the same safety process every day too, Gurenlian says.
Some practices may allow you to sit in their waiting rooms momentarily, which will have limited seating and no high-touch items like magazines or toys, says Dr. Chad Gehani, a New York City dentist and president of the American Dental Association. You’ll also be asked to limit the number of people you bring with you, Gehani says: preferably just the patient if you’re an adult, although a spouse or advocate is welcome, and one parent if the patient is a child.
Then, while still wearing your mask, you’ll be taken to a fully sanitized exam room.
Dental professionals will be in head-to-toe PPE
When Abrams first set foot in her dentist’s reception area, she hardly recognized the person waiting for her. “I’ve gone to the same dental hygienist for the last 15 years,” she says, “and I didn’t recognize her because she had a HAZMAT suit on.”
Because you’ll have your mask off during your appointment and dental hygienists will be in close proximity, they’re taking extra precautions when it comes to personal protective equipment. “We’re going to look a little different,” Gurenlian says. Hygienists will be wearing gowns, gloves, masks, glasses, surgical caps and face shields for the duration of your appointment. After you leave and between every appointment, they’ll discard their used gear and replace it with fresh PPE.
Other parts of the office might look a little different too. The CDC has advised practices to erect plastic or glass barriers in front of the reception desk, as well as floor-to-ceiling barriers in between patient chairs in open-concept dental facilities.
Techniques and tools will reduce spit and aerosols
By nature, dentistry produces lots of spit and debris, from scraping, rinsing and spraying. Since COVID-19 is spread through saliva and aerosols, it’s highly plausible for the virus to spread if an infectious patient’s aerosols or saliva castoff were to linger in the air or on surfaces.
For this reason, dentists say, some of the tools used during a typical cleaning that generate a lot of aerosols — like drills, ultrasonic scalers and water syringes — won’t be used during your hygiene visit. Instead, hygienists will use hand instruments for your cleaning and might use suctioning devices throughout the entire procedure to control saliva production. Dental pros may also use rubber dams, a little rubber device that exposes only the tooth or teeth that the dentist wishes to work on. “This way there is minimal contact with the saiva and aerosols,” Gehani says.
These new tools or protocols don’t lower the level of care you’re receiving, Gurenlian says; it’s simply another way of cleaning teeth.
Only the tools used on you will be out and available during your appointment. All other equipment will be stored to avoid exposure to other patients’ aerosols.
Some practices also require patients to rinse with a hydrogen peroxide solution for one minute at the start of their appointment to mitigate the spread of COVID-19, Tiersky says. However, the CDC has found no evidence that pre-appointment rinses prevent disease transmission or lower the viral load in potentially infectious patients.
In some practices, instead of heading to the reception area after your visit to schedule the next one, you’ll put your mask back on and promptly exit the practice. An office staff member may follow up in a few days by phone to schedule your next appointment and make sure you’re not experiencing any COVID-19 symptoms.
For Abrams, the initial shock of seeing her dental hygienist in full PPE wore off quickly, and she felt safe and well cared for during her visit. While the new protocols of pandemic dentistry may appear daunting at first, it’s all for the sake of public health and clean teeth.