When the coronavirus peaked last March, the American Dental Association instructed dentists to postpone all but urgent and emergency procedures from March 16 until April 30. The directive was an attempt to slow the spread of the virus, keep dental patients out of hospital emergency rooms and conserve personal protective equipment. Many dental offices in New York reopened on June 1, but changes were made to offices to protect patients, doctors and staff.
Northwell Health renovated its Dental Medicine at Glen Cove, at 10 Medical Plaza. The clinical services there included routine dental care, crowns and bridges, dental implants, oral surgery and sleep apnea treatment.
Investing $25,000, the hospital system added state-of-the art equipment and changed its treatment rooms, which are now fully compliant with infection-control measures to prevent the spread of Covid-19. The hospital’s dental practice reopened on Jan. 4.
“We are the only [medical] group seeing patients who do not wear a mask,” explained Dr. Leonard Patella, chairman of dental medicine at Glen Cove Hospital. “Drilling is in the mouth, and it generates an aerosol, which can be infectious.”
Surgical extractions, dental implant placements and any routine use of hand instruments including teeth cleanings, also produce aerosols.
Three single-occupant isolation rooms were constructed at the dental center in Glen Cove to contain airborne pathogens. In the negatively pressurized rooms, air is pulled in and exhaust is routed through ductwork and high-efficiency particulate air filters. Unlike traditional dental-office configurations, the center’s reconstructed rooms have doors.
“We have purified fresh air circulating in the rooms,” Patella said. “And the aerosols leave the room through the negative pressure ventilation system. That’s why the room has to be sealed. The bad air is taken out and fresh air is always coming in.”
High-speed suction also helps contain aerosols, Patella said. “I use the Isodry self-isolation system, because while drilling, the saliva goes into it and it sucks in the aerosol.”
The dentists wear full personal protective equipment, including N95 masks, which they cover with surgical masks. After each patient, dentists and hygienists dispose of all PPE except the N95’s.
Complying with ADA recommendations, no one enters the sealed treatment room for 15 minutes after a patient leaves, because aerosols can still be in the air. The aerosol will settle, and can then be removed from surfaces when the room is cleaned.
In the interest of safety, patients no longer sit in the waiting room. They wait outside the office for a call when it’s time to go in for their appointment.
Dr. Joshua Segal has been an oral surgeon at Glen Cove’s dental center for two years. The renovated center provides more opportunities for sedation to be used for extractions and dental implants, he said. Segal, the director of the oral maxillofacial surgery program at Northwell, said he enjoys working at the Glen Cove facility. “It’s nice to treat patients in a facility like this in a medical suite close to the Glen Cove Hospital,” he said.
Many people have avoided going to the dentist during the pandemic, Segal said. As a result, some have needed oral surgery because decayed teeth can no longer be saved. Patella said he had seen nine fractured teeth as a result of people delaying dental visits, or clenching and grinding excessively from the stress of the pandemic. “They come in and point to their jaw and think the pain is from their teeth,” he said, “but it’s from their jaw.”
Dr. Jacqueline Sobota, one of the center’s dentists, said that most patients accept the new precautions, which include a new procedure when patients sit down in the dental chair. They rinse for a minute with a peroxide-and-water solution to reduce the “viral load” in their mouth, Sobota explained.
Once they’re accustomed to the sight of their dentist in full-body PPE, Sobota said, “Then it’s the same, except for the use of extra suction, which the patient might notice. We’re probably doing above and beyond anything the [Centers for Disease Control] is recommending.”
As for the possibility of dentists having the virus, a study from the ADA Science & Research Institute and Health Policy Institute found that fewer than 1 percent of dentists nationwide were estimated to be Covid-19 positive as of June, during the springtime peak. The study was published in the November issue of The Journal of the American Dental Association.
Patella said he could still remember a patient who came into his Northwell Manhasset dental office in June, before renovations were complete in Glen Cove. “She said she had to stand six feet away at the window,” he recounted. “Then she opened her mouth and pointed to the area that was hurting her. I said, ‘I can’t see from here.’”
The patient asked him to change his gloves in front of her, and only then did she sit down in the dental chair and allow Patella to look into her mouth.
“Dentistry is about trust,” he said, “and that is developed over time.”