"It's the Wild West over there." Your visit to the dentist is about to become more painful, but not for the reason you might think.

To attract patients and ensure their own safety and that of their staff, Anthony Ceccacci, dentist and owner of Madison Avenue Smiles, a New York-based dental clinic, said he had become a financial member of the poor guidance from health authorities.

For $ 85, he offers finger-based antibody tests. He also instructs all of his patients to rinse their mouths with iodine before being seen.

He spent nearly $ 35,000 to disinfect equipment such as high-speed oral aerosol evacuation units, ozone generators and ultraviolet lamps.

After donating masks and other forms of personal protective equipment (PPE) to front-line health workers in New York, they are now taking the price of N95 masks, surgical gowns, face shields and glasses which dentists should now use as directed by the CDC.

Republican Senator Susan Collins of Maine on Tuesday voiced concerns from dentists in her state that they could not see the patients, saying "it is causing growing health problems". He asked Robert Redfield, head of the CDC, if the existing guidelines were adequate enough for dentists to return to work.

"We have interacted and chatted with dentists, and worked with local and state public health physicians to update our guidelines on reopening a variety of medical services," said Redfield at the time. A COVID-19 Senate hearing on Tuesday. "We are in the process of updating these guidelines and they will include direct guidelines for dental offices."

In addition to PPE and a one-page questionnaire on coronavirus screening for patients, Ceccacci said: "They were crickets" from the New York State Dental Association as well as from the American Dental Association. “Their advice was very poor. They didn't give me a clear directive. "

"If I had to bring my staff back according to their recommendation, how can I look them in the face and say that they will be safe?" Said Ceccacci.

in one tool kit For the provisional reopening guidelines published by the ADA in early May, there is no mention of the disinfection kit you bought or the antibody tests.

"At the moment, the ADA does not have an official policy on antigen testing," said Matthew Messina, a dentist based in Columbus, Ohio, who is spokesperson for the. 39; ADA.

"The dentists I spoke to greatly appreciate the advice of the ADA and its national and local dental associations during this pandemic," he added.

This is certainly not the case for Ceccacci, who has instead taken cues from Kwang-Bum Park, a well-known South Korean dentist who runs a multi-practice clinic based in the Daegu metropolitan area, the ; epicenter of the country's coronavirus.

"South Korea has already passed it," said Ceccacci, as he looks at Park over the ADA. ADA and NYSDA, he added, "aim to protect themselves". He said they were walking cautiously to avoid being criticized later. "I don't hold it against them, but I didn't expect any direct response from them on how to reopen my office."

ADA and other dental associations count on CDC advice

Last week, Chad Gehani, President of ADA wrote a letter to CDC call the agency to "provide prompt advice on how to safely reopen dental offices during the downturn phase of the COVID-19 epidemic".

"The latest CDC guide (April 27) remains appropriate for areas of the country where rates of COVID-19 infection are accelerating or peaking," the letter notes. "However, the situation is very different in regions where infection rates are falling and the risks of acquiring or transmitting COVID-19 are very low. It is essential that dentists have a new or revised directive that recognizes a risk-based approach. "

"The CDC appreciates the letter from the American Dental Association and is actively adjusting its response and advice as conditions change and as we learn more about COVID-19," said Kate Fowlie, a spokesperson for the CDC.

"The CDC has recently worked on updating the COVID-19 guide for dental parameters for resumption of care. We anticipate that the updated guide will be available soon."

Although dentists in 31 states can reopen and perform elective procedures, the CDC recommends that dentists only provide emergency services. Currently, the agency does not have a published protocol on how to safely offer non-emergency services.

But for emergency care, the CDC says, "If you don't have a surgical mask and full face mask, don't do emergency dental care." Refer the patient to a doctor who has the appropriate PPE. "

Reputations at stake

During the AIDS crisis, Ceccacci said that dentists had "a bad sequence" and that some people saw them as a mechanism for the transmission of the deadly disease.

Remember one story published in the New York Times in 1993 Regarding a Florida dentist who inadvertently caused six of his patients to contract AIDS, Ceccacci said, "I don't want to be that guy."

To avoid this, he went further in preparing his office to see patients next month, assuming New York City governor Andrew Cuomo, a Democrat, is not issuing new guidelines that delay the date.

