The first question: Is your state allowing elective dental procedures? The second: How comfortable are you with going to the dentist right now?

By Leah Groth
May 13, 2020
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Like so many other industries across the US (and really, the world), the dental industry has been dramatically impacted by the COVID-19 pandemic. According to the American Dental Association (ADA), 90% of all dental offices opted to close except for urgent or emergency procedures, per guidelines directly from the Centers for Disease Control and Prevention.

The main reason for this, of course, is due to the nature of how novel coronavirus is spread—mainly via respiratory droplets—and how likely it is for the virus to spread in the dental setting. And while personal protective equipment (PPE) can be an effective barrier, due to the shortage, there isn’t enough gear available to go around—even for emergency healthcare workers. (Dentists in France have even taken to protesting these PPE shortages by getting naked.)

But now, as social distancing guidelines are starting to relax across the country, many states—39 as of May 13, per the ADA's interactive map—are allowing dental offices to reopen for elective procedures, such as teeth cleaning. But should you make an appointment ASAP, or is it better to wait it out a little bit longer? And if you do need an emergency dental procedure, what types of safety precautions are dental offices taking to ensure not only your health, but the health of their employees? Here's everything you know about going to the dentist right now, during a pandemic.

Credit: Getty Images

How safe is it to go to the dentist right now, in general?

So let's say your state is allowing dental offices to be open for elective procedures. There are a few things you, as a patient, should know about your risk of contracting COVID-19 in a dental setting—specifically regarding how exposed you are as a dental patient.

Because COVID-19 spreads primarily through respiratory droplets that often make their way into your mouth, nose, or even eyes, you may be putting yourself in danger while sitting in the dentist chair (remember: dental hygienists and dentists are all up in your mouth during cleanings and procedures—and you wearing a mask is basically impossible). Viral transmission can happen if someone isn't showing symptoms yet, so even if a dental office is making staff who are showing symptoms stay home, that won't be helpful if a staffer is asymptomatic. That said, "as long as the dentist and assistants wear masks and get tested," a dental procedure can be perfectly safe, Joseph Vinetz, MD, a Yale Medicine infectious disease doctor and professor at Yale School of Medicine, tells Health.

What many fail to consider in these situations is the health and safety of the dentists and dental hygienists, who are actually much more at risk for contracting COVID-19 than patients, Bill Dorfman, DDS, a Los Angeles-based celebrity cosmetic dentist, tells Health. It comes down to proper PPE again—while dental staff wear face masks and protective eyewear, patients cannot. (Overall, face coverings have more protective benefits in keeping germs away from healthy individuals when an infected person is wearing a mask, not necessarily vice-versa.)

Also, as you probably know, those dental procedures are often pretty messy—teeth cleaning, water flossing, and other similar procedures that use high-speed dental instruments can potentially spray viral particles in greater amounts and longer distances throughout a dental office and onto the dentists themselves, only adding to the possibility of infection. Ultimately, "the chances of a patient being infected by a dentist is much, much lower than a patient infecting a dentist," says Dr. Dorfman. "The biggest exposure is going into somebody's mouth. It's the dentist and dental office that is at a bigger risk."

What are dental offices doing to protect patients and staff from COVID-19?

Even before the pandemic, dental offices were required to maintain pretty strict hygiene practices. Charles Sutera, DMD, FAGD, cosmetic dentist and founder of Aesthetic Smile Reconstruction, tells Health. He explains that all dental practices already follow OSHA standards for cleaning and sanitizing everything with EPA-approved disinfectants specially designed for use in a healthcare setting to kill viruses, bacteria, and other pathogens. Additionally, it has long been standard protocol for an entire dental care team to wear protective gear, including gloves, surgical masks, and goggles for eye protection to minimize the risk of transmitting germs from one patient to another. “These standards are in practice every day, regardless of whether there’s a known outbreak of an infectious disease,” he says. 

Now, due to COVID-19, there are additional safety precautions in place, many of them recommended by the Centers for Disease Control and Prevention and the American Dental Association. “When open during the COVID-19 pandemic, we enforce social distancing between all individuals in the office—patients and staff—when not wearing personal protective equipment, and routinely disinfect common surfaces in lobbies or waiting rooms, including doorknobs, countertops, and pens,” says Dr. Sutera.

When more people eventually start coming in for dental procedures, Dr. Sutera says that many offices—including his own—will start staggering appointments with more time allotted for each patient in order to reduce the number of people in the office at any given time. “Chairs will be placed six feet apart in the waiting room," he says, and "depending on the facility design, you may be asked to wait in your car, or you may be taken immediately back to a private room upon arrival." And if you want reading material, you may have to bring your own. "The usual magazines, toys, etc in waiting rooms will be removed," says Dr. Sutera. "In their place you will find tissues, hand sanitizer, and extra trashcans."

Staff will also take many extra precautions, including having illness screenings and daily temperature checks, and being required to change from their street clothes and shoes to scrubs (or vice-versa) before entering or exiting the practice. Dentists, hygienists, and assistants will also wear "more robust [PPE] equipment for higher-risk procedures that create more aerosols," says Dr. Sutera. "Personally, I am wearing a hairnet, double mask, shield over the mask, and long sleeve shirts and pants, which I'm changing in between every patient, as well as shoe covers," he adds.

And screening won’t be limited to staff. Due to the fact that dental workers are more at risk of infection than patients, it is important to make sure that anyone getting treatment is infection-free. Dr. Dorfman explains that patients should expect to fill out a questionnaire the day before they come in and also when they arrive at the office. Dr. Sutera says to expect questions covering possible symptoms, recent travel, and any caregiver responsibilities for those who are ill. Expect to have your temperature taken and possibly a pulse oximeter reading done as well, says Dr. Sutera.

Finally, the dental procedure itself may look a little different: "We are also using what’s called an extra oral," says Dr. Dorfman, who explains it's a machine used outside of the mouth. "It is a high powered suction unit that picks up all the aerosol in the air from when we use a drill,” he adds. You might also be asked to swish with 1% hydrogen peroxide prior to treatment, “to reduce any pathogens in the saliva,” adds Dr. Sutera. 

So, when should you schedule your next dental appointment?

First and foremost, if you're experiencing any type of dental emergency—swelling, uncontrolled bleeding, pain, trauma from an accident, or if you have a dental concern related to an underlying condition (chemotherapy, uncontrolled diabetes, etc.)—it's important to see your dentist as soon as possible since, again, many offices are still open for emergency procedures and visits.

If you're in need of a cleaning, but your state's dental offices are still closed to any non-essential procedures, you'll have to wait until they open back up. But if your state has started to allow elective procedures, you have to think about your own comfort level in going to the dentist. You can also feel free to call up your local dental practice and ask what they'd recommend, depending on the level of the COVID-19 outbreak in your area.

In the meantime, and again, as long as you're not currently facing a dental emergency, remember to keep your teeth and mouth healthy by brushing your teeth and flossing twice a day (yes, even in quarantine).

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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