Dentists worldwide have taken a substantial financial hit from COVID-19 closures. Rather than providing relief, the re-opening of practices is bringing a whole new set of business challenges: increased PPE costs, reduced patient volumes, and the restriction of aerosol-generating procedures, to name but a few. With the situation becoming financially untenable and the pandemic continuing with no clear end in sight, we discuss how recent research can help you can adapt, optimize and strengthen your business to overcome the challenges ahead.
The impact of COVID-19 on the dental practice
As we know, SARS-CoV-2 is primarily transmitted via infected droplets and aerosols. With the need for close patient contact and the high potential for aerosol generation, the dental operatory was considered one of the riskiest environments as the COVID-19 pandemic took hold. As a result, clinics worldwide were forced to close to all but the most urgent of cases.
It didn’t take long for dentists to feel the financial pressure. By June 2020, only 8% of British Dental Association members reported that they felt confident in their ability to maintain financial sustainability throughout the closures. But rather than providing much-needed relief, the re-opening of practices has come with its own set of business challenges.
One substantial challenge is the ongoing need for strict infection control protocols. Although absolutely necessary, the cost of additional PPE is a burden on already-stretched budgets. Meanwhile, patient volume (and practice revenue) is restricted by longer fallow times and enhanced disinfection procedures. And to complicate matters further, dentists are still limited in the range of procedures they can perform because of the need to minimize aerosols.
These conditions are becoming financially untenable for dentists. With the end of the pandemic not yet in sight, how can you strengthen your business and overcome the challenges ahead?
1. Optimize drill usage
In a 2020 study published in the Journal of Oral Rehabilitation, researchers discovered that aerosols generated from the use of a high-speed air turbine could be found up to four meters away from the treatment site, taking up to 30 minutes to dissipate.
While this validates the restriction of aerosol-generating procedures (AGPs) to date, researchers from Imperial and King’s College recognize that we cannot avoid AGPs indefinitely. After analyzing aerosol generation during dental procedures, the team identified a number of ways to mitigate contamination risk in the dental operatory.
The research team found that rotary instruments that used both water and air as a coolant projected droplets at speeds in excess of 12m/s. They recommend using water-only instruments, which were observed to significantly reduce small droplets compared to water- and air-cooled devices.
The team also found that using high-torque electric micromotor drills at speeds below 100,000 rpm, without air streams, produced 60x fewer droplets than air turbines. They identified an ideal speed range of 80,000-100,000 rpm to minimize projection while maintaining cutting efficiency.
Co-author Professor Owen Addison acknowledges that the slower use of drills will inevitably mean that some procedures still cannot be performed. Nonetheless, he points out that these new parameters will allow dentists to safely expand the range of treatments beyond the restrictions currently in place.
2. Try the ART procedure
Thanks to techniques like Atraumatic Restorative Treatment (ART), certain high-risk AGPs like caries removal can now be performed without using any mechanical instruments at all.
ART relies on slow-speed hand instruments to excavate decayed tissue, greatly reducing aerosol generation and SARS-CoV-2 transmission risk. The overlying restoration can be placed in the same session, reducing the need for further visits and limiting exposure.
With the need for high-quality products becoming more apparent than ever, consider using a bio bulk-fill material like Biodentine™ for your restorations. This all-in-one, bioactive and biocompatible dentine substitute is able to fully replace dentine in both the crown and the root, from the pulp all the way to the top of the cavity.
Thanks to its high resistance to compressive strength and superior sealant qualities, Biodentine™ has consistently proven to be an effective and reliable dentine substitute under composite restorations. In a study published in the Journal of Conservative Dentistry, Biodentine™ used in conjunction with a handpiece was found to have a success rate of 83.3% in pulp capping procedures.
Being able to offer your patients exceptional results with quick, minimally invasive treatment is a sure-fire way to guarantee their satisfaction, during the pandemic and beyond. And of course, happier patients and efficient treatment times translate to a healthier bottom line for your practice.
3. Use combined evacuation systems
Despite your best efforts to minimize it, some degree of aerosol generation is inevitable in the dental operatory. In response to this risk, researchers from Loma Linda University investigated the effectiveness of various evacuation systems.
During the use of ultrasonic scalers, the research team tested conditions including high-volume evacuation (HVE) and a combination of HVE and an intraoral suction device. The combination of both resulted in the greatest reduction of microbial aerosols.
For dentists, this could present an effective way to reduce not just transmission risk, but also costly fallow time between appointments.
4. Communicate with your patients
As the pandemic unfolded, the dental operatory was deemed unsafe and dental professionals were ranked among the highest for infection risk. Despite this, the Dental Tribune reports that there are currently no recorded cases of dental patients contracting COVID-19 during the course of treatment. Further, they report that the infection rate among dentists is lower than 1%.
What does this mean for business? Well, reducing fallow time and optimizing procedures means that you can see more patients — in theory. In practice, though, we know that some patients are still delaying treatment due to fears about virus exposure. If you can’t get your patients through the door, then none of the other measures you take will matter when it comes to your bottom line.
The findings reported in the Dental Tribune strongly suggest that the precautions you’ve been taking to keep yourself, your staff, and your patients safe have been very successful. Consider how you can proactively communicate this to your patients to reassure them that your practice is a safe place to receive treatment.
While the dental profession is still some way from “business as usual”, research is identifying new opportunities to rebuild and fortify your practice every day. The challenges ahead will no doubt continue to test us, but for the dentist who keeps on adapting, innovating, and optimizing, they can certainly be conquered.
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