Teams at the University of Colorado School of Dental Medicine are part of the community of healthcare workers on the frontline during the coronavirus (COVID-19) pandemic.
While Colorado health officials suspended elective medical and dental procedures in mid-March, CU Dental’s emergency clinic has remained open, treating between five and ten patients each day. The number of patients is similar to pre-pandemic cases, but it still isn’t business as usual.
“Our goal is to keep as many patients as possible from going to the emergency department,” says Ryan Dobbs, DDS, MD, chair of CU Dental’s Division of Oral and Maxillofacial Surgery. Dobbs divides his time between CU Dental and the hospital at UC Health. “My biggest fear at the beginning of this is that all dental care would be shut down leaving only the emergency room as an option.”
Dobbs says the greater Denver dental community has been incredible. “We’re seeing our current patients, but we’re also getting referrals coming from the hospital emergency departments and other maxillofacial clinics throughout the region for infections, pathology and trauma,” he says.
So, while the building normally would be bustling with both clinical and academic activity, a small team conducts the emergency procedures. The residents and dentists can extract teeth, perform root canals, administer antibiotics and replace permanent crowns that were fitted before the labs closed. They also see orthodontic patients who have problems they can’t resolve at home.
“We’ve had so many patients thank us for being here,” says Heidi Tyrrell, director of clinical operations for CU Dental’s Heroes Clinic.
“The Veterans Administration referred a patient to us who was in excruciating agony for several weeks while in lockdown,” she says. “After we ended up pulling two teeth, he was so grateful to be finally pain-free.”
It’s not entirely business as usual. Because of the fear the virus spreads through aerosol, clinic staff can’t remove decayed enamel or dentin before filling a cavity.
“We’ve told a few patients to buy dental repair kits, which can be found at the drug store, to alleviate pain and serve as a stopgap measure,” Tyrrell says.
Tyrrell is one of a couple of staff members stationed at the front desk, acting as gatekeepers. They screen the patients in the building’s vestibule—asking a series of COVID-19-related questions. They also triage patients to determine if the procedure is necessary.
“No one is allowed in the building without having their temperature taken,” Tyrrell says. “If they have a fever, we ask that they call their primary care physician.” The measures are in place for the safety of both patients and dental providers.
To that end, patients must wear a facial covering while the staff has on head-to-toe personal protective equipment. (PPE).
A staff member stays with the patient at all times—escorting them to the clinic, which is divided into three sections. As a way to physically distance, only one patient is allowed in a section at a time.
“After the procedure, we disinfect everything and close up the room for at least four hours,” Tyrrell says. That cleaning regimen assures that patients aren’t interacting with each other and will be in place for the foreseeable future.
Increasing use of telehealth
One significant way the pandemic has changed healthcare is in the use of telehealth. Dentists –like other health professionals—have increased the use of videoconferencing for nonemergency patients.
Dobbs had an appointment with a patient who recently had surgery. During the post-op videoconference, he could determine how well the patient was healing and was able to consult on pain medicine management. He says dentistry will still need in-person visits since not all cases can be handled via computer.
“It’s kind of hard to diagnose someone by looking into their mouth through a camera phone,” Dobbs says.
Plans for a new reality
Preparations are underway for CU Dental to begin seeing nonemergency patients. Everyone will go through intense screenings before being allowed in the building. Only after safety protocols are in place will clinic staff start making appointments.
“This pandemic has stressed out a lot of people and stress can cause people to grind their teeth. We may start seeing patients with pain associated with teething grinding,” Tyrrell says. She already has answered calls from people eager to resume daily life by wanting to make a routine dental appointment.
“Most of them understand that we’re not completely ready because their safety is our number one priority,” she says.