A General Practitioner’s Response to Covid-19: A Conversation Terry L. Norris, DMD, FACD Dr. Norris practices general dentistry in Owensboro, Kentucky and is the Regent from Regency 4 of the American College of Dentists.
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rom the outset I want to state that this epidemic, no, this pandemic, has turned the world and healthcare upside down. I have never seen anything like it in my 43 years of professional life; I hope I never see it again. It caused me to lose two bets in March of 2020, details of which I will share later.
To say that I am a seasoned veteran would be the kind way to refer to me. In my practice I refer to myself as “The Old Guy.” In May, I will be starting my 44th year in dentistry; in fact, I have practiced in six different decades. I say all of this to let you know I have been around the block and have seen a lot. I will be addressing this pandemic from a practitioner’s lens as I am not an academic in the traditional sense. Before addressing COVID-19 I would like review the nuances of dentistry beginning in the 1970’s and up through the present time. Gloves, what were gloves used for except oral surgery rotations? Masks, what were masks? At best, dental handpieces were wiped down. We even had little disposable prophy cups, not angles, that were snapped on metal prophy angles. Some practitioners even used ovens to sterilize instruments. And, yes, we did wash our hands, which is probably the only thing that is common with today’s practice. Two significant events happened in the 1980’s that had a profound effect on the practice of dentistry. The mid 80’s saw the HIV/AIDS epidemic emerge. My referring periodontist was in residency at that time, and he tells of practicing dentistry in what appeared to be space suits with plastic draping on the walls and floor. That epidemic re39
ally shook-up dentistry. It was common to have telephone calls inquiring if HIV patients were treated in our practices. This epidemic required the utmost sensitivity to ensure access to care and confidence in the environment of care. Starting then, education courses in HIV transmission were required for license renewal. The emergence of HIV as a deadly pathogen had profound effects on our knowledge of the immune system and revolutionized the field of immunology. Another transformational event in the 80’s was the availability of the Hepatitis B vaccine. It did not protect against HIV, however it provided protection from dentistry’s number one nemesis, HBV. The 1990’s ushered in OSHA Universal Precautions and the required training in Bloodborne Pathogens which were born out of the HIV epidemic. This was one of the the first of the clinical disrupters in practicing dentistry. Initially, gloves were a nuisance. Not only did we start gloving up for procedures, but we also found out we needed to keep Material Safety Data Sheets (MSDS) on all products and supplies, including the least threatening of supplies such as gauze and cotton tips. The routine use of masks was yet to come. OSHA had surprise inspections of dental offices and fines were levied for lack of compliance. No one likes change, however the advent of the Bloodborne Pathogen Standards propelled dentistry into the 21st century, well ahead of other professions. Change is hard. Change involves instituting a new paradigm; it costs money and requires extra time. Was it an inconvenience? Yes. Did it protect my patients, my staff and me? Yes. Did it make dentistry safer? Absolutely. Much has been said up to this point, but COVID-19 has not been mentioned. Not much happened in dentistry regarding communicable diseases in the first two decades of the new millennium; our hands were full with insurance company PPO’s and corporate dentistry DSO’s. Then came 2020. 2021 Volume 88, Number 1
