As dentists open, expensive PPE is in short supply

EVERETT — During work before the pandemic, dentist Amy Norman wore her everyday clothes under a gown, along with gloves, eye protection and a basic face mask.

Now she’s added scrubs, a face shield over a heavy-duty mask, such as an N95 or respirator, and hair and shoe covers.

“Without wearing all that gear, the risk to the dentist and dental assistant is very high,” she said. “They are splattering all that stuff out of the patient and into their face, their eyes, their mouth.”

Norman’s office is in Everett, at the corner of 36th Street and Colby Avenue.

She and other dentists around the state closed for two months because of the coronavirus pandemic. In March, Gov. Jay Inslee halted elective procedures to save protective equipment for medical workers exposed to COVID-19.

Even though dental offices were allowed to reopen at the end of May, there still isn’t enough protective gear to go around. Norman and other dentists have had to find supplies in places they usually wouldn’t, and prices have skyrocketed. In many cases they’re working together to trade equipment and letting others know where they’ve found supplies. Single-use masks can now cost around $10 each.

Most dentists donated supplies to hospitals when the closures were announced and have had to stock up again, almost from scratch. Employees also need more protective gear than before, and masks must have high filtration.

“What works for one person doesn’t work for another,” Norman said.

Most workers now wear a mask for much longer than they’re used to. One day a dental hygienist started to feel woozy and had to step away from an appointment.

“It was obvious she was in distress,” Norman said. “She didn’t even make sense, she wasn’t speaking right.”

They found out she wasn’t getting enough oxygen while wearing the mask. Now she has to use an oxygen tank to breathe while working.

Norman has converted a consultation room to store all the supplies, including air filtration systems and other equipment. With all the extra gear employees are wearing while working under bright lights, she also has started to crank up the air conditioner, which adds to the costs. She’s asked patients to bring blankets into the office.

At the same time, employees are reusing much of the protective gear, wearing it longer than usual. While it doesn’t harm the patient, it’s gross for the worker, Norman said.

“You breathe your own air for four days before you throw a mask out and watch what it does to your skin,” she said. “The skin comes off, there’s acne, there’s bacteria that you’re breathing in. We need to get the supply chain fixed so that we can have masks that are meant to be single-use back to being single-use.”

Some agencies have been handing out gear, but dentists still have to purchase most of their own equipment. Because of that, patients might begin to see new charges on their bills.

Travis Gnehm didn’t notice any of these kinds of fees after a couple of recent trips to the dentist. He lives southwest of Snohomish, and his dentist is on Seattle Hill Road.

He and his 4-year-old son, Asher Gnehm, both had emergency visits during the closures. Gnehm, 31, didn’t notice the dentist wearing any extra gear either of those times, but no other workers or patients were in the office.

He was slightly worried during the first procedure.

“We don’t know a ton about the virus, so in my head I was like, ‘Could the virus be sitting on the chair?’” he said. “I felt better the second time, because I knew they were super serious about taking all the precautions.”

Gnehm came back a couple of weeks later and was the first patient to return when the office opened.

He pulled into the parking lot and called inside the office. On the phone the receptionist asked a series of questions. After, she came outside to check his temperature while wearing full protective gear: gloves, a gown and a face shield. He didn’t see any other patients during the visit.

Both the dentists and assistant were wearing two masks, plus a face shield that got in the way of the dentist’s headlight. The dentist said he hadn’t planned for that before getting to work.

“I remember him mentioning, for the face shield, it sounded like it was hard to come by,” Gnehm said. “I guess eventually he got them from a welding distributor.”

Some insurance companies have announced they’re covering a portion of the new equipment charges, said Bracken Killpack, executive director of the Washington State Dental Association.

“The concerns about personal protective equipment are right,” he said. “One of the things we’ve been working tirelessly on for the last few weeks has been working with state and federal resources to get PPE to dental offices.”

So far, the association has acquired about 150,000 surgical masks and 300,000 N95 masks for dentists across the state, he said.

Dentists also have been confused about what guidelines to follow. There’s been conflicting information from various sources, such as the American Dental Association, the Centers for Disease Control and Prevention, the state Department of Health, state Labor and Industries, and the governor.

At times the rules can be contradictory even when coronavirus is not part of the equation, Killpack said.

He points out that dentist offices are some of the most sanitary places once cleaning is complete. No COVID-19 cases have been traced back to a dental office, according to the CDC.

People should not put off going to the dentist if they think they need help, Killpack said.

He’s heard of people who chipped a tooth and didn’t call their dentist during the closure and ended up needing a more serious procedure than they would have if they had taken care of it right away. Offices were allowed to open in case of an emergency during the shutdown.

“Oral care is integral to overall health,” he said. “Going to the dentist may look a little different before you get there and when you get there, but dental professionals are doing everything in their power to make it as safe and patient-friendly as possible.”

During the closures, business in dental offices fell 90% to 95% of normal capacity, Killpack said.

Even now, Norman has been seeing about half the patients she normally would. Mostly that’s because of social distancing and the time it takes to clean the office between visits.

“You cannot do that at the pace dentist offices were doing before,” she said.

Dentist B. Ardi Pribadi has seen somewhat more than that at his Arlington office, Autumnwood Dental. He’s also president of the Snohomish County Dental Society.

“We are seeing 25% less people, but doing 25% more of the work,” he said.

Though he’s seeing fewer patients than usual, he’s booked until August.

He has many of the same concerns as Norman when it comes to protective gear and the conflicting guidelines. Plus, he’s had employees quit because of worries about coming back to work. He’s been training people while trying to navigate the new system.

When asked what it’s been like to open again, he replied: “It’s a nightmare.” He’s heard from other dentists who have had the same frustrations.

When it comes to protective gear, Pribadi so far has paid for it himself. He knows many dentists who have kept their businesses going through the pandemic and with the new financial burdens, but others have closed.

“Those that were teetering on the edge of bankruptcy,” he said, “this is probably pushing them over the edge mentally and financially.”

With all the extra costs, Norman said, her business is “hemorrhaging money.” She hasn’t taken home a paycheck in three months. But even with the extra costs, she doesn’t see an alternative.

She loves what she does and is happy to see her patients again, and knows her team is working hard to make sure they’re safe inside the office. If she stayed closed any longer, she might as well close for good, she said.

“What am I waiting for?” she asked. “COVID’s not going away.”

Stephanie Davey: 425-339-3192; sdavey@heraldnet.com; Twitter: @stephrdavey.