Safety in Dentistry Relating to COVID-19





By Lexi Marino April 3, 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. As the world fights an unforeseen pandemic, Dr. Mike Maroon discusses how he’s dealing with safety in the face of the coronoavirus as a dentist.

Watch this video to learn the following:

  • Importance of reducing aerosols with continuous HVE
  • Dealing with office closures and financial advice
  • Advice on planning for the future of dentistry
  • Ways to stay in touch with patients and employees during crisis

Transcription

Rolando Mia:

Second and you are live. Good morning, Dr. Maroon. How are you doing?

Dr. Mike Maroon:

Rolando – How are you?

Rolando Mia:

Thank you. First of all, really appreciate you getting on a call with us and especially fact that you’re willing to share kind of your insights and what’s going on. So everybody, this is Dr. Mike Maroon. He’s a full time practicing dentist at advanced dental in Connecticut.

He’s also one of the directors at Smile Source and he’s been a good friend of Zyris for I think ever. Really, really appreciate you getting on here. The purpose of the call or the purpose of this chat is just to get some insight from you and we spoke briefly before about, I mean, a lot of things are going on, so I’d love to kind of understand how you’re, how you’re navigating through this and what, what you are doing specifically.

Dr. Mike Maroon:

Okay. Well, I mean obviously the way that we’re navigating through this is we’re listening to our government officials and the federal officials. They’re telling us to stay home and stay safe. And that’s what we’re trying to do. And I urge everyone who’s watching this broadcast to listen to your local and state officials and please help your team and your patients do the same and be as safe as possible.

I mean, that’s priority number one is the safety of everyone in your circle. And as leaders, I believe that we have a social responsibility to lead by example. So do you know did I want to shut my office down? Do I want my business to suffer? Absolutely not. But do I want my team and my patients and my family to be safe? Yes. Obviously. So we’re going to listen to the officials.

We’re going to do the things we need to do in the short term. And you know, I’m an optimistic person. You know me. So you know, I feel like dentists or dental licenses are kind of like the golden goose and somebody could take the eggs away from us, but as long as the goose could still lay the egg we’ll be okay. So I think we’re all going to be okay.

It’s not like this is something that’s just happening to one individual person. It’s happening to everybody, every industry around the world, all at the same time. So collectively everybody’s kinda like, “Oh my God, what’s going on?” And then when it’s all over, we’re all going to be like, let me out of here. I have cabin fever and I think things will ramp up fairly quickly depending on, you know, what’s happening in certain communities.

So I think metropolitan centers like, you know, major metropolitan centers like New York, San Francisco, Seattle, LA, Chicago, they may take a little bit longer. I think suburban communities and urban areas will ramp up fairly quickly. I don’t think this is a longterm depression or recession. I think it’s a short term. You know, it’s an anomaly something that’s a once in a generation and hopefully we won’t see it again. So that’s my personal take on, you know. Like I said, I’m an optimistic person.

Rolando Mia:

Well, so appreciate that. It’s crazy. You’ve been in dental practice. How long now?

Dr. Mike Maroon:

I’ve been in, well, let’s see. I think I have some of the disciples who are still paying off some crowns that I did on them, you know, a few years ago now. I’ve been in dentistry for 34 years.

Global Impact on Dentistry

Rolando Mia:

Wow. Have you ever, have you ever seen anything this, this broad-base, with such a global impact, especially in dentistry?

Dr. Mike Maroon:

Well, for me this kind of rivals a little bit on a smaller scale, the terrorist attacks of  9/11. And I think that from, for the country, the United States, I think, you know, the collective like shock, the initial shock and then the horror and the, “Oh my God, what’s going to happen?” And then everything just basically shut down.

People didn’t know how to respond cause it was a new experience for everybody. And then I think what happened is you gradually saw that, okay, some of the rules changed how we went to the airport change. You know, we, we had a new opportunities that developed, you know, there were new businesses that came out of the crisis. And you know, like security businesses, screening businesses in airports, things like that. You know, the safety industry kind of exploded.

And I think that you’re going to see similar things happen because of this crisis. People are gonna want to err on the side of caution. So but you know, the closest thing to me to answer your question is that the 9/11 attacks where everything basically shut down, the airlines were off, you know, transportation was there.

We basically at to, we weren’t even able to hunker at our homes. We, you can kind of have the hunger wherever the hell you are. You know, if you were at a hotel, you hunkered at the hotel. So at least here they telling you to stay home. Hopefully you’d have a decent place to live or a place to live. And you got some food there and you know, and you like your family and your kids. And I mean, it’s, yeah, we’re not, I don’t know if we’re really, a lot of us I don’t think are really suffering too bad by being told to stay home.

