COVID-19: On the Front Lines of Oral Health

Covid PhotoOn March 9, University of Florida dental students had just returned from spring break. Many were returning from travel to other parts of the state, the nation, as well as from international locations. Across the country, leaders in academic institutions were following news of the spread of the novel coronavirus and the disease it caused, dubbed COVID-19; the UF College of Dentistry was no different.

For a few months, UF College of Dentistry Dean Isabel Garcia had been paying close attention to reports about a yet-unnamed new viral entity that was eventually named SARS-CoV-2. Based on the emerging data and her network of colleagues in public health, it seemed to her that it would be a matter of time before the novel coronavirus would affect broad parts of the U.S. Unfortunately, the dangerous new coronavirus outbreak accelerated quickly, ultimately leading to drastic precaution measures across many colleges and universities. At UF, all classes were moved online, students were sent home, and off campus operations were reduced to only those deemed essential.

During the first week in March, Garcia began bi-weekly meetings with college leadership to create a plan to safely provide care during the emerging novel coronavirus threat. When the World Health Organization, or WHO, declared the COVID-19 pandemic on March 11, the college had identified challenges, including a severe national and local shortage of personal protective equipment, or PPE, and also strategies to maintain critical functions including teaching and patient care. Of special concern was the virus’ transmission through particles in the air. Dentistry, with its high number of procedures that produce an aerosol spray, created a potentially vulnerable environment for patients and dental providers.

“On Friday, March 13, I made the decision to pause all non-emergency care in UFCD dental centers, five days before Florida Governor Ron DeSantis issued an executive order to that effect,” Garcia said. “We sprang into action, with only the weekend to implement processes for a completely different clinical landscape on Monday morning.”

UFCD clinical leaders outlined what types of dental conditions represented true emergencies, knowing that every interaction between patients and providers brought a level of risk of transmission. Together they created screening, patient care, administrative and safety protocols, and identified clinical space where care could be delivered as safely as possible.

Roberta Pileggi, D.D.S., chair of endodontics and associate dean for advanced and graduate dental education, and John Hardeman, D.D.S., M.D., interim chair of oral and maxillofacial surgery, were two of the faculty members who took the lead in planning and providing care, coordinating teams of faculty and residents that screened patients for health issues and provided emergency care.

Dental students’ didactic education was moved entirely on line by March 16 and the didactic curriculum “front loaded” to free-up time for when students would be able to safely return and provide patient care. In addition, every effort was made to keep personnel who might be more vulnerable to the effects of the virus, or who were caregivers for young children or elderly family members, away from direct dental care.

Because of the types of problems that that typically cause a dental emergency, it fell to a handful of faculty and residents in endodontics, oral and maxillofacial surgery, pediatric dentistry and periodontics to take positions on the front lines of oral health care. Clinical staff from all departments volunteered to help with patient screenings and to assist with providing care.

Hardeman said that providers from different specialties in the college worked together very well, supporting one another and doing what was best for patients and the community, “Looking back and considering the amount of uncertainty in our entire society and stress it created, it was really wonderful how well things went.”

Everyone involved did a lot of adapting – to new team members, to more protection levels and layers of PPE, and in different clinics than many were used to working in, “Almost daily, we changed operations to apply lessons learned. It was like building a boat after you were already on your voyage,” he said.

Staying Positive During Uncertain Times

Jeffrey Westra, D.D.S., an endodontics resident, was one of the front-line providers. He said it was stressful trying to keep up with changing protocols and new PPE measures while also worrying about his own safety and providing quality care for emergency patients.

“We tried to stay positive during those uncertain times. Each day brought new challenges so we had to be flexible and understanding. We learned how to communicate very well and became closer because of the experience,” Westra said.

He admitted it was nerve-racking treating patients when there were so many unknowns about COVID-19 and hearing stories about younger people, initially thought to be relatively-mildly affected by the virus, experiencing more severe disease in some instances.

“The science and our understanding are still evolving and I believe that we will continue to work around COVID-19 for months and possibly years,” he said.

Mani Mirpourian, D.D.S, also an endodontics resident, was impressed by Pileggi’s leadership and the calmness she instilled in everyone involved.

“Through it all, she stayed calm and led from the front as great leaders do. She was in the college every day, making sure staff and residents were okay and complying with the rapid-fire changes in safety recommendations. I feel fortunate to have been a part of experiencing what it is like to be a front-line health care professional during a crisis,” Mirpourian said.

Covid 19 HardemanPatients In Need

Garcia and UFCD leadership believed that the college had a responsibility to provide care not just for their patients, but for the entire community. Patients with emergency conditions often traveled a distance to the college, some coming from areas where there were few options for oral health care. Others chose to come to UF for a different reason.

Pileggi said that one patient traveled from a large city to UF because he believed a university-centered program would have access to information and resources more quickly than a smaller dental practice during the ever-changing landscape of COVID-19.

“This patient came to Gainesville a total of four times from March through June and witnessed the transformation of our clinical environment as we added more protections and equipment. Through it all, he told me that he felt comfortable and confident in his safety, and that he also enjoyed seeing the evolution in our practices,” she said.

Hardeman said the hardest thing was telling a someone that their condition wasn’t a true emergency and they would have to wait until Florida dentists were once again allowed to return to all normal dental care. UFCD dental centers began a phased, careful return to elective care on May 11.

A Changed Landscape

Today, returning dental patients notice several important environmental changes that ensure comfortable care delivered as safe as possible. Visible changes include plexiglass shields at front desks, HEPA air filters in dental suites and high-grade plastic barriers that seal off areas where patients are receiving care – protecting everyone in the area. For dental procedures, providers are now wearing higher-level PPE, including N95 masks, head covering and face shields when necessary. Many other administrative changes, less visible to patients, are in place to minimize crowding, maintain social distancing, and lessen the risks for everyone.

Until further notice, everyone entering UF dental facilities – patients, visitors, faculty, staff, dental students and residents – has their temperatures taken and recorded daily, whether they work in a clinical, research or office setting, per American Dental Association recommendations.

Garcia continues to focus on carefully balancing risk with UFCD’s obligations to serve the community, ensure safety for everyone in the dental care setting, and to support the college’s teaching missions across all programs.

“March through June 2020 certainly changed the landscape of our daily lives, and I believe that the protections in place to create a safe environment for oral health care will not be relaxed anytime soon; if anything, they may be enhanced as we learn more,” Garcia said.

For all the hardships COVID19 has brought, testing our grit and determination, it also reaffirmed how the creative, caring and talented people in our UFCD family can come together and be their very best.

Safety Information for Dental Patients

For more information about how UFCD is working to provide care in the safest-possible environment, visit Return to Care.