Corona- The Crown Jewel that can bring positive changes in the future of dentistry: Dr Biju Abraham
If one gives it a thought, COVID-19 is arm-twisting us into accepting a new normal. COVID-19 has indeed made us aware of the lacunae in the functioning of private dental setups, which need to be filled. Coronavirus, while being the reason behind almost all things bad in recent times, can also be the harbinger of a positive change in the field of dentistry.
If one gives it a thought, is COVID-19 arm-twisting us into accepting a NEW NORMAL, what everyone is speaking about? Hope the ‘new normal’ is a reference to the PPE, which is mandated as a precaution, as we don’t know everything about this virus, yet. Everything else, namely the known pathogens, are already covered by the standard care imparted at the dental office.
Seniors in the profession will concur that till the late 1980s, and at some places till mid-1990s, dentists, yours truly included, would NOT wear gloves, while carrying out dental procedures, if it did not involve blood. It was perhaps the scare of Hepatitis B & HIV that finally did put gloves onto the hands of the dental surgeon, for all dental procedures, bloody, or not. This was followed by advisories by various agencies, on sterilization & infection control. Most private practitioners who took it upon themselves to adhere to the same. Others did not follow all guidelines, perhaps because, reports of incidences of transmission of infection in a private dental set up, though feared, were not heard of.
In fact, in 2004, ADA released an article with detailed guidelines on how to practice dentistry such that transmission of infection is negated or minimized at the dental office. With OSHA (Occupation Safety & Health Administration) breathing down their necks, American dentists in the private set up were quick to adapt, if had not already. Likewise, with European counterparts. In India, however, with no regulatory authority to monitor private dental practices, the situation remained unchanged, for almost all the dental practitioners. A few did adapt and reaped benefits at a different scale.
CORONAVIRUS - THE “ENFORCER”
What exactly is COVID-19 “forcing upon us”.
1. It has mandated work by appointment only.
2. Stringent disinfection & sterilization (DnS) protocols
3. Be attired to minimise chances of contraction or cross-contamination - PPE, N95, face shield
4. Social distancing
Work by appointment only
This is every dentist’s desire. However, in the initial years of struggle, the fresh graduate, more often than not, succumbs to the patient’s whims & fancies, regarding the appointment time. Very few get out of this trap. In the author’s opinion, such a work pattern, in a very subtle manner, fails to garner the respectability, our profession deserves, in the eyes of the common man. Given the “hectic” schedule, the dentist never had the time to ponder over its implications on the profession. And now, when ”forced” to work as per appointment, the dentist feels like a fish out of water.
Stringent disinfection & sterilization (DnS) protocol
Thanks to the high virulence of the Coronavirus, dentists and his/her staff need to be extra careful and meticulous in their DnS protocols. Dentists who ‘feel the pinch’ in this matter, are probably those who do not routinely, follow the protocols advised by the various agencies, which anyways take care of all dental procedure-related pathogens. Those who were, all the measures “forced upon”, are a simple upgrade.
The new attire
The whole body suit/surgical overalls, and perhaps, the N95 masks, in place of the regular 2-3 ply masks, are perhaps the only additional items, which the dentist would have to add to his/her inventory, if DnS protocols were being followed, routinely. To be a successful dental practitioner, one needs to be not just good in his/her/clinical skills, he/she has to be good in his/her physical appearance, communication & other soft skills, etc. too. The new attire puts a big spoke in this part of the interaction with the patient.
Social distancing is the only variable, which is the tricky one, in the dental office; specifically, if the clinical set up has more than two chairs. Even that is no big deal, and appointments can be cleverly scheduled to ensure social distancing between patients in the reception area of a multi chair practice.
The bottom line
COVID-19 has indeed made us aware of the lacunae within the workings of private dental setups, which need to be filled. Irrespective of how it pans out from here on - whether a cure is discovered, virulence is decreased, or a vaccine is developed, it is vital that the people in charge of regulations and guidelines for the dental profession, take this opportunity to catch the bull by the horn and take the first step, - acknowledge the seriousness of the situation, to put in structured regulations to ensure a better future of the dental profession.
Of course, in the current economic state, the recommendations below, perhaps, cannot be implemented in the immediate future. Background work can, however, be initiated, to get things in place by the time everyone has recovered from the economic catastrophe.
CORONAVIRUS - THE UTOPIAN
“Oh! You are a dentist!!” That’s a response dental graduates get, once too often. (Some are blunt enough to say that you are not a ‘real doctor’). Incidentally, it has a lot to do what has been the image of a dental surgeon over the last few decades in the eyes of the common man. With dental sciences taking big leaps, an upgrade of the image is long overdue!
Better late than never! If something better than the existing can and should be rendered as standard care, it is essential that the same be implemented uniformly, in the greater good of humanity, and the service providers are guided in the right direction to make it happen.
Coronavirus, while being the reason behind almost all things bad in recent times, can simultaneously be the harbinger of a positive change in the field of dentistry. It is up to the will and vision of those at the helm of affairs, to make the most out of this opportunity.
The 2nd step
With no single legitimate resource guiding the private dental practitioner, The Dental Council & Ministry of Health together must come up with a regulatory authority like OSHA, for dentistry. (Dental Safety & Health Administration - DSHA) If positive steps have to be taken, to carry dentistry to the next level, the dental professionals should be guided to incorporate the features mentioned below, among others, by that regulatory body,. The regulatory authority must come out with specifics based on clear and scientific evidence, regarding sq ft area, ventilation, disinfection, equipment, etc. which can be practically implemented and are necessary for the optimal functioning of the dental office, so that in the near or distant future, when a pandemic like COVID-19 hits us again, the entire dental community of our country, is better equipped to handle it.