It’s just that, you know, as dental professionals, we have this mindset of like, “I have to produce, I have to produce, I have to produce.” Because you know, when we walk in the door, nothing is guaranteed and every month nothing is guaranteed. So for us to tell, telling that type of person, especially somebody like me who’s been in it 34 years to stop everything that, you know, psychologically it takes you a few days to kind of be like, “okay, now what do I do?”

I think some people will handle that shut down a little bit better than others. But this is not the end of your career. This is not the end of dentistry. This is not the end of the world. I mean, this isn’t these zombie apocalypse. It’s just, you know, it’s something that was unforeseen. It’s a medical. And once they get a feel for what the actual numbers are, I think things will go back to beat to some semblance of normal, whatever that new normal will be. And I don’t think it’s going to be too far from what the old normal, we’ll have relations, you know the head bro.

Rolando Mia:

Yeah, I was going to say, you know, I’ve spoken to quite a few dentists and there’s definitely a feeling of uncertainty that’s going out there. Especially, you know, some of these dentists who are just starting out having to close down. I mean there’s, I spoke, there was some contexts around debt and you know, what am I going to do? I mean, having been through this, what would advice would you give or kind of what are you doing and what advice would you give people who are, who are, you know, little freaked out.

Dr. Mike Maroon:

So it’s a very good question. So step one, I would tell you to make a list like what are your, if you don’t know what your assets and your liabilities are, understand what that is. How much cash do you have on hand? How how long can you reasonably continue to pay your team members? And if you can’t, then you need to do what’s right by them.

And just, you know, either, I know the laws are changing so rapidly, but you know, until the laws actually become more specific, I would tell people to, you know, let, let your team members collect unemployment. That’s what it’s there for. And it’s not in the longterm, you’re not firing them. You’re basically just laying them off. Just like a big company would lay off workers like the auto industry might lay off a thousand workers. You have to lay off some people.

I’ve laid off my team of 16 and they will start collecting unemployment in April. I kept them on payroll until the end of March, but I was fortunate enough to have a little bit of a reserve, but I will tell you, you look at your cashflow. What’s the the most important thing over the course of the next two months?

So in my mind, I’m looking at, okay, how long are we realistically going to be shut down? I’m looking at it as, I’m going to lose a quarter of 2020. Okay. So I’m going to lose the month of March, April, and I’m expecting to be back up and running either May 1st or sometime in May. I don’t think it’s going to go much longer.

And the reason I say that is if you look where this problem started in China, and then you look at South Korea and some of the other countries where it’s kind of already run its course, they were basically shutting down two to three months.

So you can, you can reasonably expect that that’s going to be happening here in the United States. And so, you know, look at your who you owe money to and make phone calls, call your auto loan company, call your leasing people in your dental practice and just say, “Hey, you know I need two or three months before I can get the payments up and running again.”

And I think you’re going to be surprised that everybody’s gonna agree with you and they’re not going to give you too much of a hard time. So the worst thing that happens if you make a phone call and they say no, and the best thing is that they’ll work with you. So call your cable company, your cell phone company, your electric company, gas company everything. And then, you know, keep your cash on hand to buy the things that you really need.

If you have a medically compromised person living with you at home, whether it’s a young child or a spouse or a parent, then you want to make sure that you have money to be able to take care of them. There’s no reason to hoard the toilet paper though. I mean, you know, the whole toilet paper thing just boggles my mind.

You can make, you know, to get back to your question, you can make certain logical steps to ease your financial situation. And we you have to look at it. I think some people, what happens is, you know, they start freaking out and they’re like, Oh, I can’t you know, how am I going to pay all my bills? Well, you’re not gonna pay all your bills and the, and the people who are loaning you the money know that you can’t because you know, literally your business got shut down.

You’ve, if you’re an employee or a staff member, you lost your paycheck. So there’s no way you’re going to pay all your bills. So what needs to happen is you need to contact those bill collectors and just say, I can’t pay all my bills. Okay. And then see what they say. I mean, the worst thing that they say is, no, you need to pay your bills.

And if they do and you still can’t and, and you can’t pay it, then I would tell you don’t pay it. Don’t pay it for two months. What are they gonna do? They’re not going to come knocking on your door and repossess your car. It’s not going to happen. So just, you know create a financial game, plan, a financial crisis game plan for yourself, your practice, and then share it with your team members.

I think this is the one thing that we can do as leaders is share that game plan with our team members and help them navigate the crisis. Because a lot of them don’t think and plan financially like we do. And so if you can help them navigate the crisis, I think that’s, that’s one of the most important things you can do for them right now. And I, you know, I told him I’d seen members stop eating out.

