The COVID-19 Pandemic has changed the definition of the word ‘normal’ for everyone. All sectors have been hit but the impact on the Private Dental clinics has been severe for several reasons. – Dr. Sushen Sharma B.D.S, M.D.S (Govt.) Prosthodontist and Implantologist, Owner Kripa Dental & Implant Centre
The Dentists are at very high risk to acquire as well as spread COVID-19 infection. This is due to the fact that the Coronavirus spreads through droplets & is abundantly present in Saliva which contacts the teeth, tongue, cheek palate, etc. Not to forget, almost all dental patients spit inside the spittoon of the dental chair. The Dentists frequently touches the lips, nose chin and face of patients inadvertently and unavoidably during the part of the treatment. Dental X-rays again require contact with saliva. All these lead to possible contamination of the Dental workplace.
Perhaps the most threatening By-product of almost all dental procedures is the production of Aerosols. The aerosols of a COVID-19 patient are a very potent source of infection to the dentist, dental assistant and can also contaminate the entire dental operatory. So the dentist and the dental assistant are not only at a higher risk of getting infected, But they pose a higher risk of transmitting the virus to other patients whom they see in the practice. Since the aerosols may have contaminated the entire dental clinic, even the people who are sitting in the waiting area accompanying the patient can also get infected by the simple breathing of those aerosols. Any area of the Dental clinic – door handles, furniture, magazines, tv remote, water dispenser – anything that has come in contact with a COVID-19 patient or the Aerosols – is now contaminated and can further infect any new patient. This can be a very dangerous scenario where a single Dental Clinic can potentially spread the coronavirus to several hundreds of other people.
The risk of COVID-19 transmission through Aerosols is so severe that the Supreme court via its 8th April order, & the Dental Council of India(DCI) via 16th April guidelines have instructed to stop all aerosol generation procedures. High-quality PPE(Personal protective equipment) & N95 masks for both the dentist and the assistant per patient are absolute must to prevent themselves from getting infected. Strict disinfection of the dental chair, spittoon, equipment, instruments, floor, door handles, furniture has to be carried out with special chemicals or by Fumigation – before and after every dental patient appointment. Only Treatment of Dental Emergencies is advised as per the DCI Guidelines. The Use of PPEs and N95 masks and the extremely high level of disinfection and sanitization protocol is not routinely employed in a dental clinic. The Dentists are usually less trained to routinely follow and employ these high levels of disinfection which are seen only in ICUs or hospital settings.
The cost of running a dental clinic in this scenario is far more than that of getting a livelihood out of it. For example, a very simple tooth removal/extraction procedure which normally costs 500-1000 rupees is impossible to do following the above guidelines and without the risk of spreading the infection. This is because the cost of the PPEs & N95 masks and the disinfection protocol will itself be a minimum of 3000-4000 rupees per patient appointment. The PPE has to be changed after every patient to minimize spreading infection to other patients and everything has to be disinfected again. So for a routine 500-1000 rupee procedure, the dentist will be at a loss of about 3000-3500 rupees.
The number of patients coming to the dental clinic will automatically decrease significantly due to the fear of getting infected along with the lockdown restrictions. Most cosmetic procedures that are highly rewarding for the dentists are also Aerosol generating, thus not possible to do as of now. Special hospital settings that cost lakhs of rupees will be needed to carry out the Aerosol generating activities such as the Negative pressure room. Thus, Dental clinics are forced to shut close during this lockdown Or worse, keep open and risk spreading the infection and making losses! Hence, you will observe that almost 100% of dentists have closed their clinics amidst the lockdown and following the AAA protocol for their patients. This includes Advise, Analgesics & Antibiotic prescription over the telephone for patient relief as recommended by the American dental association.
The lockdown has indeed been very painful for those dentists who have taken loans to purchase dental equipment and machinery. The Dentists who pay their monthly rents are also severely stressed in these times. It’s difficult to pay the salaries to their staff as they are completely shut. Thousands of Dental labs which make dental prosthesis like Dentures, caps, and bridges are also completely out of work and not even getting their previous due from dentists due to lockdown. The Dental Tourism Industry which formed 10% of medical tourism will also be hit severely. There seems no relief over the next 2-3 months and we as dental fraternity can only hope for the things to get better soon.
