A Look Inside a COVID-19 Safe Dental Office





By Lexi Marino December 29, 2020

In this episode, we met with Dr. Dan Roberts, DDS and owner of Encinitas Perio to take a virtual tour through his office to see what safety looks like in dental settings from a patient perspective relating to COVID-19.

Watch this video to learn the following:

  • Increasing infection control tools you already have in your office
  • What the future looks like for dentistry
  • All this extra PPE can make your job tiring. How can teams stay motivated?

Rolando Mia, from Zyris, is the host of our series, Dental Voice. In this show, we focus on the latest news, topics, and conversations happening in dentistry and assess differing views across the nation. In Season 2, we’re focused on, “What’s Working and What’s Not”, where we’re debunking myths by assessing trial and error since the start of Covid-19.

Transcription:

Rolando Mia: Hello everybody. Welcome to Dental Voice, season two with Zyris. Thank you for joining us. My name is Rolando Mia, and today we have a returning guest. The purpose of Dental Voice is to hear directly from professionals in dentistry, and hear their perspectives, observations, opinions, and get some advice.

We got some phenomenal feedback from our guest Dr. Dan Roberts, oh, almost seven months ago, just as we were entering into this pandemic, COVID and all that type of stuff. Dr. Dan Roberts is the owner of Encinitas Perio down in San Diego and we’re really excited to have him here. Good morning Dr. Dan, how the heck are you?

Dr. Dan Roberts: Good morning, Rolando, I’m well, thank you.

Rolando Mia: First of all, thank you so much for joining. I’m really looking forward to understanding what’s happened over the past seven months and then share with us what’s working, what’s not, and then maybe some more advice, is that cool?

Dr. Dan Roberts: Oh, that sounds great.

KPBS Interview ft. Encinitas Perio

Rolando Mia: Awesome, all right. So before we begin, I happened to find something that I’d like to share with our viewers here. So everyone, early in the process of this, Dr. Dan’s office, Dr. Dan and his office were highlighted the KPBS which is a local radio station. So what I’d like to do is share with you the short interview or video that was done, Oh, we’re talking seven months ago. And then Dr. Dan I’d love to understand your thoughts around that. So let me go ahead and add this here, there you go. Check this out, everybody, listen to this.

KPBS Video Interview:

    • [Eric] Dan Roberts has a periodontal practice in Encinitas. He’s looking forward to seeing patients again, but he knows it’ll be different. Robert says the best way to beat COVID-19 is to keep it out of the office.
    • And that’s where we do the questionnaire over the phone. We take a temperature outside before the patients come into the office. We have them wash their hands with hand sanitizer before they come in.
    • [Eric] COVID-19 is spread in the air and some of the high-speed tools like drills and scalers create aerosols that can carry the virus. Roberts and his staff wear masks, medical scrubs, and gloves to prevent transmission. They also plan to use specialized tools like this Isolite® for surgical procedures.
    • These little holes work as suction. It also has a light, very cool. So it makes a dark hole, light. It creates a barrier and it creates suction.
    • [Eric] Roberts is currently only taking emergency patients. He’s eager to begin seeing patients again because he’s still paying bills to get ready for the new normal, but his incoming revenues have stopped. The new tools and processes won’t go into effect until the California department of public health clears the way to reopen for more regular procedures. Dentists would also like a little peace of mind about their patients, and that can only happen one way.
    • And then we also would like to test patients to make sure patients don’t have the active virus currently, which is an antigen test as well as being able to do an antibody test to see if they’ve been exposed.
    • [Eric] Dentists want to get back to serving people, but they know they have to do it in a way that protects themselves, staff and patients. Eric Anderson, KPBS news.

Rolando Mia: Wow, so Dr. Dan, how was that experience? That was almost seven months ago. What has changed? And if you could share with us what’s going on with your practice since then.

