Two orthodontists share their thoughts on the road ahead as they settle into this new normal

By Bob Kumra, DDS, and Mina Abdolahi, DDS

Doctor, your 3:40 archwire adjustment has three broken brackets; the 4:30 consult is here early…mom is asking if you saw their dentist’s email…and Ashley H.’s mom just walked in, but we are SRO (standing room only).

For some of us, this describes a typical Wednesday afternoon—the after-school rush. Bouncing from chair to chair, providing orthodontic care to our patients in a 2,000-square-foot space with 20+ bodies in it at any time. This, of course, was pre-COVID-19.

What started out 4 weeks ago as a myriad of uncertainty is still just that. Hesitations of when non-essential businesses can reopen, what an actual orthodontic emergency constitutes while we are forced to be shut down, do I furlough or let go of employees? The longer the situation goes on, the more we can collectively agree; there is a going to be a new normal when this is all over.

In early February, rumblings of a respiratory illness in Seattle, Wash, were becoming more and more frequent. On March 11, 2020, the coronavirus outbreak was formally classified as a global pandemic. Since then, we all have had our fast-paced practices and lives come to a screeching halt. On March 16, a week into the COVID-19 pandemic (prior to a formal stay at home mandate), I made the decision to shut down both of my orthodontic offices in downtown Washington, DC, and 40 miles away in Stafford County, Va. Battling guilt for unnecessary/non-urgent use of personal protective equipment (PPE), which the nation was already short on, and concerns of staff and family members falling ill from a virus that we ourselves may or may not show symptoms to became overbearing. Four days later, the painful decision to let go of 19 employees and an associate doctor was made. Initially, I figured this would last for a few weeks to a month, giving me a chance to clean up scheduling and business operations, then everything would be back to normal. But instead,  we are all itching to get back to some normalcy and wondering what exactly will that even entail?

In general, the specialty of orthodontics lends itself to volume-based treatment with proper sequencing. When we are all able to return to seeing patients in our office, will there be a limit on the number of people that can be seen in an office at one time? Even if no formal order is set, how long will it take for that one parent to raise legitimate concerns of just that? How do we ensure proper disinfection between patients with four to six chairs filled at any given time? Do we need to look into negative pressure rooms with filtration to ensure minimizing spread? Will we need to limit the number of procedures that create aerosol, such as debands, in any given day? What happens if any staff members or I get sick? Does PPE need to be changed between every patient? (Speaking of which, I donated all of our masks, gloves, and gowns to frontline COVID healthcare providers, which certainly allowed for an awesome Facebook photo, but now looking into re-ordering these products, prices have suddenly increased exponentially.)

Orthodontists are not the only healthcare providers feeling the pressures of a COVID-19 shutdown. My brother-in-law is a pediatrician at Johns Hopkins University in Baltimore, Md, but has been serving as COVID-unit physician for the last 4 weeks. “You go where you are needed, and you try to do what’s best for everyone,” he tells me. He describes the almost half-hour PPE ‘scrub-in’ technique doctors must go through to both enter and exit a COVID unit, triggering memories of the first time I was in oral surgery rotation in dental school. A dedicated team member is assigned to watch doctors ‘scrub’ for duty—will this be the new norm in orthodontic practices? Do we need to take temperature readings of everyone as they enter our facilities? What if a patient with a known COVID-19 diagnosis is in need of emergency orthodontic care? How will all of this play into the marketing strategies of direct-to-consumer treatment without in-office visits?

Another huge dilemma will certainly be consumer confidence, not in our abilities as providers, but in the safety and desire to commit to a 24-month treatment plan. Although I may not agree with these principles, we must certainly be prepared as business owners to start treatment with no down payment or have clear and concise refund for treatment policies in place. How can we fault a patient or parent when they say, “I no longer feel it is safe to come in given the state of the world right now”?

A few things that I am certain of for the post-COVID-19 era are longer hours worked per day, preparedness in answering questions about the unknown, and an empathetic service-first attitude. How do we take the potentially hundreds of patients and appointments that are not conducted while offices are shut down and ensure treatment plans not only stay on course, but also actually finish better because of this? Is there a role for a virtual follow-up after braces are initially installed on a patient or do retainer checks become quarterly virtual meetings? One of the biggest strengths a business owner and healthcare provider can have is the ability to be dynamic. This pandemic has forced many healthcare providers into performing virtual appointments. The post-COVID19 era will certainly allow for us to reshape our practices and keep up with the new normal that is to come.

While I believe virtual appointments can be more convenient for both patients and orthodontic providers, I think there is a limit to what types of orthodontic appointments should be made virtual. Most orthodontists pride themselves in providing top notch care, comprehensive treatment plans (radiographs are necessary), multiple treatment options to best suit patients’ needs, and providing a special patient-doctor relationship that can only be provided by in-office visits. Patients become our second family, and that relationship helps shape their orthodontic treatment experience. This allows us to maintain proper control of patient cases, which distinguishes what we do as specialists from direct-to-consumer orthodontic products. Patients typically come into our office every 6 to 8 weeks for adjustments or checks, and there are certainly some types of appointments that could be performed virtually—retainer checks, bite checks, Invisalign checks. Moving forward, we can possibly spread out in-office patient appointments to every 3 to 4 months, with virtual checks in between, and allowing us to maintain proper infection control as we slowly move out of the COVID shutdown.

The COVID-19 pandemic has had a widespread, dramatic impact on every level. In the orthodontic world, jobs, business operation, and patient care all came to an abrupt stop. As we think about what lies ahead and slowly ease back in to the new normal of orthodontic care, we can expect changes in scheduling, protective barriers in office, and PPE. Although change and future uncertainty can be scary, it is important that we focus on not only what matters the most, but also makes us most successful: a safe environment for ourselves and our staff members and providing high quality orthodontic care to our patients. OP

Bob Kumra, DDS, is a graduate of Howard University for both dental and orthodontic training. He has proudly built Kumra Orthodontics, two thriving offices located in downtown Washington, DC, and Stafford, Virginia, with one simple philosophy: honest and affordable care.

Mina Abdolahi, DDS, MS, obtained her dental degree from Virginia Commonwealth University in 2011 and orthodontic degree from the University of Iowa in 2013. She works as an associate orthodontist at both Kumra Orthodontics locations.