You know, your Internet’s still still there. The cell companies are decreasing the data. There’s a thousand recipes on TV. Learn how to cook, you know, don’t spend money that you don’t need to spend at this point in time. Just, you know look after your family, looking after yourself and everything’s going to be okay.

Rolando Mia:

Really appreciate that. You mentioned before the banks don’t want your dental practice, is that right?

Dr. Mike Maroon:

No, no. I mean, think about it Rolando. You think the banks, just like the housing crisis, do you think that banks really want to foreclose on a dental practice? They don’t. They’re going to make their most money by keeping you alive and keeping you in business. And the banks realize that, you know, they’re, they’re going through it as well. I mean, they basically had the rug cut out from underneath them as well. Cause if everybody in the country automatically shuts down for the most part, they don’t have the income coming in that they did as well.

And so they’re going to have to be flexible just like we have to be, you know. And so I think most of the, from what I’ve heard and what I’ve seen we’ll give you, you know, they’ll extend your mortgage or they’ll give you interest free or they’ll create a balloon payment on the end.

I think, you know, depending on, on what the bank is and what their crisis management is at, at the bank we’ll determine ultimately what offers they give you. But I think that it’s, it’s in everyone’s best interest to make that phone call or, or send an email and just ask the question and then see what you can get.

You’ll be able to save thousands of dollars. I mean, I contacted some companies that I have equipment leases with and they said, totally understand. They gave me three months, I’m going to start the payments back up in July. So, and I think people understand, you know, that the whole country in the world is going through a crisis and they’re going to be realistic about it. You know, they’re not going to come down and send moose and Rocco to your house and the money that you don’t have.

Rolando Mia:

That’s right. Well, I really appreciate that. So you’re currently only treating emergency cases, is that right?

Dr. Mike Maroon:

Yeah, we are following that. The guidelines established by the state of Connecticut and our governor who wants Connecticut to stay basically shut down until April 22nd. And so we are considered an essential service. And we’re following the ADA guidelines. Connecticut did not say that you cannot do any type of dental care, but we’re, you know, we’re members of the ADA and Connecticut State Dental Association and both of them agree that we should postpone elective services.

So we’re just doing emergency care for the next foreseeable future. The next few weeks. And I’ve even limited that down to a couple of days a week. So I mean, you’re not going to make, you know, it’s not business as usual, you know, I mean, we went from being, you know anywhere on any given month between 250,000 to 450,000 in production and collection. And now we’re down to, you know, if I make four or 5,000 in the month of April, I’ll be happy.

So it’s, you know, you’re not going to be able to sustain your business with that amount of money. And so, you know, again, I’ve reached out landlords, leasing companies, mortgage companies, suppliers, all that stuff, you know, make the call and you know, cut your expenses for a few months and you’ll be fine.

Aerosols and Safety in Dentistry

Rolando Mia:

Awesome. Awesome. So how do you, are you, as far as those procedures and all that type of stuff, is it, and with regard to, Zyris and our Isolite system, do you use us with that or is that something you also push off?

Dr. Mike Maroon:

Yeah, absolutely. I mean, you know, right now there is concerns that the aerosols in dentistry could potentially be a could potentially be a route of transmission, although there’s no known research indicating that. And I think that before we get all crazy with any new regulations that we have to really take a close look at the route of transmission of the disease.

That being said, I mean, I don’t to, you know, potentially put myself or my patients or my staff at risk. So we’re trying to minimize the aerosol aerosolization fluids in our practice. I think Isolite is one of the tools that people can use and it’s an excellent tool to help keep the aerosols away. We use Isolite on every procedure that I can and you know, it’s that the Isolite product itself is very unique in that you can modify it to different situations.

So we, the majority of procedures will use it the way that it comes, you know, the full size. But for example, if I’m doing surgery where I’m doing extractions or anything like that, I can cut off pieces. I can modify it to make it fit the way I want so that I’m not worried about people ingesting things of things going down their throat. And it allows me to still have the full field of vision that I need to do the procedure. So I, you know, I love Isolite.

We use it for just about everything in our practice. And I can’t imagine going through this crisis without it. I mean you know, I used to use rubber dam a lot before, but we rarely use rubber dam just about everything that we do is Isolite. And so it’s great. Number one, you know, getting rid of the fluids and the aerosols.

