Global News Interview: Emergency Dentist During Covid 19 Outbreak

Dr archer interviewed on Global News

On Wednesday, March 25th Rachael D’Amore telephoned Dr Natalie Archer DDS to ask about dentistry in the Age of Coronovirus. Like so many other Canadians, dentists have also had to adjust to a new business reality amid the pandemic that has now closed most dental clinics in Ontario.  Yet we search for ways to be productive and helpful.

“I think dentists, in general, feel helpless and frustrated,” Dr Archer is quoted saying in the article, and she continued. “We are health professionals too. We’re educated. We’re willing to help but, in a lot of ways, our hands are tied right now.” Dentists have a unique perspective on social distancing in the workplace; its more difficult here. Dentists and hygienists sit right beside patients; new distancing protocols amid the pandemic are particularly difficult to work around.

What exactly does ‘Emergency Care Only’ mean for dentists and patients?

Provinces and local governments have imposed increasingly tight controls to try and curtail the spread of COVID-19 and they ultimately encourage as many people as possible to stay home. Quebec and Ontario, for example, have ordered all non-essential businesses to close, but the rule vary and are slightly different in each jurisdiction.

Global News update

Those deemed essential are somewhat obvious; health-care workers, first responders, suppliers of critical goods like food and medicine, and utility workers are encouraged to go to work and help save lives and keep society functioning. So where does that leave dentists?

Ontario, Quebec and British Columbia have ordered a pause on “non-essential” dental services like teeth cleaning, teeth whitening obviously and other cosmetic procedures. Only emergency care, like facial trauma or pain that can’t be managed with antibiotics or over-the-counter medications, can be performed.  Dentists in other provinces, like Manitoba, have taken it upon themselves to put similar measures in place for their residents. But even then, there are risks.

“We have to set a high bar for emergencies in dentistry because it’s such high risk. We’re one of the most at risk in this,” said Dr Natalie Archer. “We’re still learning about the virus, but we definitely know it’s spread through things like mucus and saliva. These are things that dentists are intimately connected with… There’s no social distancing when it comes to treating patients in dentistry.”

The respiratory virus is spread mainly from person-to-person, either by close contact or “respiratory droplets.” So when an infected person coughs or sneezes, if the resulting droplets end up in the mouths or noses of people nearby, either by inhalation or contact, those people can become infected.

In health care, increased risk comes with increased protocols. In Ontario for example the Royal College of Dental Surgeons (RCDSO) has clamped down on what constitutes an emergency dental situation and has issued directives on screening procedures as well as which tools to use when.  They stipulate that only emergency care, like facial trauma or pain that can’t be managed with antibiotics or over-the-counter medications, can be performed.

What is an essential service?

Rachael D’Amore’s reporting also shared some interesting data.  Between 2017 and 2018 there were over 93,000 dental visits at the University of Toronto’s Faculty of Dentistry, which allow students to treat patients. Of those, 4,000 were considered emergency dental visits.  So based on that ratio you can see there’s a demand that will not be abated by stay-at-home social directives. Some dentistry is essential.

Readers should know that infection control in dentistry is already at a high professional standard. Sterilizers are tested every day, there are chemical indicators that show that everything’s been sterilized properly, there’s tracking of every instrument, everyone’s wearing the proper PPE (personal protective equipment),” he said.  Infection control protocol standards for dentistry are incredibly high. But that efficiency doesn’t negate the fact that dentists need to be in close contact with patients to do the job.

infection control - autoclave

Sterilization of equipment happens routinely in autoclave at Archer Dental Rosedale

“The primary thing is to keep people safe and healthy but you also really have to keep them out of hospitals unless they absolutely need to be there — the system’s already facing a burden.”

Archer Dental Emergency Dental Service in Toronto

Archer Dental patients can set up phone-call screening and counseling or FaceTime a dentist for certain inquiries. We offer emergency dental services such as it abides with RCDSO’s new required safety practices, but we can also provide some level of comfort to patients locked away at home who need advice, said Archer.  Patients are encouraged to call their office and their calls will be received and scheduled accordingly.

