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.
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A receptionist cleans a protective screen as another answers phone calls. The American Dental Association advises that patients should wear face coverings and wait outside for their appointments.Credit…Brittainy Newman for The New York Times
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.
“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.
Personal protective equipment is a must for dental appointments, experts say. This equipment is covered with adhesive to prevent the spread of coronavirus.Credit…Brittainy Newman for The New York Times
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.
Frequently Asked Questions and Advice
Updated June 24, 2020
Is it harder to exercise while wearing a mask?
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
I’ve heard about a treatment called dexamethasone. Does it work?
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
What is pandemic paid leave?
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
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.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
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 theUniversity 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
A young patient getting his teeth X-rayed.Credit…Brittainy Newman for The New York Times
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.