Number two, having the ability to have enhanced vision in the field of that we’re working in. I mean, that’s a huge, a huge positive. Especially as I get older, my eyes kinda gets smaller, you know, having that that ability to see things is really great.

 know the three products that you guys have, have the ability to go from that white led light to the orange led lights on. So I mean there’s a lot of benefits of the Isolite and I really think that this product is something that in a crisis like this, if you’re going to be seeing emergencies, you really need this, you know, have this in your practice and be able to use it. 

Rolando Mia:

Can you see that? Yes. Yeah. So the question is what advice can we give patients on when they should come in for a procedure or a postponement?

Dr. Mike Maroon:

My personal belief and based on, you know, again, what your local and state officials are asking you to do is postpartum electric procedures. So elective procedures to me are, you know, a regular replacement of fillings hygiene visits. You know, scaling and root planings for me are, are still an elective procedure.

You know, I don’t know too many scaling root planes that are life threatening situation, but if, if for some reason somebody needs it for like a cardiac surgery or something like that, then obviously that becomes, that changes the you know, the level of what that procedure is and then you’re going to have to make that decision as to what you’re going to do.

But again, it’s not business as usual. Like even even for example, Orlando, say you broke a tooth eating, you know, a beef jerky thing or whatever are climbing a tree and cutting down some branches on the weekend doing crazy stuff like you do. I mean, if that tooth is not in pain and you just chip the edge, that’s not an emergency, you know, that, that’s something that I would hesitate on coming in.

But if it was something where you broke it off and I can see the pulp or you’re in pain or something like that, yeah, then it becomes an emergency. So I think each of us has to look at what the emergency guidelines are for our own practice. I think the ADA came out with a sheet that really did a nice job on defining what emergency and not emergency care is. And I think people should use that as a preliminary guideline and then go from there.

Dr. Mike Maroon:

Awesome. Appreciate that. So it’s kind of amazing that the things are the way they are, but I love the perspective that you have, especially taking a proactive approach to actively managing the situation as opposed to becoming a, for lack of a better term a victim of what’s going on and the, the message that you sent and the context about reaching out to everybody cause you, you hit it right on the nose.

Rolando Mia:

Everybody is going through this and to not take that into consideration is crazy. And, and I think it’s really, really helpful. How are you doing and family? How is your, you know, how’s, how’s that all going?

Dr. Mike Maroon:

You know, Ro. It was funny because I was talking to my office manager this morning and she goes, you’re so calm. I said, I thrive on chaos anyway. So for me, more or less in chaos, this has happened for me. I’m like, this is awesome. You know, everybody’s crazy. The other thing that I, you know, I wanted to just make sure that everybody understands is, you know taking care of your team because they’re really your extended family.

I know that all of us, you know, we have a hard time because, you know, we want to keep them on the payroll, but you know, we may not financially be able to do that. Even if you can’t keep them on the payroll, they’re still your family. You still have to look after them. You still have to take care of them.

One of the things that we’re doing right now, Ro, is we’re having a video conference. When this crisis first started, I signed up for a video conferencing program and we held a team meeting yesterday on video conference. So everybody logged in. We’re all on video. How you guys doing? How you holding up, does anybody need anything? That type of thing. And then, you know, we’ve talked about, okay, here’s what we’re going to do for the rest of March. Here’s the school.

I knew this thing, telling us to stay shut down until April 22nd. Here’s where I think that we should reschedule patients too, which would make birth and then we can adjust, either move people forward or move them back, you know if we need to, but at least we have some type of dates of people can kind of, you know mentally compartmentalize their lives and put things in order.

Okay. May 1st I just have to get some rape roll and then, you know, we get there, but let’s, you know, let’s say, God forbid it’s not going to be made for us. Let’s say it moves the jumper. Even if that happens, at least they know that, okay, I at that point and made it through April, I can make it another month. You know what I mean? This is not going to go until September or 2021 and says not we’re not in a shutdown or a zombie apocalypse scenario.

We are in a situation where, you know, a few weeks where we’re going to be back up and running and we’re not gonna, we’re not going to forget it. I mean, I put things in perspective. The Superbowl was what, six or seven weeks ago, and everybody, you know, was going crazy at that point in time. And now here we are and here we are in March and it’s like the world is in chaos.

It’s not gonna stay in chaos. It’s all gonna come back. I see a question there. How often are you updating social media feeds for the practice and what type of resources should coronations be sharing? That’s a very good question. You know, I’d been doing some video updates for my patients on practice and also sharing things that I think would help them in their safety going through the initial stages.

So, you know, just like all the questions that we have in our mind and our teams have a, I think our patients are the same way and the more information that you can get them to help steer them through the crisis based on what your government officials are suggesting, I think that would you know, help you, it also positions you as, as a leader in the community and you know, it’s good for you to lead by example.

