The Toothaches That Can’t Wait
You could say that Patrick McGarry has been preparing for this moment for more than a decade. McGarry, D83, was studying for a master’s degree in public health administration in 2007 when a virulent strain of bird flu began making its way across the globe. McGarry decided to write his thesis on how dentists can respond to pandemics.
Responding is exactly what he is doing now. When the COVID-19 crisis shuttered the bustling clinical operations at Tufts School of Dental Medicine to slow the spread of the disease, care for the most urgent cases fell to the school’s emergency clinic, where McGarry has been director since 2010. He and the clinic team jumped into action to ensure patients would still have a place to go.
Since even people who are asymptomatic can carry COVID-19, a system for protecting everyone at the clinic had to be devised—and quickly. That meant adding several layers of screening before the dentists could examine a patient, additional personal protective equipment for the dental team, and creating a “clean room”—in the course of a single weekend—for treating those awaiting test results for the virus.
Because McGarry was already familiar with what a pandemic could entail, the Tufts clinic got a head start on preparations, adjusting its operations even ahead of recommendations from the Centers for Disease Control and Prevention.
Normally, the dental school has about 13,500 patient visits a month for treatments such as root canals, implants, or adjustments on braces. Since March 16, when the general and specialty clinics were put on pause, traffic has declined dramatically overall, but those patients who still need care, need it immediately.
“There are dental emergencies that simply can’t wait,” said McGarry, an assistant professor in the department of comprehensive care. A month in, Tufts dentists have handled more than two hundred emergency cases, both adults and children. “The majority were in acute pain—the kind of pain that medication wasn’t going to help.”
Dentistry poses unique risks for COVID-19 transmission to both patients and doctors. The drills, syringes, and other equipment used by dentists produce aerosols—fine particles or liquid droplets suspended in the air—that could potentially harbor the virus for hours at a time. Plus, there is a risk to the dentist or dental assistant if saliva or blood enters a patient’s airway, where breathing or coughing can then transmit the virus.
And so, the emergency clinic rushed to create an additional layer of infection control. Step one was limiting clinic traffic. Patients were urged to call ahead of time. Before being allowed up to the second-floor clinic, they had their temperature taken, were screened for symptoms, and were given a face mask and hand sanitizer on the first floor.
Any procedure that could safely be delayed was put on hold. Chairs in the waiting room were spaced six feet apart. The operatories underwent deep cleaning, and cleaning crews were equipped with PPE. In one weekend, the school procured and installed two large HEPA filters to create an isolation unit for treating patients who were confirmed or suspected virus cases, and installed another HEPA filter in the waiting room.
One patient who was treated in the isolation room was a woman who developed a toothache shortly before the COVID-19 restrictions started, said Joey Chang, D08, DG12, assistant professor and predoctoral director of the department of oral and maxillofacial surgery, who sees patients at both the emergency clinic and Tufts Medical Center. “A week later, she had more pain and some swelling, and she developed a sore throat and a fever,” he said. The woman went to a local hospital to be tested for the coronavirus, but the results took over a week to come back.
In the meantime, she went to the dental school clinic, where she was taken to the isolation room, and ultimately had two teeth extracted, Chang said. “The procedure itself was straightforward,” he said, but the precautions to avoid exposure, including wearing both N95 masks and face shields, were extraordinary. “We were able to treat her without any complications and we found out days later that she was COVID negative,” Chang said.
Most emergency patients who are being seen right now need extractions, endodontic procedures, or treatments for infection. (Notably, self-quarantine, social distancing, and no scholastic sports has led to a decline in the number of damaged teeth from car crashes, barroom fights, or wayward baseballs.)
For some patients, the emergency clinic has been a lifeline. In one case, a patient of the dental school’s oral surgery clinic who had been in Tennessee drove all the way back to Boston for help when no one could see her there.
The emergency clinic also helps lift the strain on the dental school’s neighbor, Tufts Medical Center. Ordinarily, toothaches are among the top reasons people show up at emergency departments. “One of our missions, in addition to helping our dental patients, is to move non-COVID patients out of the ER during the prime of this pandemic,” McGarry said.
To manage the flow of patients until the crisis abates, treatment at the dental school has been limited to those who have been patients there during the last two years. Others who suspect they have a dental emergency are advised to call their own dentists.
Faculty and postgraduates from the school’s residency programs are providing treatment; some third- and fourth-year predoctoral students have volunteered to screen patients and assist in other ways. Front-desk staff, dental assistants, and members of the team that sterilizes instruments and materials have also been reporting to work—like most essential employees these days, carrying on through a pandemic pushes the edge of their job descriptions.
“The staff has been amazing,” said Robert Amato, D80, DG83, assistant dean for postgraduate clinical affairs. “They have stepped up, they are all self-starters, and they have been a great help through a difficult situation.”
“We’ve been very blessed with our community,” McGarry said. “I’m so proud of all the students, residents, faculty, and staff. And I can generally tell you, the patients we have seen, they have been quite thankful and humbled that we have still been able to provide them service.”
Back in 2007, when McGarry was writing his thesis, the avian flu seemed like a likely worst-case scenario—few were thinking of an outbreak on the scale of COVID-19. Yet, here we are. “I’ve been able to apply a lot of what I studied then to the current situation,” he said. “There’s always a meaning to what you do in life.”