Nevada Dental Association VP: ‘We’re hoping there’s not another resurgence’ of COVID

SPARKS, Nev. — Like many sectors of the U.S. economy, the dental care industry took it on the chin after the coronavirus pandemic closed the country in mid-March.

For roughly two and a half months, more than three-fourths of U.S. dental practices saw only emergency patients, and another 18% were fully closed, according to the Health Policy Institute, which predicts dental care spending could decline by up to 66% in 2020 and 32% in 2021.

To get a local perspective on the state of the industry, the NNBW spoke with Jason Doucette, DMD, at Caffaratti Dental Group in Sparks. Doucette, who has been a practicing dentist for 21 years, is also the vice president of the Nevada Dental Association.

Q: How has the COVID pandemic impacted the Nevada dental care industry?

Jason Doucette: From a financial perspective, it’s definitely been damaging as far as numbers or profitability goes; just like every other business — from restaurants to the airline industry — because we were mandated to shut down for a good two and a half months until the soft reopening at the beginning of May. We were just treating emergency patients.

Now that we’re back up and running, we’ve had all the same issues as other industries, such as having a hard time getting some employees back to work, whether they’re concerned about the virus or not having enough hours to offer. And, of course, some patients are a little skeptical to come in if they’re in the high-risk group. So, that’s affected the number of patients we’re seeing daily and monthly.

Q: What kind of protocols does the industry now have to follow because of COVID?

Doucette: As dentists, we have been trained to adhere to universal precautions and protocols that basically treat everybody the same. Whether you have somebody who has a very contagious, infectious condition like tuberculosis or Hepatitis C or HIV, we treat everybody the same. We have sterilization techniques for all the instruments we use, different kinds of disinfectants we use to spray rooms down and everything the patient comes in contact with to kill any kind of organism that may be present in the room within minutes, if not seconds, to keep everybody safe and sterile as possible within the confides of the dental office.

Q: What have been the biggest challenges of operating now versus before the pandemic?

Doucette: From a practicing standpoint, seeing patients. We definitely had to slow things down to where we were seeing less patients per day due to the different things we’ve added to our protocols. We’ve always been in line with the CDC, but with the new CDC requirements concerning COVID-19, now we’re increasing the amount of time with each patient before and after to do things like visual screenings of each patient and clinical screenings. Before we see a patient, we keep them in the parking lot and bring them straight in for the screening — nobody’s waiting in the waiting room anymore. And spending more time at the end, turning our operatory over as far as cleaning it, sterilizing it and disinfecting it and preparing it for the next patient. These extra precautions are necessary, and we want our patients’ safety to be at the top of priority list of precautions that need to be taken.

The other one might just be some of the other patients that are in a high-risk group, whether they’re immunocompromised or above the age of 60-65, we’ve had to try to reassure patients that we adhere to the highest standards so that there is no communication of anything from us to a patient or a patient to us. And just to reassure patients so that they feel safe coming in to get what needs to be done from their dentist.

We’re treating what’s necessary. Ninety percent of what we do as clinicians, as doctors, is treating infectious processes, whether it be decay or gum infection. So, it’s necessary in nature. Cosmetic — veneers or bleaching — is not recommended until further notice.

Q: With fewer patients and less treatment options available right now, how has that impacted revenue and earnings?

Doucette: It’s hard to say because we’re still kind of assessing last quarter. But, I know for some practices, it’s probably hurt them financially by 50% or more. I’d probably say from what I’ve heard across the board, it might be 20%-50%, but in some areas it could be more than that. For instance, in Nevada, thankfully we were able to go back to being open to treat a little more than we were after the first week in May. So, we were able to help get patients treated again a lot more than just emergent care versus a state like California that stayed locked down another few weeks to a month, it could be north of that 50% (loss in revenue) mark. 

Q: What do you see the recovery in the dental industry looking like?

Doucette: Everyone is kind of sitting, watching and waiting, and we’re hoping there’s not another resurgence, if you will. Obviously, in the dental community, I can speak for Nevada. Being the vice president of the Nevada Dental Association, I’m on the front lines of communication on multiple different committees around what’s going on. And we’re committed to doing as much as we possibly can to mitigate any type of resurgence of COVID-19.

I think whenever the infectious rate either stabilizes or declines and the death rate vastly declines, then it still might be a good three to six months for things to really ramp up and recover well. Having said that, it’s different for every practice, of course, depending on their cash reserves, their amount of employees, and maybe the amount of federal assistance they got from the PPP or EIDL loans, etc. I’ve seen, in any business, sometimes if you have a bad month or two, depending on how large the percentage is, that can be a half a year or more to recover from that.

If you have a practitioner that’s been practicing for 40 years and they don’t have any debt on their business, it’s just operating costs, that practice within a month or two, if they’re back up and running full time and fully staffed, can probably recover and not look back. Someone who just borrowed half a million dollars to open up a dental practice, they’ve been out of school on year, they have student loans, they have all kind of payments and overhead, it may take them a year to recover from this slowdown.

Q: After being shut down for a couple months, did you see a surge in pent-up demand? 

Doucette: Absolutely. Everything we do is essential, whether it’s teeth that are broken with nerves exposed inside the teeth, prior to actually turning into some type of abscess or really serious issue. There were a lot of kinds of care that needed to be handled. It was surprising as much as some patients were fearful to go anywhere outside the house, there was probably a larger majority that realized we do adhere to universal precautions and their dental needs needed to be handled sooner than later. So, they wanted to get in as soon as possible. And that’s pretty tough to do when the doors open up and the phones turn back on, so to speak, and you have this pent-up demand. It was a little hard to manage there for a while.

We did the best we could and I think we’re mitigating that really well now. The other part of that was not only being open and available to treat patients, but also getting all of our team back. Not everybody came back all at the same time — we couldn’t afford to bring everybody back, some didn’t want to come back. So, it was definitely a challenge.

Q: Why is it vital for Nevadans to continue getting the care they need to stay healthy during the pandemic?

Doucette: The big thing is, if you have a poor oral health environment, if your gums are infected or you have active decay or abscesses that are active, even though you’re not in pain, your immune system is having to work overtime to manage or keep those infections at bay. Basically, you’re walking around, in a sense, like someone who is immunocompromised because you’ve got 30% of your immune system is keeping at bay these infections in your mouth, whether it’s in your teeth or your gums. We’ve known for 20-30 years that if you have infected gums, that bacteria that is circulating around your bone and your gums in your mouth is getting into your bloodstream and it causes heart disease and leads to heart disease. So, we know that heart health is hugely connected to oral health. If you’re going in for a surgery, they always send you to the dentist to make sure you have no abscesses and don’t have infected gums because they know the recovery and healing of where the surgery is going to be done can be greatly affected by the presence or absence of any type of infection in the mouth.

It’s really not a good idea, whether COVID-19 exists or not, to avoid the dentist because eventually there’s going to be consequences if you’re in that risk group where your teeth are decaying or gums are infected. It’s going to deplete your overall health over time until you either confront something that you can’t get over without our intervention or your sent to us from some other physician and finding out how the oral health is infecting something else in the rest of the body.

Editor’s note: This interview was edited and condensed for clarity.