Making use of unexpected dental practice downtime

Jennifer Sanders, DDS, acted quickly in her private practice in Frenchtown, Mont., when the stay-at-home orders hit. As soon as the ADA came out with their recommendations, she began canceling appointments a week at a time. 

“We are not sure how long this is going to last,” Dr. Sanders says. “Nobody is.”

You don’t know either, but you are doing your part. You have closed your practice to all but the emergencies. With the “stay-at-home” directives moving from being counted in days to weeks and beyond, what else can you do?

Plenty, according to our experts. Here are a few things dentists are doing during the shutdown.

Treating emergencies

The first thing Jeff Lineberry, DDS, FAGD, did with his private practice in Mooresville, N.C., was cancel scheduled appointments. With a skeleton crew on hand to reschedule patients, process claims, and other business, he is treating emergencies only. 

“I see our role during this pandemic is to keep patients out of the emergency room,” Dr. Lineberry says, adding he now pre-screens patients on the phone.

Jason Goodchild, DMD, vice president of clinical affairs for Premier Dental Products Company, says at his Havertown, Penn. practice, they adopted the emergency-care-only protocol immediately after the CDC and state recommended it in mid-March. While he admits that everyone is handling the emergency care only order in their own way, he feels the CDC and ADA put out useful guidelines on what a dental emergency is. 

 “We strictly adhere to that, and I think that’s the right thing to do,” Dr. Goodchild says. 

The ADA’s guidance from March 18th defines emergencies as those conditions considered life-threatening, require treatment to stop bleeding, or alleviate severe pain or infection. Bleeding, cellulitis, soft tissue bacterial infections causing swelling that can compromise the airway, trauma for facial bones that can compromise the airway are all identified as emergencies. Additional situations that could require immediate dental care include pulpal inflammation, pericoronitis, suture removal, and denture repairs.¹

It’s up to the dentist to determine if the situation warrants an in-person visit. However, the ADA published algorithms in their “Interim Guidance for Management of Emergency and Urgent Dental Care” to help. The algorithms can “assist dentists and dental offices in making informed decisions concerning patient triage, evaluation, and treatment during the COVID-19 crisis.”

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The ADA seeks to have the dentist help alleviate the need for these patients to go to the emergency room. However, the ADA urges dental professionals to treat them as minimally invasively as possible to avoid conditions that can spread the novel coronavirus that causes COVID-19. 

Dr. Goodchild says it is incumbent upon dentists to be learning the facts about the pandemic on a day-to-day basis because it changes by the minute. He recommends monitoring the ADA, the CDC, and Clinician’s Report websites for the daily updates they publish. 

“You have to learn what’s going on and do what you can to protect yourself, your team, your patients, and everybody else,” Dr. Goodchild says.

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Communicating-a lot 

Tera Poole, DDS, MS, is the clinical director for Uniform Teeth, a doctor-led orthodontic practice applying the latest technology, including telehealth, to orthodontic treatment. Once the stay-at-home order arrived, the practice increased communication with patients through its mobile app, email, and social media. 

“We’ve had a steady stream of updates and progress messages for patients. We make sure that once we have information on our end, we continue to pass that along,” Dr. Poole says.

Uniform Teeth is taking the same approach to communication with its entire team. They spent a lot of time researching the dental boards, the CDC, and the ADA recommendations, which they relay to the team. 

“One of the core concerns for our business is to preserve our team’s benefits as much as possible during this challenging time. We’ve focused on doing everything we can to support our team during the clinic closure period. Ultimately, we believe we will come out stronger together.” Dr. Poole says. 

Since February, Uniform Teeth has been proactively communicating about COVID-19 and its plans to its team, even on a weekly and at times daily basis. Since the shutdown, the communications are about what the company is working on during this time. From app updates to operational improvements, communication is critical for the Uniform Teeth team. 

“We still have people reaching out from the customer service team to our patients. Our model is that patients do not have to come in as often, so we have a lot of patients mid-treatment and progressing. If there is a silver lining in this, it’s that patients can still check-in and progress through their trays by keeping that communication line open.”

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At Dr. Goodchild’s practice they believe it is the dentist’s responsibility to make a plan and communicate it with the team and patients. Dr. Goodchild suggests updating the website, using social media, and leveraging practice management and patient communication technology to this effort. 

“Over-communicate with patients to let them know that you’re available for emergencies and that when things normalize a bit, we’ll be ready for you again,” Dr. Goodchild says. 

Re-examining business as usual 

Sarah Jebreil, DDS, AAACD, has a private practice in Newport Beach, Calif. When she goes in to treat emergencies, there are a few different new protocols. For example, Dr. Jebreil ensures that there are only three people in the office, and patients wait in the car until they can enter the operatory. They also take temperatures of patients and staff to ensure no one is bringing COVID-19 to the practice. The team is also meticulous in their wipe-downs between patients. 

During the shutdown, Dr. Jebreil has also been using Smile Snap, a website widget for virtual consultations. She likes Smile Snap because it allows her to do the consults when she has time, which is in short supply while she is working from home with children. 

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“With the roles changing and not having a nanny or a housecleaner and not having the kids at school, I can’t do online consults on demand. So, Smile Snap is nice because I can do them when I have the time,” Dr. Jebreil explains. 

