How Is Dentistry Going To Be Post Covid-19?

Are you a glass half empty or half full type of person? Well, whichever way you look at it the glass contains the exact same amount of water. It’s how you perceive it and think about it that matters. Right now, dentistry due to covid-19 is facing a massive challenge that could change the way we practice forever. As much as I hate to talk about coronavirus and covid-19 it would be wrong not to address the elephant in the room.

Covid-19 Shuts Down Dental Practices


Right now, across the world many countries are in lock down, or as they are politely calling it here in Australia home confinement, self-isolation and social distancing. Have we overreacted or done the right thing – only time will tell.


My two pennies worth is that at some point restrictions must be eased – we need to broaden testing, look at development of herd immunity and protection of the vulnerable. Look I’m no epidemiologist but it is common sense that we can’t hide in our homes in the hope this virus simply goes away or we find some cure or vaccine.


The impact on people’s mental health and the devastating effect this is having on our economies with people facing massive financial hardship is as damaging to our communities as the spread of a virus.


Because of the regulations dentistry has coped it right on the chin and took almost a knockout punch. Many practices have had to close their doors, stand down or layoff staff and have no means of a viable income. Aerosol generation and being in close proximity to others means that our profession is and always has been high risk to exposure of some pretty nasty contaminates.


But What About Infection Control for Dentistry in Covid-19?


Yes, we have infection control regulations and standards and PPE rules that rightly so should be applied stringently. My question is, is what we already have not sufficient measures to protect the dental team and our patients? Well given the shutdown of dentistry it would appear not to be not so. So now unless you can drill without spray and have the equivalent of hazmat suits your days of dentistry have come to a grinding halt (pardon the pun).


I know many of my colleagues are doing what they can to see severe cases under the mandates but the odd tooth ache or two is not going to cover overhead and pay the bills.


I also know of practices that are re-interpreting the regulations to suit themselves and continuing to practice at almost full scope – which to me is of grave concern.


Glass Half Empty or Half Full?


So, glass half empty or half full? Me I’m a pragmatist – there is water in the glass, maybe not as much as I like but if I need a drink then at least I have one. This is my approach to life and this situation; it is what it is.


We can complain and moan, throw our hands in the air, stress and worry about it, over think it, over analyse it and second guess it (as I’ve witnessed on many dental forums), or we can pretend everything is fine, dentistry will bounce back, restrictions will be lifted soon right and then we’ll be busier than ever because people haven’t been able to get an appointment, we can strategically plan how to make more money after this and take advantage of a bad situation.


The problem that I see is that there is a lack of honesty and transparency in both approaches, no-one (not publicly anyway) is talking about how they can’t service the debt on their practice, how they can’t pay their team yet alone themselves, that they have had to file for hardship with the bank to defer payments on business and home loans and mortgages. That many practices were already doing it tough and that this hiatus period will be something they can’t recover from.


Is Dentistry In Crisis Because of A Global Pandemic?


Dentistry is facing a crisis – many older dentists may simply retire, some practices will not be able to weather the closures and loss of income and will fold, younger dentists and new grads may find themselves out of work or on lower commission and hygienists and oral therapists are going to be pushed into hand scaling and reduced hours as practice principles will need to step in to take the lion’s share of the patient load and income generation.


Mindset is an important factor in how we are going to cope with the aftermath of covid-19 not just personally and societally but as a profession and business owner. I feel those who think it will be a boom time for dentists once we reopen are sitting far too much in the glass half full mentality and hey, I don’t want to burst that bubble we must stay positive and plan for the future, but we must be real.


Unemployment is going to be at an all time high, people are going to be financially stretched (yes not everyone but a significant amount). So many people were laid off from jobs and will not be going back to work because the small business that employed them simply didn’t make it.


Hence many of our patients are going to avoid their dental care, many will only want a cheap quick fix, not because they don’t care about their teeth but because they simply cannot afford it. Economies are going to be in recession and people will be reluctant to spend and we all know that dentistry gets pushed down the priority list when this happens.


The other issue we must face is have the public lost confidence in our ability to protect their health and safety – surely if our infection measures and masks etc were any good we could have seen them without the risk of them catching a virus?


Make Patient Safety Your Strong Message


The profession will need to be able to show and offer strong reassurance that not only are we taking every measure to protect their health and wellbeing but that we are going above and beyond.


Yet, this will pose another impact on dentistry as we have known it – the additional cost and financial burden of additional PPE along with longer clean down and set up times, the need to apply rubber dam and even use high-vacuum air exchange devices in each treatment room and operatory. None of that comes cheap and it all takes longer to do which will reduce the ability to produce the same level of dentistry and thus business turnover. Who is going to bear the cost – the practice or the patients?


