Letters

Crisis was a Teachable Moment

Congratulations, everyone. New York State dental offices are finally open. I, for one, will take the win. I am grateful that part of this ordeal is over. However, all New York State dentists have been put on notice. We need to prepare. We need to engage with one another, with our local components and with NYSDA directly. My hope is we can start a productive dialogue, learn from our mistakes, and be a force to be reckoned with in the future.

My purpose in writing this letter is not to criticize or single out any individuals for blame but, rather, to stress that we need to learn from our mistakes, or we will be doomed to repeat them. I realize this is a cliché, but it is the truth. I don’t know about you, but when I have a less-than-ideal outcome clinically, I perform a self-review to see if I can improve and avoid mistakes in the future. This is no different.

We cannot afford to be complacent. When an anticipated “second wave” hits New York, what is the plan? Many people have criticized NYSDA for its response to this crisis. A voluntary closure for the public good became a three-month mandate. We were blindsided. But this time, we know it is coming. We need a prepared protocol, a public outreach campaign and a strong lobbying position beforehand. We are professionals and a critical part of healthcare. It is hard not to take the blatant lack of respect displayed to our profession personally. We deserve and should demand more dignity then we received. What is the plan for when the governor wants to impose another mandated restriction? We cannot tolerate further disruption to patient care.

Media coverage of our situation was abysmal. We watched with dismay as auxiliary dental staff spread fear and doubt about our ability to protect them and our patients. We saw individual dentists brag about updates to their offices, unsubstantiated gadgets they had purchased and idiosyncratic procedures they had adopted. My interpretation of these reports was no more than sly, or not-so-sly advertising intended to sow fear and distrust of other dental offices. NYSDA needs to launch a PR campaign that will start to heal the damage caused by the recent depiction of our profession in the media. We need to look back and see why we were not controlling the message. We need to be prepared to advocate for our profession as a block. The small gains we can make as individuals pale in comparison to the cost of eroding public trust in dentistry.

I am concerned also about lack of transparency. My hats are off to NYSDA for getting the job done. I am incredibly grateful to the individuals, almost all of whom are volunteers, who took time away from their own personal and professional struggles to fight for all of us. Let those of us who sat on the sidelines show some gratitude. But that doesn’t mean we shouldn’t ask questions.

I have seen a lot of talk online about people’s concerns about organized dentistry. Some people have even said they want to terminate their membership. I understand, and at times during this crisis, I felt the same way. I have decided that for me, the solution is to become more involved. There is too much at stake to become jaded and non-contributory. My generation needs to rise up and take its rightful place at the highest places of power within NYSDA. I hope we can be a source of dramatic change—not one that seeks to dismantle and destroy but one that revitalizes and restores. We owe nothing less to ourselves and, more importantly, to the patients we serve.

Joseph P. Denning, D.D.S. Schenectady, NY

NYSDA was there for its Members and will be in the Future

Thank you for your letter, Dr. Denning. We appreciate all input— positive and negative—from our members as we strive for continuous improvement at NYSDA. I know you wrote out of some frustration, but also out of passion for the Association and the profession of dentistry.

The seven weeks that dental offices were open only for urgent and emergency services were difficult for all of us, but all the while, NYSDA was advocating continuously on your behalf. The work was tenuous and delicate on many occasions, and we chose to keep our communications with state, regional and local leaders somewhat quiet so as not to confuse or threaten any of the progress being made. I take your point that we could have been more transparent throughout the negotiation process. Let me try to partially remedy that by sharing the steps that, ultimately, led to a successful reopening on June 1.

Beginning on March 16, when Gov. Cuomo issued an executive order limiting dentists to only “emergency and urgent” care, NYSDA got right to work advocating on behalf of our members. Our primary focus was always on speeding up the adoption of state guidelines and laying out the quickest possible timeline for dentists to reopen their offices. All the while, we advocated non-stop against phased reopening and on behalf of a broad statewide reopening.

