Dentists say PPE shortage, 'aerosol' concerns could delay reopening of services

Saskatchewan dentists say shortages of personal protective equipment (PPE) and challenges with managing airborne particles from dental work could delay the return of routine services beyond May 4. 

'It’s definitely not going to be anything like business as usual,' says dentist Lauretta Gray

Dentists say their work presents unique challenges for dealing with COVID-19, along with shortages of personal protective equipment. (Kai Pfaffenbach/Reuters)

Saskatchewan dentists say shortages of personal protective equipment (PPE) and challenges with managing airborne particles from dental work could delay the return of routine services beyond May 4. 

The provincial government announced Thursday that medical services, including dental clinics, will be allowed to resume in the first phase of its plan to re-open the provincial economy next month. 

The dental industry in Saskatchewan is now moving quickly to refine its safety precautions so clinics can start taking patients whose dental needs have been put on hold for a month. 

The College of Dental Surgeons of Saskatchewan (CDSS) has provided more detailed reopening guidelines for clinics to meet if they plan to open by May 4th, according to an emailed statement by Dr. Douglas Brothwell.

Brothwell, the dean of the College of Dentistry at the University of Saskatchewan, added there is currently no date set for when the CDSS itself will reopen.

Organizational staff are currently working to meet the standards and protocols of the CDSS within the infrastructure of the school, which is described as "a complex procedure." 

The college said in a news release that dentists will be ready to provide care on May 4. Dentists say the services offered will likely be limited.

"We are going to look after you; these are challenging times for everyone in Saskatchewan including dentists and their dental teams," said associate registrar for the college, Dr. Mitch Taillon. 

"We are in this together and we will be there on May 4 at the door to welcome you back." 

Airborne particles create cleaning challenges

Dr. Lauretta Gray, a dentist at the Warman Dental Centre, said there are challenges unique to dentistry that make reopening more complicated.

Many dental procedures create aerosols — airborne particles thrown up by drilling and cleaning.  

"There is tons of evidence that this virus is in the saliva and the throats of potentially asymptomatic people," said Gray. 

Precautions already in place for emergency procedures, which are allowed under the current rules, require dental staff to wear N95 masks for services that produce aerosols. 

Staff have to put on and take off their PPE in a separate room before entering and after exiting the room where the procedure happens. There are more precautions in place for when the procedure is over. 

Provincial guidelines state dental equipment used must stay zipped up for at least two hours after use. Gray says that timeframe is to allow any airborne particles which may potentially have been in the room to settle.

"Then you don PPE again, you go back into that room, and then you can start the cleaning procedures," she added.

Gray said air filtration and evacuation systems could potentially get the turnaround time down to under 20 minutes, but the equipment would cost $5,000 to $7,000 per room — if it was available. 

N95s required under current rules

She expects N95 masks will continue to be required after May 4. 

"Given Saskatchewan is opening before some of the other provinces, my feeling is that the suppliers and the good graces of all the other — the dentists — that maybe have been keeping stuff will share their access if they happen to have any," said Gray. 

"I know that everybody is working really, really hard trying to get access to these things." 

She said a flood of the market with counterfeit N95s has led to recalls and there are problems with fit-testing, which she said is required for the masks to be effective. 

Gray said when clinics do open, "it's definitely not going to be anything like business as usual."

"We are all going to be looking for those guidelines [from the college] on Monday to see what other, maybe non-aerosol generating procedures, that we might be allowed to do," said Gray. 

"But unfortunately a lot of those procedures aren't super helpful for people with pain."

Ensuring public safety

New Brunswick, which became the second province to announce its recovery plan on Friday, has not set a date on reopening dental clinics. 

There, clinics will be opened three to four weeks after the COVID-19 curve flattens. 

Bryce Bahrey is a dentist and the co-owner of Downtown Dental in Saskatoon. He said he was surprised to hear Premier Scott Moe announce dentists would be included in the first phase of reopenings. 

"But it's good news, it's good news that we're able to get back to work," said Bahrey. "I think there's going to be a degree of caution that we all are going to need to proceed with. 

"Our priority going forward is going to be public safety and making sure our patients and our staff are well taken care of." 

Premier Moe says Saskatchewan's five-stage reopening plan will begin in May. 9:25

He too is waiting to find out how personal-protective equipment will be accessed, and if the province will play a role in assisting. 

The Saskatchewan Health Authority has been working to source more PPE for the province amid concerns about shortages.  

"Standard practice in dentistry is to get our PPE from several supplying companies," he said.  

"We've never had a direct affiliation with the government in terms of getting the equipment that's needed, it's usually privatized companies that we buy our stuff through.

"Which is where [although] the decision yesterday to reopen dental offices was good, it was still a little bit confusing to some of us in terms of, I'm assuming the government expects us to have the appropriate PPE, we're just kind of scrambling now to make sure that we can find it." 

'A new world'

In terms of aerosols, Bahrey said COVID-19 makes it a "new world." 

"It's becoming more of a discussion piece now and I think that's again where all the dentists are kind of looking towards the college and the government just to give us some guidelines in terms of how they want us to proceed," said Bahrey. 

"Is it a concern? I think the answer is yes and that's our hesitation in terms of getting back to full capacity. As much as we want to go back and fix people up and get back to standard dentistry we need to make sure that we're taking the appropriate precautions."

The College of Dental Surgeons of Saskatchewan said in a news released issued Friday that patients can expect changes when they go to their next appointment after May 4.

"Dental offices will be adhering to social distancing protocols by limiting the number of people and adhering to personal protective equipment guidelines such as face masks, face shields and gowns," it said.

The Saskatchewan Health Authority said it continues to work with suppliers and the federal government to acquire PPE.

It encouraged dentist offices to reach out the provincial Business Response Team for support.


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