Periodontics in a Pandemic? Watch Dr. Dan Roberts





By Lexi Marino July 6, 2020

Rolando Mia, from Zyris, hosts a video series focused on the latest news, topics, and conversations happening in dentistry featuring dentists across the nation. In this session, we sat down with Dr. Dan Roberts, DDS at Encinitas Perio to get his take on what it’s like being a specialist, specifically in periodontics, during the COVID-19 era.

Watch this video to learn the following:

    • How specialists such as periodontists are navigating through the COVID-19 era.
    • Importance of having strong connections between your team, your clients, and then general dentists who refer you.
    • Understanding what qualifies as an emergency case during COVID-19.
    • Reducing aerosols and how the Isolite® can successfully do that for any dental practice.

Rolando Mia:

This is Rolando Mia from Zyris and we’re on Dental Voice. I’m really excited today because we have a special guest, Dr. Dan Roberts, who is a Periodontist that we work with and we are very excited to hear the things that he’s doing. The purpose of Dental Voice is to meet clinicians out in the field, understand their story and the things that they’re dealing with today. A lot of our guests have wonderful experience and wisdom. So, good morning, Dr. Roberts, it’s a pleasure to see you and thank you for coming on. How are you doing sir?

Dr. Dan Roberts:

I’m doing great, Ro. Call me Dan please.

Rolando Mia:

Okay, Dan.

Awesome. I appreciate that clarification. Before we begin and before we do anything, I need to get this off my chest because you know, prior to our guests coming on and our speakers, it’s always cool to understand what people are doing. I hear that 4 out of 5 dentists recommend something that you do and they recommend Novocain but not Novocain with regard to the pharmaceutical, rather Novocain with regard to a band that you’re in, is that correct?

Dr. Dan Roberts:

That is correct. You can find as a Novocain The Band or Novocain rocks on Facebook. This band started as a dental study group that was on a ski trip. A couple of guys were injured, and they brought their guitars. Anyway, that was the inception of the band about 8 or 9 years ago. These guys have been my friends for half of my life.

It’s really a pleasure to have such a tight group of guys. We love practicing together and we love performing. We’ve been able to perform for the dental society and we played on the midway down here in San Diego. We played at the San Diego Zoo for some fundraisers and we play out in bars for our friends. It’s a great time.

Rolando Mia:

So, you are the first bonafide dental rockstar that we’ve had on Dental Voice and we’re kind of excited about that. That’s pretty cool. Nova rocks, I love it.

So, you are a Periodontist and you’re a specialist. It’s great to have you on and I really appreciate it. I’m looking forward to getting your insight from a procedural perspective, from a Periodontology perspective. I’m going to start with what’s most relevant topical right now and it’s Covid-19. How is this affecting you, your practice, and your team?

Dr. Dan Roberts:

I think it affects us just like it effects most other doctors. The first thing was, “Oh, we got to be down for two weeks.” And I said, “Two weeks is not going to be enough.” That’s going to get extended. I had no idea how long. But you know, the first thing everybody was panicked about was, “Okay, what are we going to do with the practice? What are we going to do with our patients and what are we going to do importantly with our team?” I mean, the gals that worked for me, gals and guys that work with me, they’re family. Honestly, that was the hardest part of this was what to do with them because I’m just looking at this going, “Wow, can I pay them? How long can I do that? Do I need to furlough them?” So that was a really difficult part.

I know that was tough for everybody because I’ve been talking to the guys in the band for instance. We all text and the guys and gals in my Spear study group, there’s a lot of communication there. We got beyond that and, we’re settling now into the new norm, which is we don’t see very many patients. I tried to put off as many as I could because I figured I don’t want to risk them or to risk my team and transmit this disease. We’ve really been putting off a lot of things and now there’s some emergencies that you really have to take care of that just cannot wait for another month. Those are some tough decisions – what can wait and what can’t.

Rolando Mia:

Thank you for that. When you say what can wait, from a general practice vs. perio are two different focuses. How would you define what an emergency is for people who are listening right now?

