Arkansas dental offices reopened on May 11 in accordance with Phase I guidelines, after closing due to the coronavirus in March. The original reopening date was intended for May 18 but came early after leadership from the Arkansas State Dental Association (ASDA) and dentists across the state pushed for an earlier opening date.
Dr. Miranda Childs, a former dental representative on the Arkansas State Board of Health and past president of ASDA, opened her Arkadelphia office on May 11. She told Arkansas Money and Politics that the Arkansas State Board of Dental Examiners (ASBDE) released a set of requirements and recommendations before the opening, outlining safety precautions and guidelines for dentist offices to put in place. These guidelines corresponded with what the American Dental Association covered in its Return to Work Interim Guidance Toolkit, released in mid-April. However, all dentists in the state have received additional notices since the reopening date.
“We are being micromanaged with heavier guidelines and procedures than hospitals with COVID-19 patients are given,” Childs said.
Referring to increased requirements for personal protection equipment (PPE), such as gloves, masks and gowns, Childs explained that the requirements and recommendations of the ASBDE goes past logical measures, especially since “a lot of the guidelines are practices dentists already have in place.” She also expressed that the price and challenge of obtaining the required quantities of PPE is hurting smaller offices.
Dr. D.J. Dailey of Smile Dailey Dentist office in Little Rock agreed that the biggest challenge since reopening his practice has been the cost and acquiring of PPE.
“Any dentist right now is facing the same thing: finding this equipment,” Dailey said. “My office has even had previous orders placed at our regular suppliers fall through. I’ve been able to find some resources, but that did come at a higher cost.”
Childs noted that even a simple box of gloves, which originally costed her an average of $15, is now $45.
“As a business owner, it’s getting really hard to balance the cost,” Childs said. “Prices have skyrocketed.”
For Dr. Montgomery Heathman of Heathman Family and Cosmetic Dentistry in Little Rock, the reopening and added regulations is easily attributed to the fact that this situation has no precedent.
“It is frustrating, because the requirements and rules change daily,” Heathman said. “However, it is necessary, and we’re doing the best we can. Nobody has experienced this yet – this kind of pandemic. I know these challenges will evolve.”
In Heathman’s office, he and his staff have modified their day-to-day by abiding by the Return to Work Interim Guidance Toolkit, as provided by the ADA. The toolkit contains various recommendations from the ADA’s Advisory Task Force on Dental Practice Recovery. The free, downloadable document is 22 pages long and includes a “Welcome Back Reassurance” sample letter for customers, an explanation of pre-appointment screening processes, in-office patient registration procedures, reception area preparation strategies, procedures for dentists and staff while in operatory rooms, staff protection strategies and a shopping list, which refers to what kind of PPE dentist offices should look into implementing in their workplaces.
For Heathman, his office has activated Weave Messaging, a two-way texting program that allows offices to manage all customer communications from their office phone number. This is how Heathman’s office has been conducting their mandatory COVID-19 questionnaires for patients. In addition, they are checking the temperatures of their patients outside the office with infrared thermometers.
“Safety is our priority,” Heathman said. “And for our customers who aren’t safe to come into the office, we understand and are here for them. We are tracking and keeping a list of those patients so they don’t fall off the map.”
In regard to the specific nature of the coronavirus, dentists today are not familiar with any shift in practice with the magnitude of how this virus is changing their day-to-day now. Dailey mentioned that he believed the most similar practice change in the world of dentistry to what is taking place today would be the shift from no gloves to gloves after HIV in the 1980s.
“I’m sure there was some degree of pushback form the industry during that shift, too,” Dailey said. “Today, I can’t imagine practicing without gloves. So I think some things will stick, but I do hope we’ll be able to scale back others eventually.”