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COVID-19: Dentists rise to the challenges as they reopen offices

Back before the lockdown, the Association des chirurgiens dentistes du Québec, which is the union representing dentists, had a series of TV spots about how dentistry is such an important medical specialty, and only their members can treat “more than 200 conditions of the mouth.” The idea was to emphasize that dentistry is essential medical care. Besides great discomfort, mouth cancers and serious eating problems, there are some dental infections that can cause brain damage, permanent disfigurement and even death. Those TV spots vanished on March 15, however, when, unlike hospitals and medical clinics, every dental clinic in Quebec was closed except for emergencies — an unclear caveat most clinics did not or could not follow. Neither the public watchdog in charge of dentistry, the Quebec Order of Dentists, nor the provincial government declared this to be an essential medical service.

The Order licenses clinics, so all closed down except for a few already specializing in ER treatments. The Order said it told regular dentists they could also stay open for emergencies, but several have reported this was not made clear. This policy left patients scrambling. If a person contracted a bone infection from an implant or root canal, their only option was to find someone to prescribe antibiotics, which, if unsuccessful, might force them into an ER at the height of COVID hospital fears and could cause serious complications, if the basic cause still wasn’t addressed. Dental clinics practising telemedicine were supposed to be available, but the majority weren’t. It was more than three weeks before the Order of Dentists finally published a list of where to find clinics actually performing ER procedures. Prior to that, people would call dozens of offices, to find only recordings or a suggestion they leave a message.

As usual in the current crisis, the Chateauguay Valley was lucky, in that it had two dentists, both in Huntingdon, who did practise telemedicine. CanAme, Dr. Ningxia Zhao’s clinic, kept her knowledgeable and sympathetic receptionist on the job answering phone calls to help patients find functioning ERs, or otherwise advise about their options. Dr. Jude Rémillard, also in Huntingdon, came into his office several times a week, to field more than 100 calls and to prescribe treatments. But other clinics, whether here, in Montreal, or in most of the suburbs where people from here might go (the West Island etc.), were silent and empty. The specific ER clinics that were open were overwhelmed, while others that actually were open had not been publicized by the Order, so the public couldn’t find them.

The issue came to a head May 8, with an article in The Montreal Gazette titled: “Reopening of Quebec dental clinics is stymied by confusion and fear.” Dentists complained that the Order told them to close completely, then castigated them for not staying open for emergency services. Many couldn’t afford to pay staff and stay open for the few people who might turn up needing an emergency root canal, or they had COVID fears themselves and the demand was very unclear. Now they’re being ordered to reopen in an equally summary way, given only a week and a half’s notice to comply with a very large list of new requirements, all to be paid for by themselves. The list, which runs 57 pages, includes not just PPE (personal protective equipment such as gowns, visors, headgear and so forth), but also the necessity of treating a very limited number of patients, about half of what a dentist would normally see in a day, in some cases waiting four hours between each one. They must invest in separate operating rooms with doors, often with special air filter systems. In the case of many clinics, this will require completely remodelling their offices and will cost many thousands of dollars, as well as taking many weeks. “I’m lucky,” Rémillard says. “I already have small operating rooms and plenty of windows for air exchange,” but he admits getting access to all the necessary PPE is still a challenge.

At the beginning of the outbreak, dentists donated their own supplies to hospitals to save the lives of health workers. This was material they had bought themselves, and now they are expected to buy more, at inflated prices — assuming they can find it. As Dr. Barry Dolman, a former president of the Order, said in the Gazette article, “We are front-line health-care providers, yet we can’t get the protective medical equipment that other health-care workers are getting.” Haz-mat suits are being required, and possibly “negative pressure rooms” to prevent the flow of air between separate spaces. He says that the committee setting all this up doesn’t include enough private-practice dentists who understand the realities of operating a clinic, all while people are allowed to go to crowded campgrounds and shop unprotected in stores. Global News and CTV also reported on the issue, with dentists they interviewed saying that the few days’ notice is insufficient and that government and professional guidelines are unclear and too stringent.

Of course, not every dentist has greeted the reopening news with dismay. On his clinic’s Facebook page, Dr. Simon Fournier announced the reopening of the Clinique dentaire St-Louis-de-Gonzague with the following words: “YOUPPIIII … UNE BONNE NOUVELLE!!” Meanwhile, both Dr. Zhao and Dr. Rémillard planned to open June 1, and VIVA in Ormstown on June 2. At this two-dentist clinic, Dr. Isabelle Barsalo echoes others’ dissatisfaction with how the Order and the government have handled an essential service that depends on preventive care to avoid far more costly and serious conditions. “We knew we’d need them,” she says, “so we’ve been buying all the PPEs we could since mid-March,” but she still feels problems with access to this equipment might be a factor in forcing clinics to close down again. She’d like to see the Order and the government try to procure N-95 masks, gowns and other needed equipment at a price dentists can afford; right now some masks are $30 each and can only be used for one patient. Because of this, all the clinics will be handling fewer cases, in VIVA’s case about two-thirds of their normal, concentrating on the most serious problems, like a break or a deep cavity that could cost the patient a tooth. Rémillard says that he’s always employed two secretaries, but will only need one because he’ll be dealing with just half the usual number of clients. “We won’t be raising our fees this year, though.” Elsewhere, young dentists who may have to remake their entire business plan have no way to manage except to charge more; and older dentists may choose to retire, which is likely to make dental care harder to find and more expensive.

“We don’t have a crystal ball,” Rémillard says. “I will just start, see how it goes, stop again if we have to. Of course, we’ll only see people with no symptoms [of COVID-19].” He adds, “We have lots of experience with viruses like SARS and AIDS, we’ve been doing certain procedures for years, even though of course this will be a new challenge. For example, most clinics are arranging it so you don’t stay in the waiting room with others, just one person in the building at a time. So don’t be scared! If you have a toothache, come, get it treated!”

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