“I think it makes patients realize what is a real emergency right now,” Dr Archer said. “As a dentist, we have to assume that everybody we come into contact with has COVID-19. So that’s the level of care we take when we decide what’s an emergency.”

The article ends with Dr Archer’s quote; “There’s a very good chance that you’re not going to get into a dental office for a check-up for quite some time, so this is the best opportunity to take care of ourselves from a preventative side,” Natalie said. “People always tell me they don’t have time to floss. Guess what? You’ve got time. You’ve got more time than you know what to do with. Now’s the time to floss.”

Dr. Archer Provides Expert Opinion on Global News

Dr. Natalie Archer discusses Best Practices for Good Dentistry

In October 2017, Dr Natalie Archer appeared on Global News to discuss how and why dental clinics should regularly be tested for infectious diseases HIV, and Hepatitis B, and C.

Dr. Archer was the guest expert that Global News consulted with when a major oral health story broke in 2017. After a routine dental check-up, a Guelph mom and her two young sons were forced to undergo an array of scary medical tests to determine whether or not they had contracted any infectious diseases.  Health officials warned them that they needed to be tested for HIV and Hepatitis after a complaint about their dental clinic resulted in a public health inspection.

You can watch Dr. Archer discuss the need for regular health inspections below and read the original Global News article here.

The Catalyst

The mom and her family were among the 3,600 patients of the Guelph Dental Associates clinic who were advised to get tested for Hepatitis B, C, and HIV in response to concerns about the sterilization practices of the equipment at the dental office.

The WDG (Wellington-Dufferin-Guelph) Public Health advised all patients who had visited the Guelph dental office anytime between January 21st 2015 and June 21st 2017 to get tested because they might have been at risk of contamination. Luckily, there haven’t been any reported infections thus far but the original warning came as a result from formal complaints from the public to health inspectors.

After the complaints were received and the office was inspected, the location was temporarily closed due to concerns of improperly sterilized dental instruments and equipment.

dental tools

The Problem is More Wide Spread than just One Clinic

The problem is bigger than just one dental clinic. In fact, a number of clinics across Ontario have been investigated after concerns of health and safety violations.

Global interviewed Dr. Archer to get her take on the situation and to hear her thoughts on what changes need to be made to the dental industry to ensure situations like this never happen again.

Dr. Archer said that while most dental clinics and offices do follow health and safety protocols and ensure their equipment and tools are safe and sterilized, there should be a move towards bi-annual or annual inspections from the province. As the system currently functions, inspections only occur if a complaint is made by a member of the public.

Dr. Archer said that she, “think[s] an annual check or some sort of system is a really great idea,” and that she knows, “there are guidelines available to dental offices … working together with the ministry, working together with our members to ensure the public feels safe.”

Dr. Archer believes that the recent HIV and Hepatitis scares have been just as troubling for dentists as they have been for the general public and are a wake-up call for the Ontario dental industry as a whole.

dental chair

What Changes Are Being Proposed?

After this latest health scare, it’s clear that something major needs to change. Kevin Marsh of the Royal College of Dental Surgeons of Ontario (RCDSO) says that the college has its own guidelines and its own process for handling complaints but that it does work with the healthcare agencies in the province to follow up with dental clinic complaints from the public.

He believes there would need to be a change in how the law currently works to allow the college to inspect all dental offices in the province. At the moment, the Ontario Ministry of Health says they have not received a formal regulation proposal from the RCDSO but are open to discussing any possibility that could improve patient safety.

Currently, the RCDSO operates inspection programs for clinics that use dental CT scanners or who provide sedation and general anesthesia. They are looking for different ways to implement mandatory or random dental clinic inspections.

Most dentists are rigorous about preventing the spread of infectious diseases but there are always a handful of dental offices that prove the exception to the rule and make regular inspections necessary.