Behind the scenes, we were in constant contact with the governor’s and lieutenant governor’s offices, the Speaker of the House, the Deputy Majority Leader of the Senate, the Health Department, health policy leaders in the administration, legislators across the entire state, and other elected officials at the county and local levels, as well as the governor’s “Reopening New York” advisory task force, on which Dr. Amarilis Jacobo serves. Over the course of our discussions, we learned that these decision makers held many misconceptions about the dangers of dental offices, which we were able to counter very effectively, while emphasizing our long-standing record of safety.

In the meantime, our Association began daily communications with you, our valued members, about resources available to you—PPP, EIDL and other small business loans, tax ramifications, PPE availability, and the Cares Act, to name a few. We also extended to members who needed it a grace period on their dues. Although the NYSDA team is working at home and communicating remotely, our employees put in long hours, fielding 3,200 calls, responding to over 5,000 emails, filling our website and social media with relevant news and sending out over 35 messages updating members on any new developments. In addition, we provided “how-tos” and “FAQs” from our own headquarters, as well as from organizations like the ADA and the SBA. We also offered webinars on all aspects of management, including furloughs, layoffs and benefits. In preparation for reopening, we helped develop our “back-to-work” guide, which supports CDC, OSHA and ADA directives, and made a comprehensive reopening toolkit available to all of our members.

While we waited—increasingly impatiently—for the guidelines and timeline to be issued, we achieved a number of big and small victories. We advocated for, and were successful in getting, the DOH to move the status of dentists from “emergency only” to the inclusion of “urgent” care. With ADA guidance, we were given more latitude in using our professional judgment to define urgent care and to make decisions about treating conditions that could advance to emergency level if left untreated. Also, with the assistance of the ADA, we managed to move dental practices up on the FEMA priority list, from seventh to fourth, and, now, to first priority to receive PPE. We helped secure PPE, vetted vendors and educated members on the availability and usage of PPE.

In early May, we decided the time was right to garner more public and media attention to our cause, and many positive stories and public communications resulted. We also coordinated a grassroots campaign helping our members deliver letters to over 6,800 legislators. We can quibble as to whether that operation should have started earlier and, perhaps, we were too conservative, but we chose not to overplay our hand on that front.

Now that dental practices have reopened, there are still many steps we will take to help you work successfully. We will continue to translate what governmental actions mean to your practices. We’ll help further increase the supply and reduce the prices of PPE. We will assure that you have the ability and the right equipment to administer point-of-care testing when it comes online. As new programs, funds, loans, tax write-offs and other forms of relief become available, we will help you navigate through them.

We will continue to answer your questions, find resources for you, and do everything we can to help you and your teams succeed, as we do our best to put the COVID-19 pandemic behind us.

I firmly believe that all of our efforts paid off with the governor’s announcement that dentists across the state—not phases— could reopen on June 1. Given all of the decisions and actions in play, it was understandable that this declaration wouldn’t be made overnight, but we agree that it took far too long. That said, I will argue that without NYSDA’s constant advocacy, the process would have taken even longer.

Going forward, we will heed your advice to be more open and transparent about the efforts we are taking and the progress we are making as we focus on the future.

Mark Feldman, D.M.D. NYSDA Executive Director

Are we Truly Prepared?

I have practiced dentistry for almost 13 years. I am a member of the ADA, NYSDA and Fifth District Dental Society, but that is all I am—a member. I consider myself a dentist who prefers to sit on the sidelines rather than be directly involved with the organizations. As a woman, my life is busy running a dental practice and taking care of my family. I’m always trying to fit the roles society has given me and those I have chosen; but being involved has never been one of them.

After reading Dr. Joseph Denning’s letter “Crisis was a Teachable Moment” and Dr. Mark Feldman’s response, “NYSDA was There for its Members and will be in the Future,” for the first time in my career I felt moved to be involved. So, I write this letter because I feel there is another view to this discussion that was not represented by either side.