Dr. Dan Roberts:

You know, it’s interesting. I’ve got a lot of patients that I see stuff that looks like it should have been dealt with 10 years ago, but somehow, they’re still limping along. So, people can live with stuff for a long time that you would think needs immediate attention. Then there’s other people that are in pain and have facial swelling and that’s all legitimate emergency. You don’t want these patients to get to the point that they opt to go to the ER and expose themselves to a medical facility.

So, now that we’re in this for a little bit longer, I’m starting to bring in some patients that I know, I have a list of patients and I call them once a week, “Hey, how are you doing? How’s that tooth? Is it worse? Can you tolerate it?” And most of the time they say, “Yeah, I can tolerate it. I’ll live with it.”

Then there’s some patients that are calling me and saying, “Hey, you know, I’ve got pain, I’ve got swelling. The antibiotics aren’t making it go away.” We’ve got to deal with these things. I know my endodontist colleagues, they’re working quite a bit because, you know, you’ve got a tooth ache and you’ve got to deal with that. So, those are the kinds of emergencies that we’re taking care of.

It’s a situation where your patient is at the point where they just can’t tolerate anymore. At the end of the day, you have to diagnose that.

Rolando Mia:

It sounds like you’re doing kind of teledentistry, which is kind of the big thing that’s coming up around now where you’re diagnosing on the phone or virtually.

Dr. Dan Roberts:

It’s interesting the photos I get when I asked them to take a picture. Good news is everybody’s got a cell phone, everybody’s got a camera. So, we’re able to do some things now that 20 years ago would have been impossible.

Rolando Mia:

From a team perspective, you with Encinitas Perio and you’ve been doing dentistry now for almost over 25 years. You started out as a general practitioner, is that correct? 

Dr. Dan Roberts:

Correct. You know, when I was in dental school, Perio was considered the, “Perio Penalty Box”, and I never dreamed of becoming a specialist. I just wanted to do restorative dentistry and I dabbled in an Endo, extractions, and perio. Through that, I got into a Perio study because I just found that I needed more information. Doing the procedures are the easy part. It’s knowing what to do when is a difficult part in this. The same is true now for implant dentistry. A lot of people will do implants.

At first, I was a little bit offended when one of my colleagues, one of my general dentist colleagues said, “Oh, implants are the easiest thing I do.” Then I thought about it and to a point in he’s bright drilling a hole and placing an implant is not truly a difficult thing, but it’s knowing what to do when and where, and the site preparation and the materials – that’s the hard part.

It’s really the diagnosis and planning that is hat’s the hard part. So, that’s what drove me back into school, get to get my specialty certificate in Perio.

Rolando Mia:

So, you went from thinking that in dental school, Perio was the, “Perio Penalty Box”, to being a Periodontist?

Dr. Dan Roberts:

Oh, absolutely. When I was a general dentist, I really didn’t understand the benefits of working with a specialist the way I understand them now. I really, I think it’s important to have a good relationship with a specialist. For one thing, a specialist, we’re here to take away your problems, your problem patients, your people that aren’t following your recommendations, people that have a problem on Friday afternoon when you’re on vacation. That’s our job – to take those patients off your hands and deal with that.

Dr. Dan Roberts:

That’s one benefit. Beyond that, we’re also here to support your treatment plan in a couple of ways. I think it’s so important that a general dentist gives a strong referral to whatever they’re referring to, whether it’s the Orthodontist, Perio, etc. Even if you work with a couple of Perio’s, pick one and say, “This guy’s the best, you need to go to him or her.” The worst thing is when I get a patient that said, “Oh yeah, he gave me three cards and told me to pick one.” The patient has no confidence in their doctor in that case. If they think that you’re the best one, then they’re confident. Then when that patient comes to me, I can say, “Oh, you are so lucky to be seeing that restorative doctor, you know, that doctor, she did work in my mouth.”

That goes a long way for a patient to have confidence in their providers. Then when you support their treatment plan and say, “Yeah, I think that’s a good idea. Let’s get this done so that you can get back and get that restorative work done.” That really goes a long way. So, that part is important.

