Returning to a new normal

As many states continue to extend social distancing measures, many people are asking, “When will things finally return to normal?” I’m here to tell you things should never return to normal as they were before — and that’s OK! As health care providers, it is our job to improve. It’s our job to innovate. It’s our job to create a new normal that makes us and our patients safer. Want some good news? Dentists have done this before.

Photo of Dr. Markiewicz

Dr. Markiewicz

My great Uncle Joe was a dentist who graduated from Loyola College of Dentistry in 1960. Like many of the dentists of his generation, Uncle Joe shared with me that he practiced without gloves, without a mask and without glasses. He mixed amalgam with his fingers. He took X-rays without lead aprons. His instruments weren’t sterilized between patients. This may seem abhorrent today, but Uncle Joe wasn’t a bad dentist — it’s just the way things were done at that time.

Although the Occupational Safety and Health Act (OSHA) was passed in 1970, safety in dentistry didn’t see considerable changes until the onset of the HIV/AIDS crisis in the 1980s. The health concerns and stigma surrounding HIV/AIDS disrupted dentistry and threw it into a rapid (and for many, unwanted) evolution. Suddenly, dentists couldn’t do things the way they’d always done them. Almost overnight, universal precautions were established and dentists were forced to change in order to protect their own and their patient’s health.

The HIV/AIDS crisis was (and continues to be) terrible in so many ways; however, the changes it spurred in safety precautions has turned out to be an unforeseen benefit. Every dentist now wears gloves and masks. Each operatory is thoroughly sprayed and wiped down with medical-grade disinfectants between patients. Instruments are heat sterilized after each use. These are all good things. Although there may have been growing pains initially, these changes are universally good.

Nearly 40 years after the onset of HIV/AIDS, dentistry finds itself in a similar position today with the COVID-19 pandemic. Just like responsible dentists post-AIDS crisis didn’t go back to practicing without gloves or masks, I believe it is foolish for dentists to assume things will go back to normal when dental offices are allowed to reopen.

Recent studies suggest that dentistry is one of the most high-risk profession to contract COVID-19 due to the amount of aerosols generated in a dental office. After looking into these studies, I often find myself thinking, “Why weren’t we concerned about this before the coronavirus outbreak?”

Just like the HIV/AIDS crisis forced dentists to consider new protections against blood-borne pathogens, the coronavirus is forcing us to look at aerosols and air quality in a way we haven’t before. Knowing what we know now, it’s our obligation to change. Although these changes will be made in response to COVID-19, the benefits will likely extend far beyond the reach of this current virus.

Unfortunately, no one knows exactly what these long-term changes will involve. Will these changes include N95 masks, external suctions, or hair nets? How about respirators, HEPA air filters, or negative pressure rooms? Who knows?! There will be no magic pill — the solution to limiting our aerosol production will likely be multi-fold.

Right now, there are many unknowns. In Facebook groups and email chains, we are inundated with new products and information whose efficacy remains unknown. Although we may not be able to commit to one solution at this time, it is important that we do commit to change. If we do, then dentistry will change. There will be growing pains as we adapt to a new way of practicing, but these changes will be universally good in the long-run.

Just like I look back at my Uncle Joe and think, “I can’t believe he practiced without gloves,” I hope that future dentists look back and think, “Can you believe that dentists used to practice without aerosol controls?” Just like dentists did after the HIV/AIDS crisis, I am confident that we can move this profession past COVID-19 and into a new normal that is safer for us and for our patients.

Dr. David Markiewicz is a New Dentist guest blogger and a member of the American Dental Association, Illinois State Dental Society and Chicago Dental Society. He grew up in Illinois and is a graduate of the UIC College of Dentistry (’19). He practices with his father, Dr. Anthony Markiewicz, at their family practice in Mundelein, Illinois. When not at the dental office, you might find David and his wife admiring their cat, Gatsby.

7 comments

  • I graduated in 1959–just before your Uncle Joe? This Covid 19 is slightly different. Right now dentists need guidelines before opening again-l-those guidelines are currently missing? The only other solution is a vaccine-which may be along time coming; or many never come?? Nevertheless Dentistry has hit a brick wall; I am uncertain that dentistry can return to the old norm l–Pre covid .-l- I think this episode will not end end my lifetime unless a readily acceptable and proven vaccine is discovered

    • I agree it cannot go back to normal! We are standing on the shoulders of the dentists that came before us. Just like previous generations were able to adapt and reform the way they practiced, so will we today. Dentistry will be different and it’s up to us to plan as if there is no vaccine coming.

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  • Which risk is higher, damage to heart etc from decay or risk of contracting airborne illness?

    Change is great, new PPE and air purifying excellent, but it takes hours/days for these to work, it can not clean air before next patient, and patient is not garbed up and mouth, nose, and eyes are wide open to this.

    Scary, no good answers especially for those who suffer from asthma, COPD, etc.

    I am worried for dentists losing money and possibly their practice in long run, but PPE has not helped exposures in the hospitals, how will it help patients and staff in a more volatile situation like dentistry?

  • Robert F Autore, DMD

    The ONLY WAY we dentists will be able to return comfortably, to our practices with staff and patients who are reasonably assured they will not become ill from this GD virus…IS to have point of service PCR OR ANTIGEN testing to VERIFY NEGATIVE VIRAL LOAD BEFORE we accept them into our offices….PERIOD!

    Focusing on masks, shields, disinfectants, air purifiers etc is critical but secondary to this requirement.

    There is absolutely NO WAY I plan on returning until we have a very reliable testing protocol..

    • I hope your practice survives long enough for you to obtain your reliable testing protocol.

      All of the PPE in the world is no match to a virus that is everywhere, including your totally clean dental office.

      You and all of us will 100% get this virus, whether we are in our dental offices, or out and about. So trying to prevent the inevitable is fool-hearty. You may have already have it, and didn’t know it. Its like trying to prevent getting the flu. So best thing to do is get your immune system as healthy as possible and hope and pray you don’t have a bad reaction to it. But what do I know, I’m just a Dentist.

      So unless you plan on wearing a hazmat suit the rest of your life, you will catch CoVid-19, or one of its strains. God bless!

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