Dr. Dan’s Thoughts 7 Months into the Pandemic

Dr. Dan Roberts: Just listening to that, that’s the first time I’ve heard that actually all the way through in the last seven months. And it’s interesting because at that time it was a pretty scary time. We really didn’t know what was going to happen. We didn’t know how viral COVID was.

And you have to remember, I was scared, my team was scared. Our patients were scared, I didn’t know when we came back. I thought, “Are we going to be seeing two patients a day? What’s it gonna look like?’ So luckily we gained some more information and really we did exactly that.

We started with the approach that first of all, first and foremost, we want to keep COVID out of the office. But then we had to take it a step further. We had to make our team feel safe because I was getting some serious pushback from my team and when the state said, “Hey, dentistry can come back and open back up, it was a mid-May, May 13th, 14th.”

I had some of my team saying, “Hey, Dan, with this stimulus package that our government has given us, we’re really financially, okay, why don’t we come back in August when the stimulus package expires?” And I said “Well, that’s great, but our patients need us now.”

I didn’t think we’d have a business to come back to if we waited that long. So, we pushed forward with what do we need to make our team feel safe second most. And then finally, what do we need to make our patients feel safe? Because they’re hearing all kinds of horror stories. You know, you turn on the news and at that time it was body bags in New York piling up. So, who the hell wants to go to the dentist?

Anyway, here’s some of the things we did, I think in the video, I mentioned a health questionnaire, health screening that goes out to the patients, and it goes out through our rep well, and so the computer generates, the same computer that spits out the confirmation for the patient. So they get a text or an email and this medical questionnaire. They fill out the questionnaire it’s like five questions and they send it back to us. It goes right into their chart. And it’s all that basic stuff. Have they been traveling? Do they have a fever? Have they been exposed? All that.

You know, I recently went to a medical appointment. And they had all that stuff on their answer machine, like before you could talk to personnel it was all the questions. And I thought, this is just a big barrier for getting to their office. I just want to confirm my appointment. And I have to listen to 30 seconds of them talking about this and that. And then if you have a medical emergency, go call 9-1-1. It just seemed a little overkill. I wanted it to go out, make it easy for the patients and it is.

The next thing, I have, some of my friends actually lock the door and we did too initially, we had our door locked, patients would come, they would call or text us from their car. And we would go out and meet them in the outside. Out front of the office, takes their temperature, gives them hand sanitizer. We don’t do that anymore. They’re able to come into the office now. But we definitely changed our scheduling.

COVID-19 Made for Changes in Dental Teams Schedules

Before my associate and myself both worked on the same days, we worked four days a week together. We had a pretty big team to make that happen. We changed that. We split our schedules up. We have one day a week where he works in the morning and I work in the afternoon and now we’re starting to open our schedules a little bit more but really we’ve reduced patient flow in the office. So hand sanitizer, the health questions.

Oh, the other thing that I don’t know that we were doing, that I wasn’t even thinking of it that time, but there was articles that mouthwash was effective and certain mouthwashes. We use a peroxyl mouthwash. So patients rinse for 30 seconds before they jump the chair. Those are the ways that we keep COVID out of the office. The next thing we do is making our staff feel safe, is the PPE, all the stuff that we had to get for that.

And I know every office assigned to do this. It’s the hat, the gown, the stage shield, all the stuff, the booties, you name it, we’ve got it all. And then the mask was a whole big thing. It’s like can you wear this N95 mask? They’re miserable to wear. But we’ve got all that provided. We had to get gowns for our team.

So, I have to say that makes dentistry a bit more tiring than it’s ever been before. And face shields, you’ve got glare, you’ve got echo. It’s making communication between patients difficult. And at first it just seemed impossible, but we’re working around it and now we’re doing it. The other thing that was mentioned on the KPBS interview is the Isolite. And we definitely use that. My hygienists use that all the time. And honestly, when I get my teeth cleaned, I want that thing in my mouth.

