Dentists asking patients for patience as they tackle backlog

Since the beginning of the COVID-19 pandemic, dentists in Ontario have only been permitted to treat emergencies. Even a gnawing toothache wouldn't get you in, unless the pain was uncontrollable with over-the-counter drugs.

But restrictions are starting to lift, and dentists are now wrestling with how to reopen safely for "essential care" as defined by the province, and explained here by the Royal College of Dental Surgeons of Ontario.

"We were … holding off what we could hold off," Dr. David Stevenson told CBC's Ottawa Morning. "But now it's come to a time where we can't hold off any longer." 

Routine checkups involving cleanings and X-rays, and the filling of minor cavities, are still considered non-essential. 

"It's not business as usual," said Stevenson, a dentist in Carleton Place, Ont., for more than 30 years. 

"Among the dental community, there's a big concern about that," said Dr. Raouf Alshahwany, who operates a dental clinic on Merivale Road in Ottawa, and preaches the power of preventative care.

"Periodic cleanings and X-rays are very, very important." An untreated cavity can reach the nerve, and "now we're dealing with a root canal," Alshahwany warned.

On Monday, the Royal College of Dental Surgeons of Ontario issued 48 guidelines for clinics to follow before they can start providing even essential services, and some dentists are already complaining it's an onerous list.

 "We are all struggling to abide by those guidelines," Alshahwany said.

Among the guidelines, clinics will have to be able to seal off treatment rooms after drilling, scaling or polishing, because those procedures send particles into the air and could potentially be a source of exposure to COVID-19. Treatment rooms also have to be vacated after each procedure for a length of time that will depend on the rate of air exchange in the building.

Clinics are being urged to contact an HVAC specialist to get their ventilation systems evaluated now. 

More bills, fewer patients

For some clinics, those requirements will mean costly renovations and the purchase of air purifiers.

"So that brings a big, big financial burden," Alshahwany said.

Prior to COVID-19, his clinic would see 15 to 20 patients a day. It's been all but closed for the past two months. 

"It's going to be difficult to catch up, especially when the new guidelines are minimizing … the number of patients that we can see every day," said Alshahwany, who estimates his patient load will be reduced by half to one-third, or fewer than 10 patients a day.

Another key challenge is finding enough personal protective equipment, or PPE, to protect staff and patients when keeping a two-metre distance isn't possible. 

"There does come a time when you actually have to … infringe on those social distancing guidelines," Stevenson observed.

He wants the Ontario government to make dental clinics a priority when distributing PPE. At the height of the pandemic, many dentists donated their own supplies of gloves, gowns, visors and masks to front-line health-care workers. Now, some are struggling to replace those essential items.

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Alshahwany wears an N95 and a surgical mask, goggles, a head covering, a visor, a disposable gown, gloves and shoe covers. It limits his vision and even his breathing.

"Work has been 10 times harder than before," he said.

Nor is the PPE cheap. "Now the equipment and the PPE is — and I'm not kidding you —  maybe 10 times more than it was before. For example, the N95 mask would usually be a dollar. Now … I've seen a company advertising it for $20 a mask."

Who's going to bear those expenses in the future? At the end, the cost will be passed to the patient. You can't operate on a negative income.- Dr. Raouf Alshahwany

Alshahwany said he's worried about his business, and he knows he's not alone. "All dentists are going really through very, very difficult times," he said. "I would say 30 to 40 per cent will go bankrupt."

That would make the current backlog of patients even worse. Procedures that were deemed non-essential were put off, and now there's a triage process to determine which patients need to jump to the front of the line, especially since the capacity of each clinic will be significantly reduced.

"We're going to have to ask our patients for some patience," Stevenson said. "We will get to you." 

Passing on the added costs

Patients should also be prepared to pay more as dentists pass some of those added costs on in order to survive.

"This is what most of the dental world is talking about. Who's going to bear those expenses in the future? At the end, the cost will be passed to the patient. You can't operate on a negative income," Alshahwany said. 

He said he's contacted the Ontario Dental Association to ask about the additional expenses, and was told "they are working on a specific code with the insurance companies to bill extra PPE costs." 

Meanwhile, he's been instructed to add the cost of the protective gear to the patient's bill.

"I let them know there will be an extra fee to offset the expense of the PPE," Alshahwany said. The amount ranges between $25 and $50 dollars.

"I ask very politely if they're OK with it. Most are very happy to be able to see me. When you're in pain, you don't think about anything else."