Costs of reopening adding up for dentists, could lead to fee increases

By | May 12, 2020

Manitoba’s dentists are trying to reopen their practices after being closed for several weeks due to the coronavirus pandemic, but increased safety measures come with added costs, supply chain issues, and less capacity to treat patients.

“It’s a much more stringent protocol because the virus is so communicable,” said Dr. Alan Grant, who owns Kildonan Place Dental Centre.

“I think the excessive amount of protocols are going to be definitely in the short term expensive, and maybe unnecessary, but we don’t know, and so that’s the problem, by not knowing we have to go more cautious than less cautious,”he said.

Dental offices were among the businesses allowed to reopen on May 4 following the closure of all non-essential businesses during the coronavirus outbreak.

Those who do reopen must follow new provincial guidelines to protect against COVID-19.

That means screening patients prior to treatments, having fewer people in waiting rooms, and implementing increased sanitization protocols — but it doesn’t mean things are back to normal once patients are in the dentist’s chair.

Guidelines set out by the Manitoba Dental Association also advise the use of personal protective equipment — like N95 masks, gloves, gowns, face shields, caps and booties — many of which have been in short supply. 

“Because everybody’s trying to get them at the same time … the prices have gone up and the availability is scarce,” said Grant.

Dr. Alan Grant says lost revenue and added expenses have already cost his practice, Kildonan Place Dental Centre, hundreds of thousands of dollars. (Holly Caruk/CBC)

Many common dental procedures use tools that can create aerosols, a vaporized mix of saliva and blood, which can carry viruses. These droplets can be suspended in the air and then breathed in, which is why proper protective gear is needed. 

But those droplets can also move through the air, which has led the MDA to make recommendations about limiting those procedures right now, and if necessary, doing them in a sealed room and not leaving the room for half an hour to allow droplets to settle.

“Thirty minutes is a long time. You can do a whole procedure in 30 minutes,” said Shannon Ferreira, a dental assistant at Grant’s practice.

“So that affects your production, that affects your wait time, everything. It’s a total game changer,” she said.

Dental assistant Shannon Ferreira says the new procedures will greatly reduce the number of patients she can see in a day. (Holly Caruk/CBC)

Once the room is cleared, dentists are also advised to allow up to 3½ hours to pass before re-entering the room to clean it, depending on the type of air filtration system being used.

Allowing more time to lapse between turning over the chair to a new patient means less capacity to treat people.

“It’s kind of crazy. It’s not going to be as fast paced as it used to be, that’s for sure because I’m used to running two chairs at the same time going back and forth,” said Ferreira.

‘Costs are going to go up’

At his Kildonan Place practice, Grant has already invested tens of thousands of dollars sealing off procedure rooms that used to be open-air cubicles, as well as ordering air filtration systems for each room, and additional filters to be placed next to patients.

“I can afford to take some of these changes, I feel really bad for some of the younger dentists who just purchased practices, and are having a difficult time being shut down so soon after starting their practices,” he said.

Grant estimates his business has lost half a million dollars in lost revenue and added costs due to the pandemic.

He said for now he’s able to carry those costs, but if the new protocols are in place long-term, prices for services will need to go up.

“We’ll only be able to bear the brunt of these costs for so long until we pass them on,” he said.

“Dentistry is a necessary service for people, they’re going to need it, so unfortunately that means costs are probably going to rise dramatically over the next year or so.”

So far Grant has only treated a handful of emergency patients over the last few months, billing just about $1000 in the month of April. He says he won’t be ready to reopen until at least mid-June, and capacity will be very limited.

Grant had to lay off more than two-dozen employees, and has only been able to hire back a few. He says retraining staff on the new protocols will take time 

Long term effects unknown

The Manitoba Dental Association acknowledged that dental practices are facing some financial challenges.

“All small private businesses are facing the same financial challenges, our financial challenges are no more important than any other small businesses,” the association’s president, Marc Mollot said in an email.

Although there is a dental fee guide in Manitoba, Mallot said fees charged are set by the practitioners themselves and are left up to the discretion of the dentist in consultation with the patient.  

“With the added costs associated with treating patients in the COVID-19 era, it may be that a dentist might choose to increase their fees for services,” he said.

“However, it may be premature to know if that will occur as we are currently seeing only urgent cases and the long-term effects of COVID-19 on the marketplace and cost of goods are yet to be determined.”

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