Other thing is comprehensive care and the ability to do multidisciplinary treatment. For example, I’m really good at treating gingival recession. I get some really extreme recession cases. Recession doesn’t just come from aggressive brushing; it can be from jaw clenching. Also, what I’m seeing is a lot of sleep problems, sleep related problems, and that shows up on their teeth. Acid reflux. So, there’s a lot of health problems that show up on teeth and you they’re being sent for recession but I’m sending them to their GI specialist or I’m sending them to an ENT because they’ve got airway obstruction or their orthodontist to have some palatal expansion so that they can breathe better.

So, the value of a specialist, we’ve got our 10,000 hours, we’re really good at seeing these things. We can help support comprehensive care and multidisciplinary care which is best for the patient. And in the end, you’re going to do a more comprehensive restorative as well.

Rolando Mia:

I appreciate that. To sum it up, you highlighted three key pieces, which is great with regard to the relationships between general practitioners and the specialist. First and foremost, it’s a support thing. From a specialist perspective, a encourage the connection, which is very important.

The second point, you mentioned is this idea that you help deal with the problems and deal with any circumstances that that may come up during the course of treatment. Then also there’s a lot more, it sounds like there’s more complex cases that you’re dealing with and this helps offload from the general practitioner. Did I kind of capture that?

Dr. Dan Roberts:

Yeah, and there’s a benefit that a lot of people don’t think of it. I can get referrals from other doctors, from out of state, out of town. Those patients need restorative dentists. So, I’m able to refer patients back. We’ve also got a big web presence our online presence. So, I get patients that see my Yelp reviews and come from that again. I say, “Where did your general dentist send you?” And they say, “Well, he sent me to somebody, but I didn’t like them.” So, I’m able to send patients back to restorative doctors as well.

Rolando Mia:

Yeah. And I think that the strongest message is, across any industry when you’re referring, make sure that you’re referring with confidence, with an understanding and with knowledge about whom you’re referring to so that it’s not, “Well, here’s three or four, pick one.” Rather, “I’m a doctor, I work with Dr. Dan Roberts. He is the best. Here’s the thing, go here. I’ll even call him and let him know that you’re going to be coming.” This gives you a stronger connection with your patient and I think it reassures the patient, “Hey, my doctor likes this doctor, therefore I like this doctor.” As opposed to, “Eh, I don’t know.” Did I get that doctor?

Dr. Dan Roberts:

I mean, really, we’re working as a team and not only do the doctors need to be able to work together, but so does our team, our staff members. It really helps when they’re familiar with each other. So, I really promote that as well as knowing the whole office and making sure that both of our offices are on board with education together, learning together and they’re familiar with each other.

That’s going to give you some really strong value. Patients see that, they recognize that, and they’re reassured.

Rolando E. Mia:

Thank you. Now I’m going to ask you a quick question. You mentioned it with the advent of technology today, there are so many systems out there that are so advanced and give clinicians so much information about the patient. I’ve heard and I’d love your perspective on it. You know, “Hey, I can use this system and do X, Y or Z. It’s a no brainer because it tells me how to do all of this…”. I’ll use guided implant surgery as an example. What advice or what feedback would you give to people who are looking at this as a way to be able to do more complex cases?

Dr. Dan Roberts:

Guided implant surgery is both a blessing and curse. The blessing is that we can do all the planning on the bench, on the computer, before we even get to the mouth. So, it really is a time saver. There are certain cases that I won’t do without it because it’s necessary when you’re in tight situations. Close nerve proximity, close root proximities – it’s wonderful. There are also areas where it’s quite difficult and to use and if you don’t get accurate impressions or something goes wrong and you don’t confirm where your drill is, it can be disastrous. Fortunately, things are pretty accurate. But again, it doesn’t take away when to do what and where. You still need to be able to diagnose the case.

You still need to be able to figure out where you need to graft and all that. So, it may simplify things, but there’s other things that it adds that you have to be aware of. So, it’s both good and bad.

Rolando E. Mia:

So, just be mindful of the limitations of it. Then as you mentioned earlier, I guess not to put words in your mouth to ask your or create a relationship with a specialist to say, “Hey, Dr. Dan, I am working on this case. Any advice that you would give me?” And they say, “Oh yeah, be careful about X, Y, and Z and if you have an issue, let me know that.” Is that right?