If one assesses dental offices that could easily adapt to the conditions “enforced upon” by COVID-19, and maximally utilise their resources, can be seen to have the following minimum features
1. A clearly defined reception area
2. A spaced-out waiting area
3. A well-defined consultation area
4. Separate operatory for each dental chair
5. Digital forms of communication & record keeping
6. A sterilization area
Private dental offices with ALL the above-mentioned features are in a minority in our country, and instances of a fresh graduate setting up such a practice is far & few in between. With no one to guide them, the fresh graduate, more often than not, takes the help of seniors, colleagues and Internet, to set up and run his/her private dental practice, the size of which and armamentarium within, are decided by his/her budget. With DSHA guiding the process, uniformity in the base standard of dental care will work, not only for the benefit of the common man but for the betterment of the dental profession, too.
Before you press the panic button or dismiss the rest of this, read along. Remember, all that follows is for the betterment of the dental profession, where the role of the dentist is not limited to taking care of teeth.
At the time of admission into dental college
The changes have to be put in place, from the aspiration stage, itself. When the individual applies for admission into a dental college, he/she should be aware of what is expected of him/her once he/she has a license to practice dentistry amongst the general population, on his/her own. The naysayer will comment on the possibility of the reduced number of admissions into dental colleges. Agreed, that will be the initial outcome. Eventually, colleges, which fail to meet up to the standards, will close down. However, the students who do seek admission into dentistry will be truly confident of what they seek, after coming out in the real world.
The upgraded dental curriculum
An upgraded curriculum is the need of the hour. Materials and topics, which are redundant in current times, need to be removed from the syllabus. Neuromuscular dentistry and the likes, where dentistry has a role to play beyond the oral cavity, should be introduced, in a structured format, into the curriculum. From the third year BDS, practice management must be made a part of the curriculum, with an extended module during the internship year. The student should be able to understand his/her value and decide upon the price attached to the services rendered by him/her. Being a successful administrator, while being an equally successful dental practitioner is an art that not many can master. At least the concepts of the same must be made clear as a part of the internship curriculum. The internship period must have an additional module to make the graduate aware of the technical & mechanical aspects of the dental equipment so that the dental dealers do not take him/her for a ride when they start their practice.
Further the reach of dental services
To meet the real estate requirements, the graduate may choose to open practices in areas farther away from metros and big cities, into the ‘interiors’ of the country. Thereby increasing the reach of the dental services into areas, which have great potential, but the lure of the big city glamour did not allow that graduate to ‘broaden the horizons’.
An upper hand over the chain of dental clinics
With a well-defined structure being the standard, dental offices will have an upper hand over the many chains of dental clinics (most of them have a structured SOP in place, regarding infrastructure as well as operations). Indian public still seeks a particular doctor when they come for their treatment, which may not be possible at the dental clinic chain.
Raise the bar for the existing
As for the existing dental practices, the regulatory bodies can give a leeway of up to 10 years to upgrade to the standards as mandated. In the author’s opinion, it might not take that long, as they would like to be ready, before the first batch with the mandated requirement opens office, in five.
Awareness about dental setups
Health is not a priority for the common man. Dental health comes further down the list. People don’t value teeth. It is up to us to add value to the treatment rendered. The common man has to be made aware that we are not just the smile-correctors; we are much more, beyond that. We are dental surgeons. The role of the dental associations in spreading awareness of the same comes into play, in addition to making them aware what a professional dental practice should comprise of.
Discourage quackery in dentistry
Once the common intelligent man will perceive what a dental office should be, appearance-wise, the likelihood of him walking into a quack’s dental clinic, will reduce, simultaneously discouraging any dental quack to start a new ‘practice’. Something like, what happened to single-screen theatres after the patron had experienced movies at a multiplex.
Enhance the positive perception of dentist in the eyes of the common man
The perception of the dentist, in the eyes of the common man needs an upgrade. Putting in the real estate requirement will surely take the dental community one step closer to that goal. Any commercial establishment, providing any service, when spread out over an area in a structured format, commands more respect, than one providing the same within a cramped space. The idea should be to introduce dental professionals as caretakers of oral, as well as, the overall health of the community. The mouth is the gateway to health. To provide the same, the dental professional should have the option of starting his/her own office as per the above requirements, or, work under/with someone, whose office fulfils the mandated requirements, and desist from opening up dental clinics in small shops, just because one can.
Every adversity harbours an opportunity. If ever there was an opportunity given to our profession to upgrade, this is it. Perhaps the limited connectivity at the time, when HIV came to the forefront, did not impact us as a community, as much as with COVID-19 around. Once the dental professionals come back on their feet and the financial outlook for the future appears stable, the author is of the opinion, that the ball should be set rolling to work towards a better future of the dental profession. These may be tough calls, on the face of it; but it is only under extreme pressure does a block of carbon becomes a diamond. If all goes as per plan, the future generation of dentists, may thank this one, and be ever grateful for SARS COV-2, to bring about the necessary changes in our approach to a dental practice, in the private set up.
Dr Biju Abraham completed his MDS in Orthodontics in 1995 and is practising in Mumbai. Maintains his practices at Ghatkopar & Santacruz. He is also a consultant at Dr LH Hiranandani Hospital, Powai.
Former Editor of IOS TIMES, the official newsletter of Indian Orthodontic Society, Dr Biju Abraham has been actively engaged in creating awareness about orthodontics amongst the common man via his social media pages of - smilewithdrbiju & YouTube channel - Braces Takes U Places® and as the Chairman of the Public Awareness Committee of Indian Orthodontic Society (2013-16 & 2017-19).