And so I would, tell you, stay in contact as much as you personally feel comfortable with your, when your clients on social media, email blasts, things like that. I mean they do look to you for guidance for in, for advice. I mean it’s funny cause people say, “Oh, the dental profession, nobody listens.” “We’re not real doctors, you know.” But we are, we are doctors and people do listen to what we have to say.

I think what we have to say is very important and we help a lot of people get through a lot of crises and in their own lives just as that this, but this is a good, good way for us to do this as well.

Rolando Mia:

That is awesome. So first of all, I so appreciate your perspective and you know, yeah, it is. It’s a tough time and people are getting through it. But what I especially really resonate with is the message that “Hey, focus on the now figuring out what has to happen, but don’t lose sight of what’s happening down the road because we’re going to get through this and when we do, you want to be prepared that so that you’re not blindsided.”

And that that message is really powerful and really loved the kind of the,”you’re not crazy”, optimistic, but you’re very realistic about it and it’s, it’s, it’s really helpful to hear the words especially, you know, you’ve been through it and yeah, “I thrive in chaos.” There you go. Dr Mike Maroon. Thriving in chaos.

Dr. Mike Maroon:

Well, I mean, Ro, every crisis has a beginning, a middle and an end. And so, you know, it’s good. It’s good for you to know, it’s good to understand where you are in the process and then plan for the future where you want to be. And so I think the people who are planning on what they’re going to do, getting out of this are going to be much better off than the people who are just kind of like, you know, in full on panic right now. And that’s not the way it should be. That doesn’t help anybody.

So I think that, I think cooler heads will prevail. The information that we’re getting from the testing that’s coming in, I think ultimately it’s going to show that this virus isn’t the major killer that, that people are worried that it’s going to be.

I think the problem is that the initial onset of the virus has the potential to impact a lot of people quickly, and that overwhelms hospitals and that’s where it becomes a problem. So if you’re in an area where your hospital becomes overwhelmed, then your numbers can spike up a little, little faster as far as the death rate is concerned.

I think overall, once everything’s said and done, I think the virus is going to come in somewhere around one between one and one and a half percent of a death rate. And I think if it does come in there that that’ll calm some people down in the economy can get back to where, you know, to crank in again and doing the things that you have to do. So in the meantime, you know, my suggestion is listen to your government officials, stay home, stay safe, wash your hands if you do have to go out and take the proper precautions.

You know, you don’t have to, you don’t have to wear the mask in public, but also take a paper prop precautions when you go out. And then when you come back in, you know come back home and be safe. Just, you know, kind of think about what you’re doing and be as safe as possible. And if you’re, if you’re told to stay home, you know, this isn’t a time to set up play dates or have, you know, family members over for a cookout or things like that. No, you’re staying home.

You, you know, last night my kids were on a huge conference call with their cousins and relatives from around the country. I think they had like 10 people on the call and then we’d blouse being in, doing, you know, doing everything and talking about what their feelings were and it was great. And I mean, that’s what you need to do. You have, you know, follow the instructions will flatten the curve. This’ll be gone and then we’ll move forward.

Rolando Mia:

Awesome. Thank you so much. You know, the one thing for me is because I am home, I have direct access to a lot of food. That’s not a good,

Yes, not only a lot of food, but a lot of tools and projects. So I really, I have to tell you that I really enjoy your projects that you’re doing because it will help me realize that I’m not the only crazy person in this world. Yeah. You did. You just made my entire day. Thank you. So, yeah, tell my wife so. Well, Hey, thank you so much for taking the time and to meet with us and share your insights. Really appreciate that when we get through this buy a beer at a nice big steak.

Dr. Mike Maroon:

Yeah, yeah, whatever. It doesn’t matter at all. It’s all good.

Rolando Mia:

We really appreciate it. Thank you. Please stay safe and you know, and I look forward to staying in touch and and hope everything is good with you and you know, really, really appreciate. Thanks.

Dr. Mike Maroon:

I want to just leave on this one thing, Rolando, and you can cut me off after that. I want everybody to remember you already have the most, the best gift that you have, you’ll ever receive in your life. And that’s, that’s the gift of life. And so life is good. And you’re calm, you’re blessed, be grateful for all the things that you have that are around you. And this too shall pass. We will all get through it. And so stay positive everyone. And if anybody needs any help, reach out to me personally. I’m happy to help you.

Rolando Mia:

Thank you so much. Really appreciate it. And it’s a pleasure knowing you. It’s a pleasure listening to you. And, and you say safe too. Thanks. All right. Take care. Thank you so much.

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