As summarized here on the Safety Protocol page of their website, all the changes listed below have been made –  in addition to their normal standards of care that meet or exceed all CDC, OSHA and ADA guidelines for dental practices.

For staff and the premises:

• Advanced training
• Daily checks of the staff
• New personal hygiene for the staff (e.g. no jewelry or long nails), and staff now changes out of their work clothes at work.
• Cleaning after every appointment and deep cleaning every evening
• CDC-approved instrument sterilization
• N95 & ASTM Level 3 masks and face shields, plus disposable protective hats (when appropriate) for clinical staff
• ASTM Level 3 masks for front- desk staff
• Negative pressure rooms for highest levels of self-containment and climate control.
• HEPA air filtration,. which captures viruses. 
• Installed clear barriers throughout the practice. (See below.)

And for patients:

• Screening via questionnaire and no-contact temperature-taking
• No handshakes or hugs; no office tours, and gloves from outside not allowed.
• A virtual waiting room – in patients’ cars – and no magazines in the waiting room.
• Socially distanced seating throughout the facility
• Anti-microbial rinses for all patients before work begins
• Advanced chair-side suction (high speed evacuation to minimize aerosol contamination and improve air quality.)

Above and in this earlier video, Dr. Richard Duarte describes McCarl’s safety precautions.

I had a chance to ask Dr. Clayton McCarl about these big changes (by phone):

How did they know what to do? Clayton responded that they’d hired a consultant in safety – the lead inspector for OSHA in Maryland, in fact – who conducted mock inspections and all-staff virtual meetings, and the practice was certified OSHA- and CDC-complaint. The clinical staff all underwent an infection control program and were certified, as well.

So what’s it like to actually see patients now? Though he’s “embraced the new normal,” it’s not without difficulty. “The layers of PPE are unbelievable!”

The masks can actually their mark! They include dents in their faces from the pressure of the masks – a look the staff is stoically calling the “mask-nose bridge of honor.”

“You should see the staff lounge – it’s full of supplies like hairnets, gloves, face shields, etc.”

In addition, the protective gear causes a substantial slowdown in their work. A visit that used to take 30 minutes can easily take 60 now, so they’re scheduling fewer patients.

There’s also an unfortunate impact on how well the staff can communicate with patients. “Those layers of masks can make speech sound muffled, and patients can’t see our smiling faces! Also, it’s scrubs only – no more tie and jacket.”

What have all those changes cost? Initially, the protective apparel was disposable, so at $10 each, that adds up. They’ve since found a uniform company that can bring in surgical gowns that can be laundered, which reduces the unit cost.

“The N-95 masks are expensive. We don that first, then a less expensive Level 1 mask on top of it, which gets changed after each patient.

“We haven’t wrapped our arms around the economics of it but are grateful that we got a government loan to off the PPE and sterilization expenses. Like many businesses, we’re hoping to have that forgiven.”

Patient Impact

I noticed plenty of positive patient reviews – recent ones – on Google and the practice’s Facebook page, and found this one posted to the Greenbelters Facebook group: “Kudos to McCarl’s Dental for taking the COVID-19 threat to their patients and staff deadly seriously. I was there twice this week and they are doing everything right to minimize risk.”

Clayton confirmed that the patients are “very, very pleased.” The only pushback has been about the suction devices used in patients’ mouths, which for some can be a mouthful.

Another impact is that appointments with hygienists are harder to get, primarily due to the three-month backlog while they were closed, then exacerbated by the retirement of a key staffer.

McCarl’s is also seeing lots of new patients from practices that still haven’t opened up or have closed permanently. One new patient reported that her previous dentist was young and seemingly healthy but has simply disappeared! Those factors have resulted in a 3-month backlog for cleanings. Clayton’s advice is that if we need a cleaning, we shouldn’t wait to make the call.  Patients who live closeby can also put their names on their will-call list in the event of cancellations.

Concerns?

Clayton says their biggest concern is about the supply of all that protective gear. “The Health Department of Prince George’s has been very good at getting masks to us, and there’s a good supply of clothing. The masks are treated like gold bullion, being stored in the doctors’ offices and dolled out carefully.

“But what would cause the practice to close again is a lack of PPE due to supply chain problems or a major flare-up across the country,” noting that several times already, their supplies have been redirected to medical facilities by the Maryland Department of Health. That’s in addition to worrying about a national redirection of supplies to other states. (Editor’s note: that assumes a national coordination we haven’t seen any evidence of yet.)

Full disclosure: Clayton McCarl has been a supporter of Greenbelt Online since its early days, and the practice is now a sponsor of the nonprofit site.

NOTE: By contributing these pandemic stories, photos, et cetera, Greenbelters are making an unconditional donation of the material to the nonprofit Greenbelt Online.org and the Greenbelt Museum/City of Greenbelt, which reserve the right to keep, lend, or otherwise dispose of the donated material, and may use the material on our website, for social media or other postings, in promotional materials or in future exhibits.