"I have always looked at each patient as a disease potential, but the coronavirus has taken him to the next level," added Ceccacci. "We just improved our office protocol due to the fear and anxiety of the patients. If they don't see us dressed in combinations of hazardous materials, they will think that they are not safe. "

"I have invested a lifetime in this multi-million dollar practice, if I lost it, I have no idea what my next career would be."

Likewise, Jeremy Peyser, a dentist based in New York, recognizes that an accusation of a patient who contacts COVID-19 to visit him could be fatal to his practice.

This is why he stopped seeing patients at the start of March when one of his employees called due to an illness. She said she had a fever and Peyser encouraged her to take a coronavirus test, but at the time, these tests were only available if she was in a category or had recently visited a COVID-19 hotspot.

Since then, he only cares for patients who need emergency care. But you will not see any patient. "He must be someone I know and have seen personally," he said. "If I really don't know them, how would I know if they practice social distancing?"

Unlike Ceccacci, Peyser delayed the purchase of new disinfection equipment until the ADA or CDC shared "what works and what didn't" in terms of destroying the coronavirus , did he declare.

Meanwhile, he trusts WhatsApp
FULL BOARD,
+ 1.96%

a group of periodontists, oral surgeons and general dentists based in New York like him.

Group members share new information, in particular on the protocol for reopening their offices, disinfecting equipment and the CARES payment check protection program.

Like the other 12 people in the chat, Peyser was unable to obtain a PPP loan in the first round. In the second round, she was approved for a loan of $ 44,000 which allowed her to bring back the staff she had to cancel. This comes at a time when the number of Americans working in dental offices has dropped by more than 53% since February, according to the Bureau of Labor Statistics.

Group chat was also a forum for industry experts to share their own ideas on how to reopen safely and discuss new equipment. They are responsible for distinguishing between opinion and fact when sharing information. He adds: "My opinion can only be very useful."

Before the coronavirus, Michael Scialabba rarely cared about having enough gloves and masks for the 260 doctors in 76 different dental offices he oversees as vice president of clinical affairs for 42 North Dental, a New England based dental service organization.

You simply placed an order with the same wholesale supplier. Sometimes shipments are late or lost in confusion. But when more patients were admitted to hospitals for a coronavirus in mid-March, his provider told him that they could not sell him anything and that everything "went to the hospital".

At the time, the 76 sites had enough surgical masks to survive, but the CDC then recommended dentists to wear N95 masks. even for patients who do not have symptoms of coronavirus.

Suppliers limited the number of masks a customer could purchase, which was far less than "what they would need to see patients," said Scialabba.

Instead of having one supplier, you buy more than six. There is also no guarantee that the masks and other PPE will arrive at his desk, added Scialabba. He is also concerned that delivery drivers end up keeping the masks for themselves.

If that happens, he said it would be almost impossible to get a refund. To make the problem worse: you are paying more for dresses, masks, gloves and masks than before.

"When you have to buy from several suppliers and you have no relationship with them, you are under the totem," said Scialabba. "It really is the Wild West."

Before the pandemic, he said that an N95 mask cost $ 1.50. And now? Pay $ 12 per mask. In addition, dresses that "cost money" now cost between $ 4 and $ 6.

"Most of our offices have not been open for eight weeks, so we have had no capital inflows," added Scialabba. Despite this, you pay $ 8,000 to $ 10,000 more in PPE per office.

Peyser and Ceccacci face the same problem.

In addition, Peyser said that the suppliers he is in contact with "cannot even guarantee me a price because they do not know how much they will have to pay for inputs from them".

They both donated PPE to front-line health workers in New York and are now deprived of the price of PPE.

"Dental offices must return to a full essential service, not just emergency services, for the health of the public," said Mark Feldman, executive director of NYSDA.

But when it comes to getting affordable PPE, the organization said it "has no comments yet".

To pay these premiums, Scialabba has argued for a new insurance code to charge for infection control fees, which ADA has signed.

You can now charge some patients an additional $ 10 per visit, as not all insurance companies are on board. While this barely covers the total cost of PPE, especially when a patient needs to see multiple providers, "it helps to lower the costs and shows that we are all in the same boat."

In the end, Scialabba is concerned about patients who completely stop going to the dentist.

"This is the last thing I want to see," he said. "It could easily cause an oral health crisis if everyone stops seeing their dentists."