NMDA Journal Summer 2020

nmdental.org 21 It was now that the real turning point happened for everyone because offices were forced to make the decision of to stay open, close, or open to limited capacity. We would go through each patient that was already scheduled and mark the appointment as either “keep, cancel, or optional.” And the optional meant to find out if the patient was in physical pain and wanted to keep their appointment, but if it wasn’t bothering them then we would reschedule. This was the worst and hardest part of our week and not simply because our schedule was decimated, but because we had to call patients and explain to them that their “treatment was not necessary, at this time.” Thankfully, we have great patients who understood the situation and fully comprehended the focus was on the second part of that sen- tence, “at this time,” as the crux of the issue and didn’t focus on the “treatment was not necessary” part. And that was the whole dilemma, we all know that all of the treatment that we offer patients is “neces- sary,” so we never want to tell them that it is not; so we emphasized the timing of it to convey our concern and most patients were happy or even relieved that we made the call for them. We continued to adapt, constantly evaluating what we were doing and seeing if there was more or less to do (usually more). After get- ting in all of our patients who had active periodontal disease who needed their scheduled maintenance cleanings, our hygienists began staying at home the week of March 23. Over the next days and weeks, we added a few steps here and there to further help pre- vent any possible spread. All staff began wearing masks fulltime in all hallways, sterilization, and reception rooms and we began taking temperatures of all staff at the beginning of each day as well as on our patients. We were still seeing patients, but between the three of us dentists, it was only a few emergencies and procedures to address disease and function that would worsen if untreated for three weeks, let alone three months. Now that we addressed our scheduling and mitigation concerns, we have the whole other dilemma to address. This was the financial, unemployment, and government stimulus ball of wax. We eventually furloughed all employees and only paid assistants and office manag- ers based on the few hours that they were asked to come in. Our staff all finally got through and applied for unemployment. Once we started hearing about the Paycheck Protection Program (PPP) loan, we began collecting all possible documentation so that we would be ready once the application process (ie: floodgates) were open. Our bank opened the application to us on April 8, which we sent every- thing right away. The SBA received our application on April 10, approved it April 11. Luckily, we were in line early enough to make the first round of funding before it ran out. This has been a significant help to us and our practice. As we were approaching May 15, the date that our state had current orders in force through, we were hopeful both for the health of our patients that we had been putting of for nearly two months now and for the health of our practice that we would be allowed to open to a greater capacity. We had meetings on what to do if we did start see- ing more patients and how we would do so appropriately. We came up with what we felt was a good game plan and once we could get the go ahead from the Governor and the association that we would be prepared to open back up safely. The most important items that we addressed were added respirator masks, the ability to conserve and reuse the respirators, added coverings, face shields, and barriers, rubber dams or isolites in addition to HVE, and still keeping our num- bers of patients and staff to 50%. We also had all our staff and den- tists tested with verified negative results prior to returning to work full time. We were hoping for the week of May 15 to hear an update that we could implement these safeguards and begin practicing again. To the credit of the NMDA and the team put together to discuss the options with the Governor, dentistry was allowed to begin treatment on non-emergencies as of May 11 if the practice could attest that they were in compliance with the added recommendations. With the added list of ADA and NMDA checklists, we were confidently able to verify and wherever necessary update our procedural plan and begin treating patients the week of May 11. That is where we are at now at the time of this writing. I am confident in the members of both our profession and associa- tion and that all along we have taken and will continue to take the appropriate steps to properly protect our patients, our staff, and our- selves. Unfortunately, we don’t have a crystal ball and can’t predict the future and how this virus may continue to affect us and our soci- ety. And even more so it is important to understand that this is a virus and like most viruses probably won’t be completely eradicated, so we do need to utilize a combination of natural immunity and man-made mitigation and/or treatment to best find a balance so that we can continue our way of life as a community and a country. Let us use each other’s knowledge and experiences to collectively come up with scientific and practical solutions. The first inklings of change started for us the week of March 9, 2020. We had been well aware, like everyone else, that there were the waves of the virus moving through the world, but still didn’t think drastic measures would make their way to us. Like most others, we were concerned with our patients’ and staff’s safety so we began at least discussing plans for new procedural changes, but didn’t know for certain to what extent we should do so, be forced to do so, or if they would even be needed at all. A Dental Practice's Recounting to COVID-19 Changes