Dr. Dan Roberts:

That’s it. So, one of the things I know a lot of people are concerned about is when are we going to get back to work full-time? What are we going to need to get back to work and what is it going to take to get back to work? I just heard our governor yesterday saying, “We’re going to have to social distance for the next 18 months until we get a vaccine.” Social distancing for us social people is very difficult. What we’re really going to need is to get some point of care testing, which we don’t have right now.

Serologic testing, blood tests, similar to what you might use for diabetes where you can do a finger stick and say, “Oh look, he’s got IgM IgG antibodies for this.” If he’s got IgM or she has IgM antibodies, that means that you’re still fighting the infection. If you have IgG antibodies, that means you had the COVID-19 and now you’re over it – that’s going to really be a big boom. Then we’ll find out what the incidence of this is. I’ve talked to a lot of people that think they probably have this back in December or January where they got the worst sickness of their life.

So, I think the incidence is way higher than what we know. When we get that kind of testing, then we’ll be able to treat with confidence and know that our patients are safe and we’re safe to treat them. Until that happens, we don’t know. We have to treat everybody just like it was with the AIDS epidemic back in the early 80’s. We didn’t know who had AIDS. So what do you do? You have to take precautions and that’s really what we’re doing now.

We’re ramping up our precautions because we’ve got, these droplets that we have to worry about. So, one of the first things I did was I looked at my stock of Isolite mouthpieces and I’ve been use Isolite mouthpiece for years. Especially when I do sedation on patients, I want to make sure that they’re not aspirating fluids. use it when I do LANAP, laser surgery. I do it even when I’m placing implants, especially in the posterior area, lower posterior where their tongue and their cheek are flapping.

So Isolite has been a value to me and I’m really happy that I have units in both of my hygiene rooms and both of my surgery ops. I figure I’m going to be using an Isolite on all of my patients where I can, because anytime I’m doing a procedure where I’ve got a drill in my hand, that’s going to be aerosolizing virus as well as bacteria.

I want that suction, that high volume suction to be taking that out of the air right there in the mouth and sucking in a way down the down the suction so it’s not spraying out into the room or spraying on me or on my team. That was one thing that I felt would be really valuable.

We’re going to put in a HEPA filterin the operatories, although I’m not sure that that’s a big value.

It might put some of our patients at ease. We’re stepping up our personal protection. I don’t currently wear a face shield, but that’s something that we’ll be doing as well. If we can get an N95 mask, we’ll be using that on our patients with aerosols. We’ll probably be dialing down the Cavitron and Piezo scalar use with hygiene patients just to reduce the amount of aerosol.

Other than that, it’s wiped out. It’s doing all this stuff that we do every day anyway. So, those are some of the things that we’re implementing in our office. I don’t know if we’ll need to go as far as like they do at the cash register, with the plexiglass screens like up in front with patients. We’ll have to see where we’re at and then adjust accordingly.

Rolando Mia:

I appreciate the comments about our system and also the context for preparing for this. Right now, you’ve got patients who are sitting back, and they’re concerned about this virus and everything that’s going on. Knowing what you now, Dr. Dan, and knowing that patients are kind of apprehensive, what message would you want to give to the listeners with their clinicians before we get the finger test, before we get all of the technology to identify it? What, what would you want them to know?

Dr. Dan Roberts:

You know, Ro, that is an excellent question because first of all, I wouldn’t deal with fearful patients every day, virus or no virus. They’re afraid to come to the dentist. So, I think that equips us to be able to communicate better than most people because that’s the kind of people we deal with all the time. But yeah, you’re right. Patients have been walking around, people have been walking around out in public with masks on, and they come in your office and you’re asking them to expose themselves and take their mask off. That’s just one more vulnerable thing.

Then you’re going to put sharp instruments in their mouth, so it does put patients in a vulnerable position. But really, I think as dentists we’re equipped for that because we do it all the time with this. Some of my colleagues have already gotten letters out or letters on our website talking about exactly what they’re doing. Some of the precautions that they’re taking help put people at ease. One of the other things that we did is when I saw this coming, I got a touchless laser thermometer. So, I think that’s part of the protocol to make sure that your patients aren’t sick. We test our team first of all, when we come in and when we leave the office. We take our temperatures and then we test our patients before they’d come in.

