Remote dentistry is about as tricky as it sounds.
In a field that’s so dependent on touch, dentists say guidance from state health officials encouraging care over the phone to prevent COVID-19 from spreading has made their jobs far more complicated.
“Teledentistry is difficult,” said Dr. Mary Grace Rizzo-Fryzel of Electric City Dentistry. “For us to have a conversation over the phone, the only thing we’re able to do is prescribe an antibiotic or pain medicine.”
For about a week, Harrisburg reduced patient/dentist interaction entirely to the phone by, among other rules, requiring negative pressure isolation rooms — a room engineered to control infection — which virtually no dentist’s office has.
On Friday, following outcry from the Pennsylvania Dental Association and dentists across the state, the Health Department walked back the negative pressure room requirement.
The department still wants dentists to remain open, first assessing patients by phone and saving appointments for only the most pressing emergencies.
For cases that don’t meet the emergency threshold, guidance recommends prescribing antibiotics and painkillers until restrictions on movement are lifted.
When performing emergency procedures, dentists must wear disposable gowns and gloves, face shields and N95 masks, which remain scarce since the outbreak’s earliest days.
Afterward, patients must stay isolated at home until their provider or other public health officials advise otherwise, according to revised guidance.
Dentistry is not like other medical fields, where patients can describe their symptoms or send pictures to a doctor and, in many cases, come back with a diagnosis.
“You can’t take a picture of a problem. You need to feel the bone. Is the bone soft? Does it have a spongy feeling?” said Dr. David Shemo in Wilkes-Barre. “You need to press on the gum. Is there pus coming out? Is there decay?”
Like dentists around the state, he fielded calls from patients last week and did the best he could by phone, but waited daily for an update on rules.
On Friday, he said the state’s reversal on emergency procedures is still restrictive because many dentists don’t typically stock personal protective equipment like gowns and N95 masks.
Rizzo-Fryzel was able to secure enough N95 masks from contractors and has enough required protective gear to see patients now.
The state’s guidance follows Centers for Disease Control and Prevention recommendations, keeping in mind some infected people have minimal or no symptoms.
COVID-19 is a respiratory disease, and dentists are at a heightened risk for exposure because they work in patients’ mouths all day.
“It’s going to be very difficult to control a dental environment unless you’re going to control it like an operating room in a hospital,” said Dr. Lawrence Abouseif, a dentist in Reading.
Most dental offices aren’t built to fend off viral infections like that, he said.
In line with state guidance, Electric City Dentistry’s staff members survey patients over the phone and again in person to check for COVID-19 symptoms.
Rizzo-Fryzel kept all 20 or so members of her staff on, and said that she’s fortunate to have a large facility with space to encourage social distancing between staff and patients — as much as possible.
“Times like these allow me to live out my mission, and I have no doubt that we will weather this storm,” she said. “Someday, this will be a memory.”
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