From Todd Weaver, DMD, MAGD
Our practice was established in January of 1994 by Todd Weaver, DMD, MAGD and John Reckner, DMD, MAGD —both classmates from the class of 1991 from Temple University Dental School, now Maurice H. Kornberg School of Dentistry. The practice has expanded from the original location in Souderton to include a second new office building in Harleysville, PA. Tracy Reinhart, DMD, FAGD and George Reinhart, DMD joined the partnership which is now known as Weaver, Reckner, and Reinhart Dental Associates, come to be known as WRR. Two additional dentists have joined WRR as associates, David Guengerich, DMD and Chris Zeledon, DMD, giving the two practice locations six full-time dentists. There are 17 Hygienists, eight EFDA’s, 16 Dental Assistants, and 20 Administrative Employees.
When the announcement came from the Pennsylvania Department of Health in March that dental offices needed to close across Pennsylvania to mitigate the spread of coronavirus, WRR immediately suspended treatment and within a week reopened for emergencies only in the Souderton office with one dentist, one or two assistants, and one or two administrative employees. Everyone treating patients wore an N95 mask covered by a surgical mask. We added a head covering, face shield, and disposable gowns. Both offices were retrofitted with filter systems in the HVAC units and each treatment room was serviced by an air filter in-room purifier. Patients were seen one at a time and waited in their cars until they were to be seated. A full infection protocol was written and has been revised periodically since March.
Hygiene did not return until June when we were advised that hygiene was permitted with some restrictions. We used rubber dam on every procedure possible and limited use of high speed as much as possible. Because we do a lot of emergent dentistry, we really were in demand for our services of oral surgery and endodontics throughout the initial three months. And because of virus transmission and travel risk, we cancelled our annual dental mission trip to Nicaragua that was scheduled in April 2020. We feel that our office is, and has been, absolutely safe. We have taken all appropriate and beyond required steps to protect our staff and patients.
Now that we are in the sixth month living through the virus impact, much of the protocol is still in place. We still wear the N95 masks with surgical masks covering them. However, we also permit KN95 masks and with non-aerosolizing procedures a traditional Level 3 mask alone. Our heads are still covered, and face shields worn. Patients still wait in their cars if possible. But what has changed is that both our offices are opened for treatment, we have hygiene resumed in both offices, orthodontics chairs are now being filled, implant surgeries are resumed, and two dentists are working at the same time in each office.
We stagger appointments in chairs and both dental and hygiene rooms have an added ten minute clean up time following the procedure. What this means is that we are seeing about 70% of the patients we used to in the same amount of time, so we have expanded our hours to accommodate the slower schedule and care for the back log of patients still needing dental appointments cancelled during the first few months of the crisis. We are working harder and longer and performing fewer dental procedures, but everyone is safe. Safety in the dental office is what we continue to celebrate.
Going forward, we will follow Pennsylvania Department of Health guidelines, CDC actions, and ADA policy recommendations. But we also move forward confidently, without fear, without anxiety, and without false information. We view the opened dental office as primary and essential for public health. We feel it is absolutely safe and always has been safe, to treat patients in our dental offices with the added precautions. We encourage all our colleagues in dental offices to pave the way forward in their communities with good procedure and protocol leading in safety and infection control measures.
Our profession as generalists in dentistry forms relationships with patients, is gifted in communicating empathy, and understands effective listening. We want to use these acquired skills we have developed in dentistry to help our communities recover and move forward and touch the lives of our patients with hope, inspiration, and good oral health.
From Frederick Lally, DMD, MAGD
I was in solo practice for eight years, had a partner for 25 years, and now am back in solo practice for the last six years. I have a mature patient base and many of them have co-existing medical issues, so I have taken great efforts to provide a safe environment for them to come and have their dental needs met.
Currently, we are down two dental assistants. Prior to COVID, I had two dental assistants, two hygienists, and one person at the front desk. One dental assistant moved on to a job in the medical field around the time of COVID beginning; the other dental assistant stayed with me up until the end of August, but has now started dental hygiene school full-time. I have attempted to hire other dental assistants with little luck. There have been very few applicants and the couple that started did not last very long. Currently, my hygienists are acting as dental assistants and alternating their days assisting me with their scheduled hygiene days. We are still advertising and looking for dental assistants.
