Perspectives: Coping with the Coronavirus fallout

As dentistry continues to settle into a new pattern following guidance relating to the Coronavirus, practitioners remain in a state of flux. Dr Gina Vega and Dr Kunal Patel talk to BDJ In Practice about how they and their businesses are coping with the pandemic crisis

How have you navigated through the lockdown phase?

GV I decided to keep one dental nurse until the end of the lockdown to help me with all logistical details for the practice. It helps that she lives within short distance of the practice for any emergencies, and to deal both with patients or suppliers. As a principal, you naturally rely on your team and in my case they have all been superb throughout the years.

The drawback is that when you are suddenly faced with such an unprecedented situation and have to furlough your staff, you soon realise how dependent you are on them and how much you need to catch up on in times like these. I had to be shown how to use the Software of Excellence to create lists and reports, be given all passwords from many sites that we use daily like DenGro and social media channels, you name it. Naturally I am anxious, but my stance is that worrying is counterproductive. I have started several planning workflows and to-do lists on Excel and, I have to admit, this has helped me tremendously.

KP Weeks before any official guidance from our governing bodies, my team and I decided to put our drills down and no longer see patients face-to-face. We didn't have the correct PPE and could not get hold of the NHS about securing any equipment. That didn't mean that our patients had to be abandoned. Without them, we are nothing. When we had the memo from the Chief Dental Officer that we had to stop practising, we already had our plans in place, so we've had longer to acclimatise to the new world order, so to speak.

Social media and technology are brilliant tools to maintain contacts in times like these. But for me, social media has been much more than that. Before we received any guidance from our governing bodies about the current situation, the dental community had collectively started discussing ways we could implement protocols to prevent the spread of the virus, and social media was such a powerful tool for this. Talks essentially revolved around preserving the safety of clinicians, staff, patients and the whole community.

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To what extent is it business as usual?

The way we prepared has helped somewhat. We proactively focused on triaging all patients over the phone.

GV As a one-man band or shall I say one-woman band, I am overwhelmed with the amount of work that needs to be done. It's not just throughout this phase - that also means getting ready for when the practice can open again. All services, such as the collection of clinical waste, oxygen cylinders replacement, etc, have now been put on hold and these will need to be reactivated in months, and fast.

My time has been split sorting my staff and dealing with their new employment status, talking to my accountant, identifying what costs I am going to be faced with over the next few months and what loan amount I will need to borrow. With careful financial planning and a good business plan for the next three to six months, I am confident we can pull through this.

It's obviously challenging, but there are still patients relying on a service. I have a list of all our patients and actions against their names - when to call them, when they have contacted me, when we need to prescribe antibiotics, which patients can move forward with their Invisalign treatment and which ones will have to wait until I see them again, to carry on with their treatment, when I need to send Invisalign aligners and so on. and I use a simple colour coding system to alert me of the various priorities.

KP The way we prepared has helped somewhat. We proactively focused on triaging all patients over the phone. My team have always been involved in every patient's treatment and are very hands on - we assessed every patient individually and adapted the ways to advise them. The power of communication is huge. Patients are understanding when you explain stuff to them patiently and with clarity - it is not knowing which is so upsetting. You look at what treatment stages they are at and you take time to go through details with them.

We have been lucky that our patients could all be followed up safely. For example, Align Technology set up a new communications portal for us and re-organised the way deliveries were configured, so patients can now receive their aligners directly to their home address, sparing a member of staff to accept deliveries in the dental practice and organising separate couriers to post to the patient. This means they didn't have to remain stuck in mid treatment and have to stay with the same aligner for some time.

We have also set up video calls where we discuss potential treatments with new patients. We continue planning their treatment and we are here to answer any issues they might have. It is about being adaptable and finding new ways to manage until we can resume normal practise in a safe environment. And patients are thrilled because they see we are going the extra mile, because they see we care and want the best for them.

The way we prepared has helped somewhat. We proactively focused on triaging all patients over the phone.

Is it possible to offer new patients assessments at this time?

KP We are still receiving lots of new enquiries about Invisalign treatments and we are responding to all of them, but we are also telling people that their first consultations will have to wait as an in depth assessment has to be conducted and that has to be face to face. People appreciate our efforts and honesty.

For patients who recently started treatment, we have recorded videos training patients how to wear aligners, how to clean them, store them, change them, and with the portal now available, we can be there for them whenever they need with an active video call with the patient.

For patients needing to collect antibiotics, we have also set up a secure box with a code outside the practice and they just tap in their unique code and take their medication without any need for human contact. We are fully aware of the constraints, but the situation also highlights how technology can help and we should make the most of it and be grateful it is there for us all. It may change the way we work once we've all had the opportunity to take stock of how we have made it through the other side.

GV Like Kunal, I am also fortunate that a large percentage of my patients are Invisalign patients, which means that I can also post aligners and follow their progress with photos or videos. I have personally called all of them and given them all personal advice and reassurance.

Asides from that, appointments had to be cancelled but we tried to be as transparent as possible. Most understood the stance we were taking and for those who did not get the gravity of the situation and lodged initial complaints for 'poor service', we took time to discuss this with them and they all profusely apologised once they obtained the reassurance we would look after them as soon as we were able to do so. Now all calls are redirected to my mobile and everyone can email me directly. I also make a point of maintaining contact with our patients. I am planning 30-minute consultations with patients via Skype or WhatsApp once I have managed my time a bit more efficiently. We have had a quarterly newsletter for quite some time, but since last week we are sending one blog every week as we believe that now it is an ideal time to reinforce the message of good oral hygiene and systemic health, and how reducing one's oral bacterial load can prevent potential lung problems for instance. My associates are all keen to contribute and write their tips, which I am so grateful for.

Dr Kunal Patel, Principal Owner, Love Teeth Dental Practice & Cosmetic Clinic

Dr Gina Vega, director of Bishopsgate Dental Care, a multi award-winning dental practice in London