I used to think, “Oh, that that’s a pain in the ass. It’s a big, bulky thing.” It’s really not. Once you put it in the mouth, it’s very comfortable for the patient. So, patients like it, it keeps water from going down my throat, it keeps me from having to swallow every couple of seconds. So, I like it and my patients respond well to it. And my team likes to use that.

Using Dental Technology to Make Patients Feel Safe

We’ve got the HEPA filters for them with the UV light. And I know some people, I had a guy that came over and he goes, “Dan, you got to get these UV lights for your operatory and all these shields.” And I said, “You know, I think I’m going to hold off on that.” I’m glad I did. But I don’t fault the people that went that far because that would really help to isolate people walking through the hallways.

So, that’s hits on the last thing is how do we make our patients feel safe? And they feel safe when there’s less congestion in the office when there’s less people walking around. So, we totally revamped our schedule. Everyone that walks in the office wears face masks when they’re walking through the halls, until the patient gets to their chair, sits down and gets ready to work, then they can remove their face mask.

They feel comfortable with the Isolite suction. All the contact surfaces are wiped routinely, all the things that everybody does. The other thing is we’re blessed, we have a chartless office. So there’s no paper pushing, everything can be done remotely. So, that makes it easy. Finally, we have, patients wait in their cars, they come in, we hardly ever have anybody in the reception area.

If we do it’s one person, our chairs are fake leather, so they’re wipeable. So we’re blessed with that. You know, at the end of the day, when we have that last surgery patient, their ride can come in and sit in a reception area, turns out most of them don’t. They prefer to wait in their cars.

Rolando Mia: So it sounds like you put in all of the things that you were talking about, and it sounds like that they’re working. Are you seeing things that you put in place that you quite frankly don’t need to? Or is there anything that you thought was really critical at the time and you’ve since discovered, you know what? Although it sounded like a great idea.

Dr. Dan Roberts: I didn’t take the bait on a couple of things. I’m glad I didn’t. And the rest of the stuff, it’s just background noise now. So we will use it all. It’s not that cumbersome. It’s not that horrible to wear a gown. It’s annoying, all the stuff that we do just adds a little bit to the stress of the day. But there’s nothing that we implemented that we say, “Nah, we don’t have to do that now.”

Rolando Mia: So it’s almost as if you’re just vamping up or doing what you’ve done before, but increasing the process around it. And am I hearing that correctly?

Dentists Have Always Been Good at Infection Control

Dr. Dan Roberts: Dentists have always been real good at infection control. We’ve been trained at that. Right from the first days of dental school. And so we come out with a good sense of infection control and we practice that. And I think that’s why, really is during those first few weeks, we were all holding our breath, going, okay. When is the next community outbreak gonna come out of a dental office? And I personally don’t know of any, it certainly hasn’t happened in our office. And luckily we live in an area where people are spread out. They’re not living on top of each other.

So, we live in a lower numbers area, but San Diego is right on the Mexican border, we’ve got, there was initially, there was a high incidence of COVID down on the border and a lot of border crossing, and I’ve had some people tell me it was because of the Americans going down to Mexico to get treatment. Not that it was Mexicans coming up here, that it was us transmitting to them, as well as them transmitting back and forth. Anyway, I think it’s mainly, it’s just high-density population right, that lives on the border. So when one person gets COVID, it’s gonna spread to everybody in their family just because they’re living close together.

Rolando Mia: Right, so.

Dr. Dan Roberts: So yeah, we did have some high numbers in San Diego and Rolando yesterday we just found out we’re in the purple tier. So all of our gyms, our restaurants, hair salons have been told they have to close back down again. Restaurants for indoor dining, now it’s back to outdoor dining only. Hair salons, now you gotta get your hair cut out in the street, I guess.

I feel really bad for those people. I don’t know how you run a business where it’s open then it’s closed, then it’s open, then it’s closed. That would be really, really troubling. So I’m hoping we can get these numbers under control. One thing I do follow closely is death rates, hospitalizations, what kind of people are succumbing to COVID, and we have definitely decreased hospitalizations.