Before voicing my concerns, I agree with Dr. Denning; I wasn’t satisfied either with NYSDA’s response to this unforeseen situation. I would like to thank Dr. Feldman for clarifying how much NYSDA advocated for us. I no longer feel like my membership dues was money down the drain.

I also agree that we should have a plan in place, not just as individuals, but as an organized profession to deal with the “second wave,” which is expected to come in the coming months. I believe, as professionals with doctorate degrees and as specialists in our field, we should be able to understand the risks of dealing with communicable, infectious agents, such as airborne pathogens. We should also understand the necessary changes in protocols and safety precautions as we adjust to this “new normal.”

That being said, I disagree with Dr. Denning’s statement on “unsubstantiated gadgets they had purchased and idiosyncratic procedures they had adopted.” Until COVID-19, our profession was prepared to treat patients with pathogens in blood and saliva, pathogens that were not transmitted by respiratory droplets or airborne in nature. We established protocols to disinfect surfaces, and we cover ourselves with a gown to protect our clothes, a surgical mask to protect the patient from us, gloves to protect both parties and goggles to prevent objects from hurting our eyes. But, in these protocols, what do we have to protect ourselves from these newer respiratory pathogens? The answer is none of the above; we simply didn’t see the patient. Most patients with serious respiratory, infectious illnesses are only contagious when symptomatic, and we prevented exposure by cancelling or rescheduling the patient.

But today, we are presented with COVID-19, a virus that is not only a respiratory pathogen but contagious as well before symptomatology is evident. As a dentist who completed two years of GPR at Bronx-Lebanon Hospital and who is experienced checking for oral pathologies on patients hospitalized with active respiratory/airborne pathogens, I truly believe a dentist in a private office setting can no longer safely see patients following preCOVID-19 procedures. New protocols and equipment are needed to lower the risk of exposure from active COVID-19 patients, including the asymptomatic carrier.

Although there are no exact dental protocols for dealing with COVID-19 in the private sector, I believe we should use those that have been previously established in hospitals for treating patients with respiratory/airborne pathogens and tweaking them to fit our private offices. I believe that organizations, like NYSDA, should create a temporary “COVID-19 dental task force” with the purpose of developing standardized safety guidelines for dentists practicing in New York State instead of leaving it to each business to purchase “unsubstantiated gadgets” and create “idiosyncratic procedures.” By doing this, we won’t leave the safety of all New Yorkers in the hands of those who may be less prepared.

I would like to make clear that I am in no way suggesting that any dentist or organization follow my belief in the need for additional protocol and equipment. But given the urgency to be ready for a possible second wave and knowing there are dentists who might believe we are already prepared concerns me.

I applaud those dentists who have attempted to take the initiative in establishing new protocols and acquiring new equipment in their offices to better protect staff and patients from COVID-19. I have done the same and believe that by doing so, I have, to the best of my abilities, reduced the risk of transmission of respiratory and airborne pathogens. At the end of the day, I have protected the people who matter to me the most—my staff, patients and family.

Mireille Cruz, D.M.D. Camillus, NY

The editor replies.

Thank you, Dr. Cruz, for your comments. NYSDA welcomes your involvement. Every dentist has the duty to do his or her best to minimize the risk of transmission of pathogens, including the coronavirus, to patients and auxiliaries. All equipment on the market that may reduce this risk should be considered and evaluated for efficacy in the oral healthcare setting. While NYSDA does not have the ability to directly undertake such a task, we can and will try to work with the ADA to clarify the uncertainties associated with various new products and protocols, and continue to focus and standardize safety guidelines.

We recommend that all dentists monitor the ADA, CDC and New York State Department of Health guidelines for the provision of dental care, and NYSDA will continue to provide updates to our members. To date, we are not aware of documented clusters of cases among dental healthcare professionals or their patients, but organized dentistry intends to remain vigilant and willing to explore any and all methods that could increase the safety of the services we deliver.