How Columbia Is Getting Patients Back into the Dentist Chair
Last March, as the COVID-19 pandemic surged, the American Dental Association recommended putting all non-emergency dental care—including elective procedures and regular checkups—on hold to prevent the spread of the virus.
By summer, scientists were confident that tiny airborne droplets called aerosols were the main mode of transmission for SARS-CoV-2. Further, the aerosols could be spread by infected individuals with or without symptoms. But how do you make a dental clinic—where most procedures, including routine cleanings, root canals, and surgical procedures, generate aerosols—safe for patients and providers?
“Dentistry has always been at the cutting edge when it comes to keeping the clinical environment clean,” says Biana Roykh, DDS, MPH, associate professor of dental medicine and senior associate dean for clinical affairs at Columbia University’s College of Dental Medicine. “The idea of taking universal precautions to prevent the spread of disease is not new to us.”
Universal use of PPE, including the addition of N95 respirators for all providers and clinical personnel, the addition of patient navigators to screen patients for COVID-19 and enhance flow throughout the clinic, and measures to create space for physical distancing were among the first changes implemented to get patients back into the clinic.
“We’ve also reduced the number of patients in the clinics at the same time to allow for sufficient distancing in the reception areas and elevators,” Roykh says.
By expanding hours with early morning, evening, and Saturday appointments, the dental clinics—including teaching and practice sites—are currently operating at 75% to 85% of pre-pandemic capacity.
Providing care for children and adolescents has remained challenging, as only one parent is allowed to accompany a child during clinic visits. “Many of our patients are from low-income households and can’t afford to arrange for child care for siblings,” says Roykh. Clinic staff has called upon social workers to help make necessary arrangements, when needed.
Aerosol management and surface cleaners
The CDC mandated a minimum of 15 minutes between patients, giving dental providers time to clean the environment and sufficient time for the air to settle before seating the next patient in the dental chair.
Roykh says, “The CDC guidance was arbitrary, so we did our own air assessments to understand how much time was needed between different types of procedures across the various clinic and practice sites to create a COVID-safe schedule. We’ve also installed air purifiers with HEPA filters in key clinical areas to ensure we are bringing each patient into a safe environment.”
To reduce the spread of aerosols, the clinic installed partitions where appropriate and outfitted all 250 dental chairs with high-volume suction devices that are placed inside the patient’s mouth during routine care and procedures.
The clinic also has temporarily suspended the use of ultrasonic cleaners to remove plaque and tartar deposits from teeth until the course of the pandemic begins to change.
Clinic staff have adopted the use of foggers to spray and disinfect high-touch common areas, such as reception rooms. At the end of the day, facilities staff disinfect all surfaces in clinical areas, teaching areas, and break rooms.
Telehealth still an option for minor issues
Until the clinic was able to resume most in-person procedures, Columbia dental faculty were providing nearly 200 telehealth visits per week. An informatics team at the College of Dental Medicine developed an algorithm, using best available evidence and recommendations from the CDC and state and other national agencies, to screen emergency dental patients during the height of the pandemic last spring. This critical step helped keep patients and clinical teams safe by determining which patients with infections and other emergent conditions required in-person care and which could be best served by teledentistry support.
“We’re doing fewer telehealth visits now,” says Roykh, “but we have found that telehealth is a great way to troubleshoot minor issues and discuss preventive oral hygiene. It’s also helpful in bridging the gap to care for patients who may not have easy access to dental care services due to pandemic-related constraints.”
Pandemic’s impact on oral health is unknown
The clinic doesn’t have data yet on how delayed care or greater consumption of sweets during the pandemic has affected oral care for its patient population. Roykh says, “We have seen the effects of pandemic-related disruptions on patients with in-progress care, such as crowns, dentures, and restorations, which need to be very precise and timely in delivery and now need to be redone. Some of our patients have spoken out about the negative impact of delayed oral care on their mental health and well-being as well.”
Roykh says the clinic has pivoted toward providing more interventional care for patients with minor issues that progressed during the pandemic.
“Oral health is a critical component of overall health, and the pandemic may have taken its toll,” says Roykh. The College of Dental Medicine’s teaching clinics and ColumbiaDoctors dentistry practices are actively helping patients get back on track with all health routines, including scheduling COVID-19 vaccinations. “Now we’re also encouraging patients to stay vigilant about their oral health and come back to the dentist.”
For more information on how the dental clinics have created safe environments, visit the College of Dental Medicine’s web page on COVID-19 Safety.