We have definitely decreased death rates. And the people that are dying seem to be pre-existing conditions. This was the one thing that, this was the last that pushed them over the edge. And I think for a lot of the people that are in the reports. But it’s still unfortunate, I mean, you don’t want anybody to have to die from anything. So, we want to keep doing our part.

Rolando Mia: There was a recent article indicating that thankfully now dentistry is not a non-essential and that there was a message that yes you need to get in and take care of your oral health because it’s tied to your systemic health. So that’s good news. I mean, dentistry went from the Mecca and the super spreader of this disease to one of the safest places, which is fantastic. You, would you be willing to show us your practice or show us some of the things that you’ve done or that type of stuff in your office?

Dr. Dan Roberts: Yeah, I can put on my mask and take you on a walk through the office.

Office Walk-Through Virtual

I’m going to go out to the front door and walk in as if I’m a patient and let’s see how this goes.

This is Nancy, our hygienists coming to work. Happy birthday, Nancy.

Stephanie’s gonna meet me at the door as if I’m a new patient and she’s going to take my temperature.

Okay, so I’m going to ask you a few questions. Have you been out of the country in the last two weeks?

No.

And have you been with anybody that has tested positive for COVID?

No.

Okay. And you haven’t tested positive for COVID either, right? In the last two weeks?

No.

Okay, awesome. Come on in.

Here’s Jenny.

We have plexiglass, we have cough etiquette, we have hand sanitizer. The no-touch hand sanitizer. We found some cool products. We have plexiglass around our…

That’s Lena our office manager. Then I would go and here’s John, our hygienist. And you can see he’s got a patient in the chair with Isolite in her mouth. John’s wearing the shield, the gown, all the personal protective equipment.

And then where are your air filters? Is that that in the back there or?

It is, yes, it’s in the back, between the operatories.

We’ll show some of the surgical ops. There’s one of the air filters there. There’s one in there.

So you’ve put one in every location, you got that going, so you’re taking care of the air through, everyone’s wearing PPE, masks. I noticed there are very few people running around and it’s not as jam packed at all, which is pretty cool.

We’ve got face shields everywhere you look, all this stuff. So, that’s our office.

Rolando Mia: Fantastic, that’s awesome. Thank you so much for doing that. And I liked the efficiency. Your commentary about making it easy for the patient, reassuring them that they’re safe.

So as far as your practice, are you busy? Are you seeing patients coming in or are they apprehensive? What’s the overall feeling that they have with regard to your practice?

We’ve Increased Our Productivity Since the Pandemic

Dr. Dan Roberts: I thought that it would be, I thought we’re gonna just see a few patients but quite the contrary. We’ve actually had right now, we need to find more hours to see our patients. We have decreased some of our scheduling hours but somehow increased our productivity.

So I have a theory about that.

Rolando Mia: Yeah, what is that I’d love to hear?

Dr. Dan Roberts: Well, I think, let me get this thing situated again. I think some of our patients have more free time because they may not be working as much or they’re working from home, and they’re thinking about themselves and they’re thinking, “You know what? I want to go ahead and get that done. I want to get that cosmetic case, and they’re doing more elective procedures right now.” They’re taking care of themselves more. So that’s been a big benefit for us. And I don’t know if other areas are seeing that. But when I talked to other dentists, it’s not just my office. It’s the colleagues in my study club, they’re all telling me they’re busy as they’ve ever been.

Rolando Mia: That’s that’s so good to hear because there were some studies that were published several weeks ago, a month ago, where practices are open, but they’re only tracking it 70, 80%. It’s interesting that you noted that you’re seeing fewer patients, but your production is actually higher than it’s been. So, it sounds like you’re doing more for each patient, but you have the time to do that. And it sounds like your patient is willing. Is that what I heard?

