Twice in a Career: An Epidemic and a Pandemic

Dr. Pansick practices prosthodontics in Delray Beach, Florida and is a Fellow of the American College of Dentists.

Ethan Pansick, DDS, MS, FACD

Having started my dental school education in New York City during the height of the HIV/AIDS epidemic, I was accustomed to universal precautions to prevent disease transmission in the dental setting. In fact, as compared to our physician colleagues, many of whom did not even have masks in their offices, we, as dentists were way ahead in the infection control game.

As I watched and read what was happening in Wuhan, I began to feel a bit less confident in our overall preparedness as private practice dental clinicians. Surgical masks began to be rationed by the dental supply companies and the new kid on the block, the coveted N95, was difficult to find. Our expertise in preventing the transmission of bloodborne pathogens was not the same knowledge base that was needed for a disease that was transmitted by respiratory droplets and aerosols. Our office was closed by state mandate for almost eight weeks. During this time, we formulated plans to help protect the patients, the dental team members, and ourselves from an invisible vector that would be invading the place we spend our days. We were kept busy by sifting through the rapidly evolving guidance from the CDC and state dental association.

Our office was closed by state mandate for almost eight weeks. During this time, we formulated plans to help protect the patients, the dental team members, and ourselves from an invisible vector that would be invading the place we spend our days. We were kept busy by sifting through the rapidly evolving guidance from the CDC and state dental association.

When we re-opened our practice there were many changes. Appointment confirmation phone calls were updated to include health and travel related questions with the goal of ferreting out COVID-19 symptoms before a patient arrived for treatment. In order to create social distancing, the reception room was closed; patients would now wait in their cars until we were ready to see them.

Body temperatures were taken, COVID-19 questionnaires and releases provided by our dental malpractice carrier were signed, and the patient’s hands were sanitized before the patient was brought into a treatment room.

Antimicrobial rinses were implemented to decrease the viral load in the patient’s oral cavity before and during treatment. Air filtration systems that used UV lights and HEPA filters were installed in the ceilings. High volume extra oral suction systems were also placed into use with the hopes of decreasing the spread of the virus.

Our team members were outfitted with N95 masks, face shields, and disposable gowns to protect everyone from the dreaded aerosols created with the use of high-speed handpieces and ultrasonic scalers. Our fears were fanned by a New York Times article that framed dentistry and dental hygiene as some of the most high-risk professions for contracting COVID-19 in the entire workforce model.

As practitioners, we changed as well. Gone were the white coats that we wore to meet our patients replaced by scrubs that could be cleaned more effectively. Lunch in our break room with our team members was replaced by lunch in the car by ourselves. More importantly, we felt that

the doctor-patient relationships that we spent so many years building were being eroded by the physical and psychological distance placed between us and our patients.

Much like the initial phase of the HIV/ AIDS crisis, we were afraid of our patients. Who harbored the virus that we could potentially take home to our families? Should we really do an elective procedure that creates an aerosol cloud? Is three- month recall really necessary or should we keep our elderly high-risk patients away from the dental office environment?

COVID-19 testing evolved in much the same fashion as HIV testing. Initially the test was difficult to get. The days after the test were filled with anxiety waiting for the results. Were the fever and cough just a run-ofthe-mill cold or was it COVID? Now, tests are plentiful and accurate results are available much more rapidly.

Fortunately, there is hope and a pathway back to a new version of pre-pandemic dentistry. Our team members have all received both doses of the COVID-19 vaccine and our patient population is slowly becoming vaccinated as well. While we have not relaxed our updated infection control protocols, we are beginning to feel less anxious about doing what we do best – caring for our patients. And, our patients, in turn, are ready to return to the practice for the dental care they need and desire.

Where we go from here is still to be determined. The gloves, masks and protective eyewear that were introduced to dentistry in the mid 1980s during the HIV/AIDS crisis have remained a constant in the practice of dentistry. Some of the protocols recently adopted to curb the spread of COVID-19 will also become a routine part of the dental care delivery system as well.

Even as optimism makes me feel that there is light at the end of the proverbial tunnel, my hopes were tempered as I learned of the death of a colleague that succumbed to COVID -19 who practiced just a few miles from my office.

While some paint dentists with the broad brush stroke of stolid and staid practitioners, we have proven that to the contrary, we are nimble leaders who can quickly adapt our procedures and protocols to serve our patients and continue our role as leaders in patient safety.

As practitioners, we changed as well. Gone were the white coats that we wore to meet our patients replaced by scrubs that could be cleaned more effectively. Lunch in our break room with our team members was replaced by lunch in the car by ourselves. More importantly, we felt that the doctor-patient relationships that we spent so many years building were being eroded by the physical and psychological distance placed between us and our patients.