Dental offices throughout the state are reopening for routine care this week, and while dentists say they’re taking numerous precautions to protect patients and employees from coronavirus exposure, some hygienists still have concerns about returning to work.

Gov. Jay Inslee on Monday announced new guidelines for nonurgent medical procedures to resume, which call for doctor’s offices and dental practices to have enough personal protective equipment (PPE) for their staffers, keep enough distance between people and check visitors and patients for symptoms of COVID-19.

A general lack of PPE was a major concern for hygienists leading up to this week, as was a lack of adequate COVID-19 testing. Some, including Jennifer Zbaraschuk, president of the Washington Dental Hygienists’ Association, are now satisfied by the state’s new guidelines.

“We’re happy to be getting back to providing care for our patients in a safe environment and we appreciate the governor’s work … on listening to all the parties involved in finding common ground for Washington,” she said.

But some hygienists — who are among workers facing the greatest coronavirus risk — remain hesitant. Specifically, they worry about the possibility that the virus can spread through aerosols, tiny airborne particles produced during nearly any type of dental procedure.

There isn’t enough research into aerosol transmission, Zbaraschuk said last week, although some research suggests it’s possible.

One Marysville hygienist said she told her dentist she wanted to wait a few more months before returning to work because “there’s no way” dental practices should be open yet. She didn’t want to be named for fear of retribution from her employer, whose office will reopen this week.

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“The level of uncertainty is too great for me. I understand the rock and the hard place that business owners are in right now, but it’s going to take a lot to get things up to speed,” she said. “… [Inslee’s Monday announcement] doesn’t really change anything.”

Bracken Killpack, executive director of the Washington State Dental Association, said the time is right and his organization fully supports the state’s guidelines for reopening.

Offices halted routine dental appointments in mid-March after Inslee issued a proclamation prohibiting hospitals, dental, orthodontic and other health care services from providing nonemergency care. The proclamation expired at midnight Monday morning.

While many offices have continued to provide emergency care for the past couple of months, some patients may still have stayed away, Killpack said.

“I think the proclamation had a chilling effect on people seeking care, even if they would’ve needed it,” he said.

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Dental issues that initially appear minor will worsen if left untreated, said Dennis Bradshaw, a dentist in Pasco. Bradshaw said one of his patients chipped her tooth shortly after the proclamation was issued, but because she didn’t feel any pain, she put off a dentist visit.

“She waited five weeks, and every day, everything she ate got packed into the broken area of the tooth,” he said. “What probably could have been fixed with a filling ended up needing a crown and a root canal.”

Bradshaw is among many dentists who have spent weeks trying to stock up on PPE and rearrange their spaces to keep enough distance between people.

The Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) had issued general safety recommendations for the pandemic, but before Monday, Washington state hadn’t required practices to take any particular precautions before reopening.

Last week, the state dental association and Delta Dental of Washington secured 300,000 masks from the state emergency management team. They spent the weekend distributing a pack of 50 masks to every practicing dentist in Washington, and Killpack said more is on the way.

“Other things are going to come up,” he said. “… This is the first of many waves of PPE we’re working to secure.”

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Bradshaw said patients should expect a lot of changes when they next visit their dentist.

For instance, the CDC and ADA recommend that patients answer screening questions about symptoms and potential virus exposure before being scheduled for an appointment. Offices might also take a patient’s temperature and ask patients to wait in their cars rather than in a waiting room.

Bradshaw said he’s also asking patients to wear masks and not to bring someone with them unless necessary. He and the other dentists and hygienists at his office will wear face shields and masks during procedures, and all surfaces and dental instruments at his office will be sterilized after each appointment, he said.

“If you’re a dentist, and you have the PPE to protect your staff, it’s safe to go back to work,” Bradshaw said. “If you don’t have the PPE, it’s not safe to go back to work. And any responsible dentist is not going to ask any of his staff members to do something without being properly protected.”

Jennifer Frame, a dental hygienist at Arthur Dental Group in Bremerton, said her dentist has worked hard to take the proper precautions before reopening, including ordering air filters for each room.

“I feel comfortable going back to work, but only because I know my doctor has been super stressed in making sure we’re taken care of,” Frame said. “I think we still need research [on the virus] … But we can’t stay holed up in our homes forever.”

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Those unknowns, however, still elicit distress from workers such as Lori Matsumura, a hygienist in Federal Way, who said she’s worried about her family’s health.

“That’s the part that makes me shake in my boots and makes me quiver,” said Matsumura, 61. “I have an 88-year-old mother and a husband medically compromised with a heart condition.”

But she still plans on returning to work when her office fully reopens Tuesday morning.

“I love and have great passion for my profession,” she said. “My dentist is doing the best he can to provide anything. But it’s a little nerve-racking. For me, if I could wait even two more weeks, I would feel a lot better.”

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