Dr. Dan Roberts: That’s it. I mean, we just have patients that, they’re ready to do it. They have a little more time on their hands. I mean dentistry, especially comprehensive dentistry, it’s a process, it takes some time. And it’s more than just money, it’s time for a lot of my patients. And now they have it. Plus, they can be walking around in a mask, the cosmetic part of it isn’t as scary to them as like, “Oh, what if I, am I going to have to wear this flipper? What if I have to do this? What I have to do that?”

They’re going to be wearing a mask. What if there’s bruising? What if there’s swelling from what you do? Who cares? Nobody’s going to see you. So I think that’s what they’re thinking. It’s just like okay. There’s never been a better time for them.

Rolando Mia: That is so good. So it sounds like as far as your team, as far as your practice is concerned, as well as your patients, there’s definitely a focus. And I noticed when we were taking a tour of your office, everyone was wearing a mask, you’ve got the shields up to minimize droplets. You’ve got your filters. We see you’re using the Isolite over there, which is really nice, all the PPE. So people recognize that there’s an issue but it’s not people aren’t freaking out anymore. Is that what I’m hearing from you?

Some Patients Are Still Apprehensive Going to the Dentist

Dr. Dan Roberts: That is the case. I do still have a couple of patients that are still not comfortable coming in. I have one patient and his wife, been patients of mine for some time now. And he feels so strongly about his commitment financially that he doesn’t come in for his maintenance visits, but he pays me as if he did.

And he sent a long letter and he just said, I feel this is, that it’s important for me to support the people that take care of me. And I’m sure he’s doing this for the restaurants that he frequents and stuff, too. And he said, I don’t feel comfortable coming in yet. And, but I’m going to support you anyway. And he sends a check. And I put it on his account as a credit but I just think, that’s just heartwarming.

I wish I could alleviate his fear, but there’s always risk. Knock on wood, we have not had any problems. And nobody I know has had problems at a dental office, but that’s not to say it’s impossible. You know, we do everything that we can. And I think our risk is extremely low and I feel more comfortable as each day goes on. But I tell you what, that first month, each person that came to the office, each one of my team members, it took them a couple of weeks before they felt like, okay, this is routine.

I mean, just everything, it was like the jitters around here. It was really, it was tough. So I’m glad those days are over. I’m glad it’s back to business as usual. And I’m glad that so far we’ve proven to ourselves that yes, everything we did is working and we’re keeping a safe environment.

Rolando Mia: Yeah, so awesome. And I do recall, and I actually got a note about it. You gave, you gave members of your team toilet paper. It’s funny to think about the fact that wait a minute, I actually got a comment back, saying, “Oh, that was so nice.”

Dr. Dan Roberts: I forgot about that.

Rolando Mia: But also it’s heartwarming, to your point your patients saying, “I want to support it.” I recognize it. I’m not comfortable, but I also know that people have to live here, and I have the means to, so I’m going to do it. And I think that’s a great message. And boy, oh boy, that made me feel something. If you were to sum up and if you were to send a message out to the community, to your patients, to your team and other colleagues around, what is it that you’d like to stay as we close this out, and what’s the message you’d like to get to them?

Unintended Benefits of Covid-19

Dr. Dan Roberts: You know, the one thing that’s come out of this is some unintended benefits. I think that we’re healthier. Gosh people aren’t coming in with common colds and flus. So that’s healthier for us. I think this has caused us all to look a little inward. I’ve had two of my full-time people have gone down to three days a week because they’ve got other interests that evolved out of their two months off.

I think we found that we need less stuff. So, we can survive on a little bit less income. And… Anyway, it’s just, I think that this gave us a chance to look at ourselves and really see what we want out of life. You know, besides beyond dentistry and beyond work what do we want for ourselves to make ourselves and our family happy? So that’s some of the unintended benefits of COVID and I’m happy that we’re getting through this. And I think that if we continue to use our precautions, we’ll get through this. Everybody does.

Rolando Mia: That is cool. Thank you, thank you so much for that, and really appreciate it. And I love the message.

Dr. Dan Roberts: You as well, take care.