Now I don’t want to be all doom and gloom – its’ not my style but I’ve not picked up a drill in weeks and I’ve had a fair bit of time on my hands mulling these things over.


What I see is that we need to be prepared to ride out the storm and accept that just like after HIV/AIDS changes to the way we practice dentistry are inevitable. The best way to cope with that is to accept it and plan for it so that when the restrictions are eased, and we can return to some kind of normal we are ready.


As I was discussing with a group of my clients and colleagues recently the practices that I see doing well are those that can go lean – reduce their staffing and their overheads and get the principle dentist back on the tools as many hours as possible for the foreseeable 6-9 months even a year.


The landscape of dentistry post covid-19 lockdown is so grey and unknown.


The other thing that will support practices to stand out from the crowd and survive are those that can show and give reassurance that they take infection control and safety seriously.


The days of a before and after of a beautiful smile as your best marketing tool for the short term have gone. Now it will be pictures of dentists in gowns, respirator masks and all the safety gear that will seed trust and reassurance to patients as right now they want safe.


Their motivation will be safety and comfort.


Many will want cheap and many always have but they will place being safe over cheap in these coming months that follow what we deem return to normal life.


Start posting photos of your hand washing, getting dressed up in you gown, hair covers, face shields etc. Talk about your protocols and additional measures that you are taking to protect your team and patients; you can even have some fun with it to show off your personality. But remember people want to feel safe in your hands, this is taking it beyond please don’t hurt me to please don’t make me sick.


Now if you’ve got a loyal patient base and good relationships with your existing patients, you already have built a level of trust and goodwill with them, so communicate with your patients, tell them what you’ve been doing and why, why you haven’t been able to see them for their routine care what your plans are going forward. Leverage what you already have, build one those relationships.


Look at ways you can offer incentives to acknowledge their loyalty. Show them how much you care.


How The Cheeky Dentist Handled Lock Down During Covid-19


Now this the longest time in my career where I haven’t been behind the chair and seeing patients, it’s way longer than the normal 2-3 weeks off that I take to have a holiday with my family.


And you know what it feels so weird, at first I felt lost, unsure what to do, upset that I couldn’t complete cases or see patients who needed me, hurt and distressed that I had to tell staff we can’t keep you on, we don’t have enough work for you. Angry at being left high and dry and thrown under the bus by our regulatory bodies who were offering no guidance or support in the early days. Anxious over money and how we were going to pay our bills and mortgages.


So much was happening so fast.


And like many of you, no I didn’t have a plan for this.


Yet I did have a plan for if I was injured and unable to work for a few weeks – in that instance my business insurance and ill health insurance would have kicked in after a month, obviously during a global pandemic that wasn’t going to be and isn’t the case but because we had a plan we put some of that into action.


We had cash reserves to keep us going for a few weeks, we had systems in place to inform staff that their role was going to be cut and we had a recovery plan that would allowed me to slowly return to work if needed after illness or surgery. I also had a plan B and C in case we could not financially weather me being out of the practice.


So, despite the stress and the uncertainty I did have a plan of sorts, the issue for many practices is they don’t have a plan or if they do, they don’t have enough cash in reserve to be able to support them through a downturn or in this case a close down (yep who would have figured that as something we would need to prep for).


What Can Dentistry Learn From Covid-19?


But can we learn from this, we can, and we must. We must be willing to be flexible to pivot and adapt.


It may mean for a while the way we do business and the style of dentistry we offer; our fee structure and our team must change.


It may be the opportunity to assess your practice and make the changes you’ve always wanted to.


It’s the time to get off the hamster wheel and work on your business and not in, to put into place the systems you’ve always wanted and to document them. It’s the time to do all the things you’ve said one day I’ll get around to this.


For me it has been the opportunity to simplify, something I had been wanting to do for the last couple of years, to streamline and make my business super lean, it has exposed those who are loyal and those who are not and brought us closer together (of course observing the strict 6-foot social distancing rule) in our resolve to pick up not where we left off but as a better practice, to become more robust and able to support our practices and our lives again.


This is the opportunity to stop waiting for one day and actually make it happen, no excuses, the glass may be half full or half empty, but we’ve all got water in our glass.


You can tip it out and drain it and end up with nothing, you can let it sit and watch it slowly evaporate like your dreams and how you wished your business could be or you can refill it, top it up and have it run over with your new ideas, plans and zest for doing what you love to do the way you want to do it.


Rip up the rule book, create your own future, imagine you are starting over but this time you are starting from a point of greater wisdom and awareness from which to build.