When we re-opened after the emergency patient only practice mandate, we made several changes in the office. We see fewer patients per day as we generally allow more time per patient than previously. I do not do hygiene checks on every hygiene patient that comes in. (We still make sure the patients have a doctor’s exam one time per year.) Appointments are staggered to keep the number of people in the waiting room or at the front desk to a minimum.
We use fewer operatories. Two internal operatory’s (without windows) are used as our “donning and doffing PPE” rooms. We converted our consultation room into our staff locker room. Staff wear their street clothes/shoes in to work, change into scrubs and work shoes and reverse the process before they leave. Scrubs are laundered on premises. We use washable gowns and surgical caps as well.
We have invested in air cleaners and extra-oral suction machines to control the aerosols. Cold fogging is done daily as needed. We have fans in the operatory windows to provide a positive airflow from the front of the office out the back where the doctors treatment rooms are located. We expanded and reorganized our supply closet to accommodate the PPE inventory and make it easier
We have received many positive comments about the changes we have instituted, and patients have shared that they have not gone out to other places too much but feel safe visiting our office. It has been quite the evolution adapting to the new dental world. I credit my staff for their efforts in making it all possible.
From Maria Tacelosky, DMD
I practice at the Susquehanna River Valley Dental Health Clinic in Sunbury. The clinic is a private non-profit (501c3) facility that takes care of patients who are either on medical assistance or are low-income and uninsured. SRVDHC opened in 2009 with four treatment rooms seeing a few hundred patients a month. In the last ten years, the community’s need has grown, and the clinic has grown alongside the demand. We now have 14 dental chairs on three floors, have a dedicated pediatric floor, and see about 1,000 patients a month.
Before COVID-19, the clinic employed:
- One full-time general dentist
- Two part-time general dentists
- One part-time pediatric dentist
- Four full-time PHDHPs
- Four EFDAS, three full-time and one part-time
- Two Dental Assistants
- Two Front Desk Coordinators
- Two Clinic Managers
Last January and February, the clinic treated an average of 82 patients per day with a 22% no-show rate. When the pandemic hit in March, SRVDHC remained opened following Governor Wolf’s guidelines, from practicing teledentistry to seeing patients for emergencies only. The clinic had no choice but to furlough some of its employees, retaining others on a part-time basis. Employees who remained at the clinic were divided into two teams to minimize their exposure to COVID-19: One team coming in the first two days of the week, and the other team covering the other two days. The teams consisted of myself, one EFDA, one front desk coordinator, and one clinic manager.
For the first four months of the pandemic, I remained the clinic’s only full-time employee. During these months, I spent many hours following the CDC, ADA, PDA, and PAGD news releases. I learned how to keep ourselves and our patients well-protected. We started alternating operatories, so disinfecting treatment rooms after each patient could be done thoroughly, allowing each room to sit for 15 minutes before disinfecting it until the CDC revised this guideline. Once Governor Wolf allowed us to see patients for extractions, we began doing so, helping so many patients out of pain, while keeping them from utilizing local emergency rooms for a visits that would have inevitably ended with a dental visit anyway.
Since March, we have slowly changed and revised how we do things. Patients are called the day before their appointment and screened for COVID; if there is no answer, they are asked to call back to confirm their appointments. Once they arrive, they call from their cars, and they are asked to wait until we can safely ask them to come in. We have created social distancing in our waiting rooms for those waiting to be taken to treatment rooms. Once a patient checks in, they are again screened for COVID. When they are taken to the treatment rooms, they are once again asked if they have flu-like symptoms, have their temperature taken, and are asked to use hand sanitizer.
As guidelines began to loosen in July, the clinic called back one more EFDA and two hygienists. We were then averaging 42 patients a day as we worked with limited staff and took longer with each patient. Our “new normal” began in September as other dentists returned to SRVDHC. We started seeing patients for prosthodontics once again, and pediatric patients who needed restorations.
We are now working with time limitations as we cannot see as many patients as we were able to see before, and with reduced staff, as some members could not come back into the field because of health or personal reasons. Personal Protective Equipment has also changed how our day goes. Keeping us adequately supplied with PPE and disinfecting materials has been challenging and time-consuming. We would not have had the necessary PPE supplies and kept our staff safe without the clinic’s supply representatives and many phone calls to different companies as items were back-ordered.
COVID-19 has made us rethink how we practice dentistry, and it has slowed us down and limited us more than we would have liked. But at the end of the day, SRVDHC has shown the community that we are here to serve them through the good times as well as the bad.