At Dr. Todd Bertman’s office, the receptionist wears a plastic face shield. So do the hygienist and the nine doctors in the practice in Manhattan’s East Village.
Dr. Bertman reopened the office two weeks ago after closing it in March in response to the coronavirus pandemic. In another change from the past, he has switched from ultrasonic cleaners that spray water and saliva into the air to laser instruments.
The dentists and hygienists wear head-to-toe personal protective equipment that they change between appointments, a time-consuming, awkward ritual that requires them to take off booties, gowns, goggles, masks, gloves and the shields and replace them with clean ones.
“It’s like changing out of a spacesuit,” Dr. Bertman said. “It’s annoying as hell but this is what it kind of comes down to until we find a vaccine.”
As of June 19, every state had allowed dentists’ offices to reopen for all procedures, according to the American Dental Association, which surveyed thousands of dentists earlier this month and found that patient volume is at nearly 60 percent of what it was before March 15, when dentists were told to shut down except for emergencies.
James Famularo, a real estate broker in Manhattan, said he was desperate for a cleaning after three months of eating too many sweets and indulging in alcohol. He recently returned to Dr. Bertman’s office, where the dentist told him there was “a lot more shmutz” on his teeth than usual.
“I asked Dr. Bertman, ‘What’s all this extra digging that I’m not used to?’” said Mr. Famularo, 51.
His teeth, he said, now feel “squeaky clean.”
But should patients take the risk? When surveyed by The Times, many epidemiologists have said they were comfortable returning to their doctors. Health specialists said neglecting routine dental care was unwise. Some also noted that it is the dentists and hygienists who are more at risk of getting sick since they are the ones on the receiving end of any aerosol droplets that could contain the virus.
“All that drilling and suctioning, it’s the provider, it’s not the patient, getting aerosolized secretions,” said Laurie Anne Ferguson, dean of the College of Nursing and Health at Loyola University New Orleans and a nurse practitioner.
The American Dental Association has made a series of recommendations including advising patients to wear a face covering when they come in, having them wait outside or in their car until the dentist is ready to see them, removing magazines and toys from the waiting area, and placing hand sanitizer throughout the office.
Getting the first appointment of the day may also limit risk, though many dentists said they are seeing fewer patients so they have more time to disinfect rooms between visits.
Still, other health experts, including dentists, said they were skeptical about going to the dentist for anything that is not urgent, like an abscess, especially in the many parts of the country where coronavirus cases are rising.
“For everything that we’re doing, we need to ask if it’s really necessary,” said Peter Jüni, an epidemiologist at the University of Toronto and St. Michael’s Hospital. “We want to make sure we don’t contribute to transmission.”
Dr. Neetu Singh, the oral health program director at Health Care For All in Boston, said for now people should use telehealth or call the dentist first for a consultation, then assess whether to come in.
“A remote conversation is probably the wiser step to take at this juncture,” she said.
But Professor Ferguson said her experience treating patients during the pandemic had made her feel reasonably secure visiting the dentist.
If a dentist is taking proper steps, like wearing protective gear and seeing fewer patients, people should feel confident, she said.
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The Coronavirus Outbreak ›
Frequently Asked Questions
Updated July 27, 2020
Should I refinance my mortgage?
- It could be a good idea, because mortgage rates have never been lower. Refinancing requests have pushed mortgage applications to some of the highest levels since 2008, so be prepared to get in line. But defaults are also up, so if you’re thinking about buying a home, be aware that some lenders have tightened their standards.
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.
Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
“None of us like to go to the dentist and we’ll use any excuse not to go,” Professor Ferguson said. “But there is growing preponderance of evidence that our oral health is very much connected to our overall health.”
Dr. Bertman said his staff had been tested for the virus and the results had all been negative. He said to reduce the risk of transmission he had scaled back the number of the treatments the office normally offers, including cleanings.
Dr. Eli Eliav, director of the University of Rochester’s Eastman Institute for Oral Health in New York, which provides dental care for low-income patients and people with complicated medical needs, said patients coming in for invasive procedures must be tested for infection at least three days before their appointment
The office has set up tents for waiting outside the facility and extended its hours so doctors can see more patients and adhere to social-distancing guidelines at the same time.
“And we’re adding more time between patients to be able to disinfect the room,” said Dr. Eliav, whose institute remained open. “I understand why people are anxious and concerned. That’s part of our job — to make sure that people are comfortable coming back.”
Dr. Tim Lahey, an infectious disease specialist at the University of Vermont, said he believed now was not the time for people to “come face to face with someone you don’t know.”
But those who feel they must return should ask a lot of questions, he said.
“Are they being clear about people not coming in if they have symptoms? Are they being strict about wearing masks? Are they making sure that the person who works on you is wearing a face shield and a mask?” Dr. Lahey said. “These are probably a few highlights that people should be looking up.”
Mr. Famularo, the Manhattan broker, said he served as the “guinea pig” for his family and was comfortable with his two sons and wife going to the dentist after seeing the precautions Dr. Bertman took.
“I felt like even if somebody had something, I wouldn’t be infected,” he said.