Dr. Lineberry thinks dental offices should also take this opportunity to reset and take care of things they don’t have time for when patients are there. They can optimize staffing, clean up patient records, and organize by active and inactive patients. His team is also taking care of other essential to-dos, including training and reorganizing materials and equipment for efficiency.

Dr. Lineberry thinks there will be changes in infection control best practices moving forward, so he is taking a proactive approach. They are replacing the cloth chairs in the waiting room with something easier to clean. Dr. Lineberry will also demonstrate more infection control management in the practice for patients. 

 “You used to wash your hands and put hand sanitizer on, but you didn’t show the patients you were doing it. Now, we will. We will also do things like open the bags in front of the patients,” Dr. Lineberry says. “It’s a good idea to role-play what you do on a day-to-day basis.” 

Dr. Goodchild recommends also managing cash flow. Most practice’s work on staggered cash-flow. For a few weeks, you have some receivables trickling in, but receivables will stop as the shutdown goes longer. Dr. Goodchild recommends applying for a small business loan, line of credit, or even talking to creditors to push payments out. 

“The unknown of it is the worst,” Dr. Goodchild says. “If you told me that we need to batten down the hatches for 30 days, I could figure out how to make that work. But the unknown is upsetting because we don’t know how long it’s going be before we can get back to normal.”

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Learning how to use what you have

Jody Rodney, vice president of marketing and education for Planmeca, oversees education for customers and dealers. Usually, their continuing education would occur in their new, state-of-the-art education center just outside of Chicago. Moreover, they feel in-person instruction is the best way for dentists to understand how to use their technology. So, virtual learning has been a significant pivot for them, and one they had to do quickly.

Planmeca hosted seven webinars by the first week in April with average attendees anywhere between 250 and 300. Many of these online webinars are like introductions to what they could expect to learn at an in-person training. Rodney says the topics garnering the most interest are those that provide value to the practice without having to make an immediate investment, such as how to incorporate dental sleep medicine into a practice. Also, Planmeca had over 500 attendees for a CBCT interpretation course, which Rodney explains helps dentists better utilize the technology that they already have. 

“One of the doctors’ biggest concerns or fears when they adopt CBCT technology is that they are responsible for all of the information within the CBCT scan,” Rodney explains. “It’s not something that comes naturally to them or something that’s taught in dental school unless they’re at a progressive school that’s using 3D technology.”

Rodney and her team are focusing on more user education webinars throughout April and the beginning of May. She and her team are brainstorming topics that they believe users want to know about and putting those online. 

Rodney says dentists are likely to get bombarded with training and webinar opportunities. She thinks choosing topics that help them be more productive with what they have is the best use of the downtime.

“Educating people on how to do their jobs better will probably be the most relevant,” Rodney says.  

One topic they are working on is how to get up and running quickly after the shutdown. Rodney says it helps dentists create a game plan.

 “Some of it is how to use technology to help them get more dental work because there’s more dentistry when you’re utilizing technology,” Rodney explains. “But also how they can position their staff and get them trained up during this downtime so that when they come out, they’re going to be more effective and ready to go.”

Getting to some of those “to-dos”

Dr. Lineberry says dentists can’t control what’s going to happen, but you can control being ready when the practice reopens. From website and server updates, to working with staff on practice priorities, the stay-at-home order can be a productive time to work on practice management.

“There are so many things that are within our control. It’s your choice to decide if you are going to do something with it,” Dr. Lineberry says.

During the shutdown, Dr. Jebreil’s team is doing their regulatory compliance, which in California includes sexual harassment training. The CDA also has OSHA guidelines to review, although she suspects these will change. 

“We are doing all of our stuff that you never have time to do, and you don’t always want to do,” Dr. Jebreil says. 

Dr. Poole says Uniform Teeth is looking at all of their best practices across the organization and improving technology and processes, including virtual comfort consults with patients. She is also taking advantage of CE opportunities. Whether it’s professional or personal development, Dr. Poole feels it is vital to keep moving forward. 

“In healthcare, we are always moving, moving, moving. When we aren’t moving, it’s scary at first. But if we embrace it, we can make sure we come out the other side a better version of ourselves,” Dr. Poole says.  

“You can look at it as a crisis or an opportunity. If you look at it as an opportunity, as a reset for your practice, the hope is when you do come back, you can be more effective and efficient,” Dr. Lineberry says.

“Personally, it’s a time to reflect and see, ‘Am I purposeful? Is this what I want to do with my practice and my team?’” Dr. Jebreil says. 

For her part, Dr. Sanders finds being home with her son, she is getting a whole lot less done than she usually does-and that isn’t all bad. 

“When I’m working, it always breaks my heart to drop him off at daycare, and I always wish I had more time with him,” Dr. Sanders says. “So, I’m focusing on gratitude.”

Dr. Sanders heard someone say, “The best thing that could happen is that we look back at this and think that we overreacted.” Dr. Sanders hopes that is true. 

“I sincerely hope we are overreacting,” Dr. Sanders says.    

References

 1. Solana, Kimber. “ADA develops guidance on dental emergency, nonemergency care.” www.ada.org.