As Ontario dental offices start to reopen to patients during the COVID-19 pandemic, behind the scenes they are juggling two sets of safety standards and growing concerns among those in the industry.
The result? Many dental office employees who’ve contacted Global News said they’re terrified to go back to work and expressed caution for patients making bookings.
“It’s putting staff safety at risk, it’s putting our family safety at risk because we’re the ones bringing it home,” said a dental hygienist with more than 25 years of experience. She agreed to speak out provided she was not identified.
Dozens of other dental hygienists and dental assistants — who are not in a regulated health care profession — expressed worry to Global News that they may contract COVID-19 when they start seeing patients again. Most expressed fear about stating their views on the record.
“Our only choice is to express our concerns publicly at the risk of losing our employment so that our safety concerns can be heard,” said one of many dental assistants who asked not to be identified.
The college that regulates dentists and their assistants has established one set of guidelines while the regulator representing dental hygienists is sticking to a stricter one.
“We’re very sorry there’s a conflict,” said Lisa Taylor, registrar and CEO of the College of Dental Hygienists of Ontario.
“The easiest would be to change ours to agree with theirs but we can’t find the evidence to support that.”
Ontario dentists are regulated by the Royal College of Dental Surgeons of Ontario (RCDSO).
In its guidance to dentists titled, COVID-19: Managing Infection Risks During In-Person Dental Care, dentists are directed on how to prepare their office, provide dental care, and how to use personal protective equipment (PPE) during aerosol-generating procedures, which may include procedures like teeth cleaning.
“We have made sure we are following what the experts are telling us to do. If there was any lack of safety we would not be allowing dentists to open under those specifications,” said Kevin Marsh, director of communications for the RCDSO.
Under the new RCDSO guidelines, dental offices are to deal with incoming patients based on screening questions.
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“Where in-person care must be provided to patients who have screened or tested positive for COVID-19, enhanced precautions must be used,” the guidelines stated.
The RCDSO released its original guidelines on May 25 but revised the document on May 31. The latter set of guidelines is less onerous on dental practices than the original one, according to those in the industry.
“There is a concern that prescreening will not pick up asymptomatic patients or clients,” said Margaret Carter, executive director of the Ontario Dental Hygienists’ Association. It represents approximately 8,000 of the 13,000 licenced hygienists in Ontario.
“It really does appear to be moving backwards in terms of a screening process,” Carter said.
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Dentists are now allowed to perform non-essential procedures that were suspended in mid-March. But each practice can move at its own pace.
“Dentists are not jumping out of the gate, it’s not like a horse-race where you’ve kicked it off. The offices are looking at what they have, what they can do, consulting with their staff and also considering the community spread of COVID-19,” said Dr. David Stevenson, a Carleton Place dentist and former president of the Ontario Dental Association.
“The key here is being able to get access to the PPE to do the procedures safely,” Stevenson said.
Other dentists say a shortage of PPE is a serious concern for them.
“They have no concept of the lack of PPE,” said Phu-My Gep, a pediatric dentist in Toronto, referring to the standards set out by the college representing hygienists.
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“I’ve been back-ordered since February,” she said, pointing out that many dentists gave away their PPE supplies back in March.
“Dentists were the first ones to donate PPE to the hospitals,” she said.
Other dentists say Ontario is moving too quickly in re-establishing access to non-essential care.
“Until everything is better understood maybe we should err on the side of caution,” said a Toronto dentist.
“I know that’s not lucrative for the dental field right now.”
The dentist insisted on not being identified “because I will be tarred and feathered for my views,” adding that making her views public “can see you drawn and quartered.”
The dentist is one of many who came forward to Global News in support of stricter protocols in support of safety for all dental office staff, including dental assistants and dental hygienists.
She said she believes patient demand for more access to dental offices is at least partly behind her college’s revised rules.
“There are patients that don’t understand the gravitas of the pandemic,” she said, adding she would advise patients to “hold off” seeking routine care at this time.
“We are in the middle of a pandemic,” she said emphatically.
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Another Ontario dentist who also asked not to be named said a “possy” of dental practice owners “likely bullied the RCDSO into flip-flopping” to create the new guidelines, which permit non-essential treatments including cosmetic procedures.
“I am outraged and do not want to practice under these new guidelines,” the dentist said.
“It’s ridiculous. Sadly, I think the RCDSO has messed up.”
The dentist said in an email that the current standards are insufficient during a pandemic.
“Dentists already have a bad rep with the public as greedy and overpaid. These new guidelines will just add fuel to the flame,” they said.
The dental college was not lobbied by dentists to change the guidelines, said spokesperson Kevin Marsh.
“The primary concern is the safety of patients, that’s the mandate of the organization,” Marsh said.
The registrar and CEO of the College of Dental Hygienists of Ontario said members are expected to abide by its rules, including the use of N95 masks during aerosol-generating procedures, regardless of the dental college rules or the instructions of their dentist for whom they work.
“The bottom line is we expect them to do everything to keep their clients safe and if they cannot, they should not perform the service,” said Taylor.
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