Lessons from the Pandemic for Dental Practices: A Year Later

Cindy V. Roark, DMD, MS


It’s hard to believe it has been about year since dentistry was shut down nationally to all but those requiring emergency care. Reflecting on the uncertainty of the early days of the crisis and the confidence with which we deliver care today, I have to say I am proud of how the dental profession has handled COVID-19.

The saying “Necessity is the mother of invention” was never more accurate than in 2020. It was a year of rapid change in terms of PPE shortages and requirements, social distancing and its implications on practices, and lightning-speed adaptation within a constantly changing regulatory landscape. Although some of the technological and functional changes we implemented at the beginning of the pandemic were out of necessity, many hopefully will be here to stay.

The Importance of PPE

One of the most important lessons we have all learned is that dentists were already doing the right things when it comes to safety. Initially, the picture was not promising. By virtue of operating in an aerosolized environment, both providers and patients feared that dental offices would be hotbeds of transmission. Dentists and hygienists were thought to be among the most vulnerable to COVID-19 from an occupational standpoint.

In reality, there has been little to no transmission in dental offices, as reported by the Centers for Disease Control and Prevention (CDC). Let’s face it. The field of dentistry is no stranger to infectious disease. Offices deal with the possibility of transmission from every patient, every day, which is why dentists are taught from day one of dental school about the importance of universal precautions. It is now clear that those precautions are effective and that dentistry was and is well-suited to deliver care before, during, and after the pandemic.

As dentists struggled to balance fear with precautionary measures, we all gained a new appreciation for the importance of good PPE. My favorite childhood dentist, Dr. Timothy Martin, was cutting-edge in all areas of practice. But cutting-edge in the 1970s did not involve wearing gloves and masks.

Contrast that to today where gowns, booties, caps, and N95 and KN95 masks are all used in addition to basic safety gloves. Though many providers find the added PPE to be a small nuisance, the ability to deliver care and still feel extremely safe—not just for ourselves but for the patients we serve—is worth its weight in gold.

Exploring New Products

One of my favorite lessons from the past year has been the importance of continuously seeking new products, because the challenges in our field are always changing. I had not always appreciated the need to continuously pivot. In the past, once I found my favorite products, oftentimes I simply stuck with them.

The pandemic caused me to investigate new products, such as IoRinse Molecular Iodine Mouth Rinse. A recent study showed that it was the only product that was completely effective at deactivating SARS-CoV-2 in the mouth.

The latest research from the Journal of Clinical Periodontology stated that patients with gum disease are nine times more likely to die from COVID-19, three and a half times more likely to be admitted to intensive care, and four and a half times more likely to need a ventilator.

Having newer molecular iodine products available as a pre-work rinse for team members and as a pre-operative rinse for patients goes a long way in terms of reassurance of safety. Would I have adopted it without a worldwide pandemic? Perhaps not as soon. Now? I can’t live without it.

Establishing Trust with Your Patients

I also learned that communicating your absolute commitment to safety was key to re-establishing trust with patients. At Sage Dental, we created a three-pronged SageSafe protocol for our supported offices, providers, and patients. This became the cornerstone of the communications we shared with patients.

The SageSafe program involves everything from text-to-check-in from your car instead of the previous “waiting room” scenario, temperature checks and a health survey at the door, as well as pre-procedural rinses, contactless payment, and online scheduling.

Sage also invested in hospital-grade air purification, additional extra-oral suction units, and enhanced PPE. Everyone from the office staff to the dentists had to be able to clearly communicate to patients how and why we were implementing such measures. 

While the ADA has strongly encouraged patients to continue regular care during the pandemic, patient volumes continue to remain at about 78% of pre-pandemic levels nationally. At Sage, however, we’re up to 105% of our pre-pandemic patient volume, meaning we’ve taken on new patients who weren’t able or weren’t comfortable getting care elsewhere.

From confirming to patients that it is safe to receive care during the pandemic and encouraging anyone who did put off care that it is safe to come back, our teams are doing an amazing job. In essence, creating a strong infection control plan was not enough. Communication of this plan was critical to our return to normalized care.

The Importance of Industry Advocacy

Though I have been a standing member of the ADA and the Florida Dental Association (FDA) Tripartite for nearly two decades, I have never concretely felt the impact more than during the pandemic. As we know, CDC recommendations changed frequently, and variations on policy and regulation differed on a state-by-state basis. Sage Dental exists across multiple states, which meant a unified reopening plan was not an option.

I was grateful to have had the guidance and advocacy of the ADA in terms of CDC guidelines and policy interpretation. Everything from the ADA Morning Huddle emails to the reports from the ADA Health Policy Institute have influenced my continued governance during these times of constant change. I’m also not sure how I could have operated without the constant updates, lobbying, and advocacy at the state level from the FDA. In short, it was incredibly helpful to have unified industry guidance as we navigated this difficult chapter.

Leveraging Technology

The final and possibly most critical lesson I learned was the importance of leveraging technology. According to an April 2020 poll from the ADA, almost 25% of dentists reported using a teledentistry platform during the two-month national shutdown. Today, that number has settled at around 20%. However, at Sage Dental, we have made teledentistry a priority.

The lockdown orders were given late on Friday, March 13, 2020. By Monday, March 16, all 60 of our supported practices were online with the Dental Monitoring teledentistry platform for emergency triage, virtual consultations, and remote monitoring.

Sage Dental had already been in the process of implementing the Dental Monitoring Orthodontic Artificial Intelligence program, which placed us in an incredibly good position to leverage teledentistry capabilities in a way that others who were new to such systems could not.

While there was no way to predict how important technology would become in 2020 due to the pandemic, those who made it a priority definitely had the advantage in terms of patient care.

2020 Hindsight Brings Future Foresight

Looking at the entirety of the last year, I can honestly say that Sage Dental has weathered the pandemic and emerged a better DSO for it. We have industry-leading infection control protocols, ample PPE supply, incredibly effective new anti-viral rinses, more efficient patient flow processes, and an AI-enabled teledentistry platform.

As we look to see what the next phase of the pandemic holds for the United States and around the world, I feel confident that dentistry can hold its own and continue to deliver first class care in a safe environment.

Dr. Roark is the senior vice president and chief clinical officer at Sage Dental, responsible for overall clinical leadership, including enterprise-wide clinical strategic planning, developing and improving clinical protocols, researching new technologies and services, overseeing quality assurance, and providing professional development opportunities to 500 clinical team members and over 65 supported dental practices. 

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