'Getting Through the Scare': How Dentists Are Responding to COVID

John Whyte, MD, MPH; Patrick Bauer; Bob Brisco

Disclosures

May 06, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

  • The biggest issue about returning patients to the dental clinic is getting the message out that it's safe.

  • Dentists are following available guidance from the CDC and the American Dental Association.

  • Digital communications are being used to review new processes with patients and assure them of their safety in the clinic.

  • Some dentists are contemplating leaving practice, primarily because they are experiencing shortages in PPE.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD.

I'm joined today by Pat Bauer, president and CEO of Heartland Dental, and Bob Brisco, CEO of WebMD and Internet Brands. Gentlemen, thanks for joining me.

Patrick Bauer: Thanks for having us.

Whyte: We've been talking a lot about COVID-19 over the past few weeks, and now we're turning to how we are going to get patients back to clinic. How are we going to get them back to dental clinics? Pat, what are you seeing in terms of people's readiness to return to the dental office?

Bauer: Obviously, the biggest issue is, are we safe? Are patients safe? Do they feel comfortable coming in? The reality is that we've been working on sterilization techniques for years, and the normal daily routine is to protect patients from all kinds of viruses and everything else.

So, for us, it's just standard operating procedure. We're very careful already, so it's just getting that message out. We're going to use teledentistry to really try to let people know that they're safe.

Bob Brisco: Pat, you have something on the order of 1000 dental clinics around the United States. That's the biggest footprint of anyone in the industry by quite a measure. How are the dentists themselves doing during this period? Can you talk about that?

Bauer: They get so much information thrown at them. My main job is to get enough experts—WebMD, other people—to say, "Here's what the real science is saying." And so, getting through everything, [we're] primarily focusing on the Centers for Disease Control and Prevention (CDC) guidelines. The American Dental Association (ADA) certainly has some guidance, but it's literally just guidance. And then we look at the state boards to say, "What is it that they're really wanting to do?"

I'm old enough to remember when AIDS hit in the '80s, and we didn't have any sterilization techniques, pretty much. We didn't have gloves and masks and everything else, so we had to go through that process. Now, it might be slightly different. There might be N95s used for some aerosol. But the CDC is saying that you can use a surgical mask with a face shield or an N95. Either is acceptable.

So once you get through all of the scare, I think our doctors are just thankful that we didn't knee-jerk. We're going through the science. We're letting them know without being scared. I think there are a lot of solo practitioners who are just scared.

Brisco: How are you thinking about patient communications now? I know we've been doing some surveys and seeing that a fair number of patients are ready to come back in. And then, of course, there's a segment that's petrified, who are going to be hard to get back in, and there are some in the middle. How are you at Heartland thinking about engaging with patients during this transition period?

Bauer: More digital than ever. We're doing a lot of digital communications through Facebook. We have 1020 clinics through 37 states. And then telemedicine, teledentistry. We're going to do recare or confirmations that way so that we can actually see them and tell them it's safe: "Here's what you're going to see when you come in."

So it's just letting them know that things are different: "You're going to be safe, and we'll make sure you come in wearing masks." It's a whole process until we can get through this over the next 12-18 months.

Whyte: How do we help patients recognize that delayed care has consequences? That cracked tooth is an emergency that needs to be addressed. I think your point is very good that people are fearful about it. They've been told not to come in. And now we need to help them remember that dental health is important for overall health.

Bauer: Whether it be prostate cancer and they delayed your surgery, or periodontal disease that's not getting better, or a cracked tooth that's only going to break when you're eating bread, nothing hard—it's going to break when you least expect it—that's the stuff that we need to take care of that's just being delayed and pushed and pushed to the point where it's going to explode if we don't do something.

Whyte: We're hearing on the medical side, especially from solo practitioners who are a year or two away from retirement, "Enough. I'm closing shop early," which compromises access to care. Are you hearing the same in dentistry? And how is that potentially compromising access to care?

Bauer: Anecdotally I'm hearing it. "I'm not going to open up because I'm not sure I can even get the PPE, and I'm already 65. Why am I even doing it anymore?" I get a little bit of "I'm sick and tired of being sick and tired."

We're not seeing a massive amount of doctors calling us and saying, "Can you help me with my practice?" It's slightly higher [than usual], but it's not massive. I think people are trying to figure it out. I have a niece who is a hygienist, and her doctor is just not sure how he's going to get PPE.

So it's mostly the fear about whether they can get the right PPE. "Can I even start properly? How many patients can I see if I don't have the right PPE?" So, it's that shortage. I mean, there's a shortage on hydrogen peroxide right now. Literally, we can't get it. It's not even real that it needs to be used, but there's a shortage. And the shortage on gowns is certainly there.

N95s are tough because there's a lot of stuff coming in that says they're FDA approved, but once you look at the actual product, they're not. So there's a lot of stuff that people are thinking they can get. It's probably at least once or twice a day that I get somebody who says, "Hey, I can get you PPE," and it's not true.

Brisco: A comment and a question. Through our joint venture with Henry Schein One, we have a massive footprint across the dental space, and we've seen just how hard-hit it is. So, across the entire Internet Brands portfolio, travel has been the most impacted, but dental is next. We're seeing patient volumes down 85% or 90%.

We've been surveying patients, though, and it looks like a lot of them are ready to come back. I want to get Pat's thoughts on this. I don't think we're going to see an immediate V-shaped recovery right back to where we were before, but I'm seeing some reasons for optimism that this escalator back to where we were may go more smoothly than we hope. What are your thoughts on where we go from here?

Bauer: I think we're seeing the same thing that you're seeing. We actually surveyed, in the past couple of weeks of April, all the patients who came in on emergency. They came in on an emergency, so they wanted and needed to come in. But most of their attitudes were, "Yeah, I'm feeling safe. I felt safe coming in."

Whyte: Thank you both for joining us, and thank you for watching Coronavirus in Context.

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