At dental clinics, the new rules have teeth

By Dallas Heltzell
news@bizwest.com

Like all other businesses in Northern Colorado and the Boulder Valley, restrictions related to the coronavirus pandemic took a big bite out of dental clinics’ revenue. However, when it came to protecting their patients and staff, dentists willingly put their money where your mouth is.
“We have had to turn everything on its head and consider everything, all of our processes,” said Laura DePorter, co-founder and business manager at Mountain Ridge Dentistry in Berthoud.
Job 1 was curbing the spread of potentially virus-laden droplets the dentists call “aerosols” that are generated during oral procedures.
“We use a dry shield that hooks up to a central suction that we have,” said Ryan Bond, owner of Bond Family Dentistry in Longmont. “It stays right inside the mouth, keeps the patient’s mouth open and is constantly pulling all the liquid and aerosols into it, straight through the vacuum system. Anything that escapes that, the air purifier is running enough that it’s cycling the air in the room every five minutes. So anything outside that should be captured and taken care of.”
At Mountain Ridge, DePorter said a similar system is used on patients.
“They’re no longer getting the water spray and using the suction,” she said. “Everything having to do with creating aerosols has stopped, and there are no high-speed handpieces. We basically give what’s considered an aerosol-free cleaning; we’re calling it within our office a ‘dry cleaning.’ It makes sure there are no aerosols for the team member or the patient.”
All the new equipment — air purifiers, N-95 masks, face shields and more — were expensive, and getting them often was challenging. Bond said he spent around $16,000 for the air purifiers and filters alone, “but we knew they were important and tried to get those as soon as we could.”
“We had to search the internet for all these new pieces of protective equipment we need to wear,” DePorter said. “We spent $4,000 to $5,000 just in the past couple of weeks on all the N-95 masks, gear and equipment we need to just to open back up.”
“The state health department has revised its guidelines to where they’re a little more reasonable,” Bond said. “At first it was saying it was mandatory for things like shoe covers that we just don’t have access to. They’re not available.”
Bond said he had to look for masks outside his normal supply route because the Federal Emergency Management Agency commandeered a portion of them. That makes what masks he could get that much more precious.
“We get these N-95 masks to last longer because we don’t touch them without gloves on, we cover them with another mask, and we use face shields.”
All those face coverings are hot, uncomfortable and make communicating with patients harder, Bond and DePorter said.
“It can be difficult for them to breathe and keep up the busy pace of their work, which can be very physical while having these restrictions,” she said. “We’ve got face shields that will fog up when they’re breathing and working, so it’s been a huge adjustment.”
That discomfort led Mountain Ridge to reduce frequency of scheduling so staffers would have time between patients to change their personal protective equipment and make sure any stray aerosols have time to settle.
At Bond Family Dentistry, nothing team members wear leaves the building, including shoes, Bond said. “Everything that’s included is washed, and we cover our N-95 masks with another mask, a face shield and glasses. For us to have any exposure is going to be pretty minimal.
“We don’t have our waiting room functioning anymore,” he said. “People wait in their cars. We go and get them directly. We screen them by asking them questions, we take their temperature. Employees do the same thing when they come into work. We limit the amount of interaction in the hall, even. We try not to have patients crossing each other in the hall.”
The biggest impact of a nearly two-month shutdown has been on revenue, but the Payroll Protection Plan loans through the Small Business Administration helped. Bond received $90,000 but said “being closed probably cost me as much as the loan I got” and DePorter’s accountant was wary of spending any of the PPP loan Mountain Ridge received, just over $28,000, on anything other than payroll — not even rent — even though the practice lost potential revenue of up to $150,000. For a startup, that’s pretty huge for us,” DePorter said.
“Of all things we’ve spent during the past couple months, that loan was not really a concern to me,” she said, “mostly because I never count on the government to give me anything so I wasn’t even hopeful we’d get it, to be honest.”
During the shutdown, Bond treated only emergency cases such as root canals and broken teeth, and DePorter said she was told “that if the patient wouldn’t take up an emergency room in a hospital, we should not see them.
“It was a scary time, just because there was still a great lack of information about what we were dealing with and the guidance from above was really strict,” said DePorter.
If a spike in COVID-19 cases this fall leads the state to order another shutdown, Bond said, “I’d petition against that. I don’t think it’s healthy for the economy as a whole.” However, he added, he’d advise a new dentist to “plan on making some adjustments to the normal routine. Make it the new normal. It’s inconvenient but it’s also for safety.”
DePorter agreed.
“I truly thought when we shut down that we’d be closed only for a week. So the surprise of it being extended for nearly two months was something that I guess I won’t have to be surprised by again,” she said.
“We always understood why we were shutting down, which was for the safety of our team and our community and our patients,” DePorter said, “so I think we’d really have to focus on that part again — doing it for the greater good.”