I think it’s going to be awhile before you’re going to be seeing patients sitting in our reception areas drinking a cup of coffee. We’re keeping them in their cars, bringing them right back to the operatories. I just want less areas that my team has to scrub down and worry about. So, putting the patients at ease and showing them that you’re taking steps I think is really important. If you list it and send it out, we have a system that that confirms the patients, but it also is a good system for shooting out letters. If you’re on Instagram, Facebook, those are also places where you can get this information out to your patients. Just put them at ease before, answer their questions before they ask them, I think is the best way.

Rolando Mia:

Yeah, I like that. So, it’s about making sure your patients know you’re already taking steps, reassuring them. You mentioned earlier about reassuring the patient that you see this, you understand it, you’re putting steps in place and we’re going to do everything we can to ensure the safety of you as well as the other members of the team.

Dr. Dan Roberts:

 

That is it. You summarized it perfectly.

Rolando Mia:

So, from a team perspective, it’s interesting in looking at your team. You all have fun; you get along and you mentioned it’s like a family. How’s the team doing right now? What advice would you give other clinicians out there who are struggling because yeah, they’ve had to furlough their teams. There’s some certainty that’s coming out. You’ve been in practice, you mentioned the HIV, you’ve seen these kinds of things before. What advice would you give people who are having anxiety or that stress?

Dr. Dan Roberts:

You know, at first it was hard to give advice because I was one of those people having the anxiety just like everybody else. I was having difficulty sleeping. I check in with my team. We’re on a text feed with the whole team and I’ll check in with that and then individually I’ll touch base with them and just make sure they’re doing okay.

I had to furlough my employees just like I think most everybody else has. You know right away at the beginning, I just made sure that they were okay. That they had toilet paper, that they had what they needed. You know, because we have a lot of that stuff at the office. I just made sure that my team members could take some home and make sure they had hand sanitizer, whatever, just, just, so they’d be safe and their families would be safe. I think we’re all in a good place.

Rolando Mia:

That is great. I can tell that you really care about them. I think that’s one of the things I’ve heard that in dentistry, dentists, clinicians are a really tight group of folks. The fact that you’re talking to each other that not just your team but also your colleagues it makes me feel good and it’s a cool thing to hear. So thank you for that. So, first of all, Dr. Dan thank you for your insight. Thank you for the advice. Really appreciate the context around the relationship between specialists and the GP. If you were to sum up to the people who are listening, what final words or advice would you like to give our listeners or other people who will see this later on?

Dr. Dan Roberts:

Well, my best advice would be controlling the things you can control and try not to worry about the things that you can’t control. I know this is a frustrating time. It’s hard to stay fit when they’ve closed the beaches, closing the trails, etc. It’s beyond frustrating in my opinion. At least in California, we’ve been spared some of the severity they definitely saw a New York. So, I’m settling into the new normal. I’m trying not to let my devices distract me. You know, phone, emails, texts sometimes you just have to put that down take care of your goals that you set for yourself during the day. That’s my best advice is to set some goals, personal business, household stuff and hopefully get to check some of that stuff off the list.

Rolando Mia:

Yeah, we will get through, this is what I’ve heard, and I love the message around that which is focused on what you can control, focus what you can deal with and not worry about the things that you can’t. So that’s awesome. Thank you for that. So, if people wanted to reach out directly to you or ask you questions or you know, what would be the best contact so that they can, they can engage with you?

Dr. Dan Roberts:

Dan@encinitasperio.com is my best contact.

Rolando Mia:

Awesome. Thank you so much for the advice. Thank you for your time. You know the this is an ongoing forum and hearing about the things that you deal with and you sharing kind of how you’re addressing that is always so helpful because you’re dealing with it right now. So, to those of you who’ve been listening, if you if you like this content or if you’d like to contact Dr. Dan Roberts, please go to his website or send him an email. If you like the content, share this and if you have any other feedback or if you’d like us to focus on or ask other things, please let us know. Again, thank you so much for talking with us.

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