How coronavirus is changing the dental visit

Over FaceTime, a Manhattan orthodontist coaches his patients to jury-rig nail clippers to snip off errant metal painfully piercing the cheek.

In a Nesconset kitchen, a mom whose daughter can’t see her own orthodontist in Ronkonkoma must pop back a teeth-straightening wire onto her 11-year-old’s dental braces — and hopes she won’t need to do more.

“I’m more just worried that I have to act as an orthodontist and break into my husband’s tools, which hopefully doesn’t happen,” said Kristin Abbate, 41, a schoolteacher whose daughter Donna has worn braces since 2019 to correct crowding, an overbite and crooked teeth.

Since March, all but the treatment of dental emergencies have been banned under Gov. Andrew M. Cuomo’s executive order to combat the spread of coronavirus, which has infected at least 295,106 people statewide and killed at least 16,966. The order has been extended until at least May 15.

Dentists are agreeing to see patients only for the most dire circumstances. And some dentists are making do with inadequate face masks, unable to obtain necessary personal protective equipment, such as N95 masks, which reduce the wearer’s exposure to small-particle aerosols that might contain the virus. 

“Surgical masks protect mucous membranes of the mouth and nose from droplet spatter, but they do not provide complete protection against inhalation of airborne infectious agents,” according to the U.S. Centers for Disease Control and Prevention's nationwide guidance on dentistry and coronavirus, recommending the use of N95s. 

The American Dental Association’s “What Constitutes a Dental Emergency?” flyer includes uncontrolled bleeding, tooth fracture and trauma involving facial bones as treatable during the pandemic; aesthetic dentistry, routine cleanings and extraction of asymptomatic teeth are not emergencies.

Nor are regular orthodontic visits, which are usually required every two or three months to keep treatment on track. That’s when the orthodontist bends or tightens wires to put pressure on the teeth and gradually shift them into new positions. Certainly, no patients can come in for new orthodontia like braces or Invisalign — the clear, plastic, removable aligners that have become increasingly common.

According to a report last year by the American Association of Orthodontists, there were 4.1 million children and adolescents and 1.6 million adults under the care of an association member.

“I can’t even make appointments for my patients right now,” said Dr. Chandra Pham, an orthodontist who works at an Islip practice with about 600 patients with various forms of orthodontia.

She’s still seeing patients, but rarely and only for emergencies. As for the practice’s income, “it’s kind of zero.”

"We haven’t made money at all this month,” she said.

She is directing patients who lose their retainers, which keep teeth straight after treatment is completed, to go online to buy a moldable night guard as an interim replacement until dental labs shuttered by the coronavirus emergency can reopen.

Dr. Binod Verma of Manhasset Hills, president of the Nassau County Dental Society, said that practitioners have faced a shortage since last month of personal-protective equipment like N95 masks, disposable gowns and face shields. As a result, he said, dentists are being choosy about which ailments they treat, even in emergencies. Toothaches, swelling and pus discharge are among the conditions that would get in-person care. 

“We are trying to be very, very selective — only patients who have real, excruciating pain,” Verma said.

He lamented how he placed an order three weeks ago for PPE that remains undelivered.

“We are working directly in front of the patient, and we can catch the virus very easily,” he said, noting that some dental procedures can aerosolize the virus from patients’ mouths. “We are risking ourselves.”

Dr. Kenneth Cooperman, who co-owns practices in TriBeCa, Harlem and the South Bronx, said, like Verma, that he is triaging patients by telephone and on video-chat apps.

But, he said, even once the governor allows nonemergency dentistry to resume, a visit might look different as dentists try to protect themselves, staff and patients.

Open-layout plans, common in some orthodontic practices where multiple patients are treated in the same room, could be reconsidered. Barriers might need to be installed, he said. Fewer people would be permitted in waiting rooms and more time left between appointments, according to Cooperman.

“We don’t think it’s going to be possible for a bunch of kids coming in after school like it was before,” he said. 

He said practices will also likely need to expand hours, at least temporarily, to accommodate the patients who couldn’t be seen during the coronavirus shutdown.

“There’s going to be a bottleneck,” said Cooperman, past president of the New York County Dental Society, which covers Manhattan. He said he had about 40 or 50 patients who had been scheduled to start orthodontia before the governor’s moratorium went into effect. The practices Cooperman co-owns have 1,200 patients currently under treatment, he said. 

Dr. Yon Lai, of Manhattan, immediate past president of the New York State Society of Orthodontics, said on Sunday that with colleagues he is testing a “cocoon” to contain vapors aerosolized during dental work. All but its frame, which is made of PVC and wiped down afterward with disinfectant, is disposable, including the side, made of food wrap, and a top sheet of clear acetate.

Over the past month, Lai has had to tell two patients over FaceTime how to use fingernail clippers to cut errant metal wire — be sure to place a cotton ball in the cheek to catch what falls off, he said. One patient completed instructions successfully, and the other had to come to be seen by Lai in person.

For the few patients who do need emergency orthodontic care now, Lai said, the office has already implemented additional safeguards to protect against aerosols, as well as mandating forehead temperature checks, questionnaires about any coronavirus symptoms, limited occupancy in the waiting room and parents waiting outdoors.

Donna Abbate of Nesconset had last been in for an appointment in February and was scheduled, before the coronavirus lockdown, for an adjustment this month.

“I’m scared that if my wire breaks, or my bracket pops out or anything, it’s going to cause pain, and I’m going to be annoyed with it,” the 11-year-old said. 

Her mom, Kristin, said she’s wary of bringing her daughter to the orthodontist's office, even in an emergency, due to coronavirus.

“It’s just a matter of, do you want to take that risk?” she said. She added: “They get so close.”

By Matthew Chayes

matthew.chayes@newsday.comchayesmatthew

Matthew Chayes, a Newsday reporter since 2007, covers New York City.