As you probably already know, there are many changes in dentistry that have been introduced to dental offices due to COVID-19. As the Ministry of Health and our governing body have been trying to figure out how to bring dentists back to work, it’s been a rollercoaster of information and adjustments made as more research about this virus comes to the surface.
Originally, we were told to do major renovations to our dental office to accommodate new air filtration systems, doors on all treatment rooms, changes to reception areas, our own PPE and extent of it, how to flow through the office with or without PPE, 3 hour waits between patients, and so much more, it became a mountain of new modifications brought to us almost daily.
Recently, the Ministry of Health and our governing body have relaxed some of these changes in dentistry and gave us, the dentists, the green light to return, with some changes, though not as extreme as previously outlined. So as most of us opened our doors to our patients and many dentists have returned to a very similar way of delivering dental care as before, the hygienists’ governing body delivered an unexpected surprise. After over 2 weeks of silence after the dental governing body released the new, more relaxed rules, and essentially creating massive concern and even conflict in some situations for dental hygienists, the CDHO (the College of Dental Hygienists in Ontario) finally released another statement saying they do not concur with the Ministry of Health and the dental governing body and stand by their original regulations of the initial changes to dental offices and PPE.
This results in a massive challenge for many reasons:
Shortages of PPE
There is an immense shortage of PPE and most of it is back-ordered with no guess as to when it will finally arrive. In addition, as it does trickle into the suppliers, the suppliers have to ration it and only deliver small amounts to each office since there is not enough to go around. Since hospitals must take priority, what we, as dentists, receive is limited and sporadic. So the CDHO’s persistence to make it mandatory for dental hygienists to have for every cleaning makes it difficult for many to come back to work due to its lack of availability
The Cost of PPE
Due to the extreme shortage and massive demand for PPE, the cost of PPE per patient per provider has sky-rocketed. Many dental offices are struggling to offset that cost by passing the cost to the patients or reducing hygiene wages in order to mitigate at least some of the cost
Conflict Between Hygienists and Dentists
Lack of supply as well as the cost of it with respect to PPE has created a new conflict as many dentists have limited numbers of PPE and are not able to provide it to their hygienists who, in turn, must have it according to their regulations. Many offices report having less than 20 sets of PPE and don’t have a clue as to when the next batch will be coming so decisions have to be made as to when and who to provide the PPE for.
Long-term Impact on the Cost of Dentistry
As the CDHO regulations are much more stringent than those for dentists, in order for dentists to bring their hygienists back to work, the CDHO conditions must be met, which results in tremendous additional costs in order to comply. For example, the 3 hour waits between patients can only be reduced by installing a medical-grade HEPA filtration system in each treatment room, that allows for 50 air exchanges per hour, which comes with significant costs. These permanent changes in dentistry offices, as well as the ongoing PPE cost to maintain an adequate supply, will inevitably result in increases in fees in order to manage the rising expenses associated with running a dental office
Confusion for Patients as to What is Right
When I first heard about the CDHO statement, my first concern was: if I do what I am told is safe by my governing body, but my hygienists have additional PPE that I don’t, then there is a perceived inconsistency when our patients come back to our office. I thought to myself if I was a patient coming back post-COVID and still very nervous and worried about my safety and my family’s safety, what would my first thought be when my hygienist is wearing an N95 mask, eye protection, face shield and a surgical gown, but my dentist looks the same as before COVID? What would I think is right? What would I think is safe? And would I be comfortable with this discrepancy between my dental care providers? And I am guessing, many of our patients would at the very least wonder, and more likely than not, worry about this incongruency.
Stay tuned for what our office is doing as a result of all this coming up in the next Blog: “Your Safety and that of our Team is our Priority: how I believe a dental office should be”