The fog of war and the Covid -19?


Seems like every day we learn new information about this virus. The facts we knew last week are different from the facts we know this week. With our information being updated daily it would seem like the best action to take is no action unless our efforts are essential to society. Most dental procedures are elective and few dental problems are life threatening.

The exception is if a patient has an infection with swelling and or a great deal of pain that maybe an emergency that should be handled. Over the course of the last six weeks I have spoken to a small number (less than 10) patients who had "emergencies". Most of them involved a broken tooth, a loose crown  or a question regarding the urgency of a dental problem they might be experiencing.

Now I should add that there a few dental practices that I have on call that will readily treat patients with dental emergencies and when my patients call I have a discussion with them about their problem. Since they are patients of record, I am able to remote into my dental office and check any pre-existing radiographs that I have on file and I ask them to explain which tooth or quadrant is bothering them. After reviewing all the information that we have available I am able to make a recommendation on whether they should visit a dentist or not. It's really a matter of risk vs benefit. What is likely to happen if they put off treatment? What will the dentist be able to do? Do they want to wait until I re-open my office or see a colleague who is seeing emergencies?

I was practicing in the early days of the Aids epidemic and I remember that then too, dentists were experiencing "the fog of war". It seemed like there were an awful lot of theories of what caused the virus, how it was spread and how we should treat our patients. Some dentists thought that Aids patients needed to be seen in a hospital setting with the treating dentist double gloving and wearing a hazmat suit (sounds familiar right?) The fact of the matter is that Aids is a very different virus and the Aids epidemic was a very different situation. It was a virus that wasn't going away and patients who were infected were for the most part, not getting better. It clearly wasn't fair not to offer HIV patients dental treatment.

After a period of confusion , it was mandated that dentists should offer dental treatments to HIV patients in their offices. If they didn't want to , they always had the option to stop practicing dentistry. In my case I maintained my own practice and also moonlighted in a friends office who had a practice with a high percentage of HIV + patients. I was apprehensive about the risks but I felt it was my duty.

The Covid-19 epidemic seems a little different. Since its such a recent phenomenon there is still much  to learn about it. With any luck, over the next months it's impact on our population will diminish and almost all currently infected will recover . There should be a sizable percentage of the population who will have antibodies and probably will have some immunity to being reinfected. Also as time goes on , testing will surely become more available and  we and our patients may be able to be tested rapidly, with a higher degree of accuracy.

While I am apprehensive about my financial situation, I don't think it is prudent to  rush to re-open my dental office. Seeing selected patients for simple treatments doesn't seem worthwhile and may not be safe for either my patients or staff. I personally will wait until the fog of war gets a little clearer and there is more definite information about who, how and why  treatment should be rendered.

At the moment I subscribe to three newspapers and the information that I am reading is not that encouraging. Yesterday our governor Cuomo informed us that the Corona virus can exist in an aerosol for over three hours. It is really hard to imagine performing significant dentistry without creating aerosols and it is not clear that the high speed vacuum systems being marketed to dentists right now will be practical or effective. I believe that applying an abundance of caution is the right thing to do for now. To my colleagues who are worried about finances I should remind them that our and our patients lives are invaluable and their are more important considerations than our dwindling bank accounts right now.



from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2020/04/the-fog-of-war-and-covid-19.html - http://lspindelnycdds.blogspot.com/

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