When businesses throughout Alabama began reopening in May following the Covid-19 shutdown, the term “office space” took on a whole new meaning. Suddenly, employees were being instructed to practice social distancing by maintaining at least six feet of separation from each other.
Then there are people such as Alice Eurick DiGiorgio, who returned to work and immediately stuck her face directly in front of a person’s mouth. Forget six feet of separation. DiGiorgio was barely leaving even six inches
of space.
That’s because DiGiorgio is one of the tens of thousands of workers in the dental industry who simply cannot do their job from six feet away. Instead, they have to stare directly into the primary transmission source of the disease. Into the very mouth of all this madness.
Say aahhh … are you sure about this?
“There definitely was some fear that first week back,” says DiGiorgio, who has worked for 21 years as a dental hygienist for Roberson Dental Care in Birmingham. “It was mentally scary because there were so many things we still didn’t know (about the disease), and all the new things we had to do in order to see the patients. It was quite an adjustment.”
Of course, life in this pandemic has been a major adjustment for everybody, but few businesses have been forced to come face-to-face with it quite like the dental industry. Most other physicians are able to maintain some semblance of space from their patients, at least most of the time. Even hair
stylists and barbers are usually able to at least stand behind their clients.
Not so with dentists and their hygienists. And yet, as the world slowly reopens, the dental industry in Alabama appears to be handling the situation well.
According to a state-by-state biweekly poll being conducted by the American Dental Association Health Policy Institute, 98.5 percent of all dental offices in Alabama had reopened as of June 1, and by the middle of the month nearly 40 percent were reporting “business as usual” in terms of volume of patients. And there have been no reports of a major Covid-19 outbreak emerging from any dental practices.
“This is a watershed moment that’s going to change the industry tremendously,” says Dr. Russell Taichman, dean of the UAB School of Dentistry. “The good news is, we’ve been relatively safe so far. We’re better prepared than most industries, and the precautions the industry is taking seem to be working.”
Part of this is due to the very nature of the dental business. After all, this is an industry that is accustomed to dealing with infectious diseases on a daily basis, from the basic flu to hepatitis. Caution increased significantly in the 1980s with the rise of AIDS/HIV.
“We’ve always been very aware of how close we have to be to our patients,” says Tuscaloosa dentist Dr. Rodney Marshall. “So our structure was already pretty stringent in that area. Our barrier protection has been extensive for many years.”
As a result, dentist offices were set up to adapt to the challenges of Covid-19 much more readily than the average business, according to Alabama Dental Association Executive Director Dr. Zack Studstill.
“We already knew the protocol, and we’re used to wearing gloves and masks and gowns,” Studstill says. “So the challenge wasn’t in knowing how to do it. It was that the masks and equipment we’d been using weren’t sufficient. It was a scramble to find the right type of PPEs, and that came slowly.”
Nearly all dental offices in the state were closed for the entire month of April except to handle emergency procedures. Officials used that time to determine exactly what was needed to reopen safely.
“We were trying to deal with the situation on the fly, and it took a lot of time and effort,” Studstill says. “I was working 10 to 12 hours a day, seven days a week for about six weeks. But the state responded beautifully. The Governor’s office, the State Health Department, the Board of Dental Examiners and the dental profession all worked together to do what we had to do.”
The new precautions begin in the parking lot. Patients have their temperature taken while still sitting in their car, and then have to answer a series health questions. This process is designed to screen out patients who might carry an increased risk of being infected with Covid-19.
“Our screening of patients has really helped,” Marshall says. “If there is any question as to whether they’ve been exposed, we’ll postpone their treatment. We’ve recommended to some patients that they be tested because of their symptoms.”
Once inside the office, patients encounter a hyper-sterilized environment, with no sign-in sheet or magazines in the waiting room. Dentists and hygienists wear a spacesuit of protection, covered head-to-toe in goggles, masks, face shields, gloves (which might be changed two or three times for each patient), gowns and booties.
Patients are required to wash their hands before sitting in the dental chair, and they rinse with a stronger Peroxyl bacterial agent. Large vacuum devices whir constantly, sucking away as much aerosol as possible from around a patient’s face.
All this extra protection comes with a cost. Marshall says most of the PPEs his
office now uses are more expensive than the previous equipment. And in addition to losing nearly two months of revenue during the shutdown, many offices have to see fewer patients each day because the entire process is more time-consuming.
Marshall says the federal government’s Payroll Protection Program loans have helped, and Studstill notes that the Alabama Dental Medicaid Agency is allowing dentists to submit a reimbursement fee for the increased cost of PPEs. Still, the industry is likely to take a
substantial financial hit.
“(Offices) have been faced with a tremendous loss of income, and this new cost of PPEs is going to drive up the cost of care,” Studstill says. “The question is, how much of that can you pass on to patients? Because there’s no question it’s going to be more costly, and you can only absorb so much of that inside your practice without passing it on.”
Marshall says one positive he has noticed is that most patients are not avoiding the dental office. “I thought it would be more depressed than it is, but people really want to get back to some sort of normal.”
That includes most of those working within the industry. Studstill says there has not been a major number of retirements or resignations at dental offices throughout the state. Likewise, Taichman says students at the School of Dentistry seemed eager to resume in-person classes, which began in July.
“This has been the most disruptive experience I have ever seen in the industry, and I would have expected some students to have rethought their career choices,” Taichman says. “But surprisingly, there has been zero movement. We haven’t lost a student yet. There is still a wait list to try to get in.”
So when it comes to the new world required by Covid-19, it appears many of those in the dental industry are determined to grin and bear it.
“After that first week back, we all kind of calmed down,” DiGiorgio says. “We just decided we can’t worry about it. This is what we do.”
Cary Estes and Cary Norton are freelance contributors to Business Alabama. Both are based in Birmingham.
