Covid Dentist Risk Calculations
January 22, 2021 3:33 PM   Subscribe

I was due to go to the dentist back in July and cancelled the appointment due to the pandemic. Now I'm wondering how I should assess the exposure risk involved in going to the dentist vs the overall health risk of not going to the dentist. I'm interested primarily in where you would go for information to make this decision, rather than you telling me what you would do or what I should do.

I realise the hygienist and dentist have way more covid exposure risk than I do and that it's in their interests to be as safe as possible, but we're talking about the closest and most prolonged contact I will have had with anyone in nearly a year and naturally it does my head in a bit. (I went on the subway to the vet today and it was my fourth subway trip since March.)

For reference, I live in NYC, in case there are any specific local sources of information I should be considering. It does occur to me that vaccination will supposedly be available to me "in summer".
posted by hoyland to Health & Fitness (26 answers total) 7 users marked this as a favorite
I would check with your dentist to see if they've been vaccinated or if they know when that is likely to happen. I would also ask how they're taking other precautions (air purification, what they're doing between patients, etc). Then maybe use a risk assessment tool. I don't know how to compare it to the risks of not going to the dentist, but I would say if it's possible to wait until your dentist has been vaccinated, that would help (obviously they'll still be wearing a mask). If you can go to a dentist within walking/biking distance so you can avoid the subway, that might also be a good idea.
posted by pinochiette at 3:45 PM on January 22, 2021

I would start by asking the dentist if they think that coming in can wait for now. They have access to your files and can give you a professional opinion on whether or not your dental history indicates that the benefits of coming in outweigh the risks.
posted by corey flood at 3:46 PM on January 22, 2021 [7 favorites]

It depends a bit on what you're doing at the dentist. A cleaning will weigh differently than a repair due to a lingering and painful issue that may cause you to lose a tooth (or worse) if left untreated for another several months.

My opinion is that a NYC subway trip for an hour is riskier for COVID transmission than sitting in a dentist chair for an hour, even though the dentist might seem worse. If you don't agree with that assessment of risk, use one or more of the risk calculators out there that weighs the size of groups, time of exposure, etc.

But that's the thing to look at: would you weigh your potential pain relief or prevention of future problems as greater or lesser need than whatever reasons you took the subway for before this year, and do you view the risk as greater or lesser, based on your own analysis and expert inputs.

Finally: I kick myself about this: in many ways things were safer in July. If it was unsafe to you in July, do you have any reason to think it's safer (or worse risks of not going) now?
posted by SaltySalticid at 3:48 PM on January 22, 2021 [8 favorites]

Speaking as a total shut in, I've been to two dental appointments and it has been fine. They spent MONTHS retraining before reopening again. They had PPE and face shields and were cutting down on aerosols and everything. They very limited how many people were in at once. Unfortunately I have bad enough teeth where skipping appointments isn't great (I had to skip April and my, were they cranky about it come my next one in August) so I had to take the risk, but so far I've been okay.
posted by jenfullmoon at 3:48 PM on January 22, 2021

Factors I would take into consideration:
  • are you or is someone in your bubble in a high-risk group for covid?
  • how's your dental health? do you have the kind of genes where you get cavities rarely, or are you someone who gets tooth pain/cavities easily?
    • are you in pain right now?

  • what kind of precautions is your dentist taking? Ask very specific questions. My partner was told "we use N95 masks" when it turned out only the dentist wore one, while the hygenists (the people you spend the most time with) only wore surgical masks.
    • how well do your dentist's reported precautions match up with your local department of health's recommendations?

My partner was in major pain and needed a root canal a couple months ago, and I'm in a high-risk group for covid. We ended up quarantining separately after his appointment.
posted by homodachi at 3:55 PM on January 22, 2021 [1 favorite]

Something else to consider is that the new mutations may mean that having an appointment in the near term is relatively safer than the medium term.

You might also want to consider employment stability.
posted by oceano at 4:52 PM on January 22, 2021 [4 favorites]

Seriously depends on how bad the tooth had become. I actually had a molar that cracked in two after I failed to get a filling replaced and it rotted out completely and I lasted over a year (long story as it wasn't hurting). Dentists, and indeed, most medical professionals are well aware of COVID risks and would have taken precautions.
posted by kschang at 4:52 PM on January 22, 2021

In addition to the above, if you decide to go, ask if you can wait outside after checking in instead of in the waiting room. Reception staff may not be wearing surgical masks and there may be other patients waiting in there too.
posted by sizeable beetle at 5:00 PM on January 22, 2021 [1 favorite]

So much of this has to do with this particular dentist and staff, as well as your travel risks. My husband has had several emergency procedures the past two months (the kind where you have to keep going back to both a dentist and endodontist to complete the process) and was satisfied with both offices' behavior and precautions, but we still quarantined for two weeks after each one (we were already being incredibly conservative but I have not been to the grocery store myself, the one thing I was still doing, since Thanksgiving). We've stayed healthy so far.

But. I know one person who went ahead and kept her yearly eye appointment and was notified days later, the day her symptoms started, that *everyone* in the fucking office had tested positive and would have been contagious the day of her appointment. And it "looked" fine, everyone had masks on, but it matters that they've been breathing in the same one or two rooms all day every day if they're not taking personal precautions, and of course after they infected her they were reluctant to answer any questions about that or any of their office cleaning/ventilation practices.

So you have to ask, and you have to believe the answer.

I wouldn't do it for a cleaning, for sure. That can wait, if you've got pain or detectable damage you'll have to figure out where your line is.
posted by Lyn Never at 5:38 PM on January 22, 2021

I would check with your dentist to see if they've been vaccinated or if they know when that is likely to happen.

After first asking "Does this need to happen now?" (which goes along with "Is whatever I have going on likely to get worse and potentially be a situation where I will NOT get to make choices?") this would be the most important thing I would be thinking about since it's winter where you are. Where I am, people at two dentists I've been to have been getting their first vaccination shots over the past few weeks. When I saw that guy (sorry, can't remember his name but he's a doctor who has been doing sensible daily updates about COVID) on twitter who does the updates, one thing he said he'd be doing once he got his second shot (and had waited for it to "take effect")was "go to the dentist"

Other things I'd be thinking about:

- how many other people would be getting dental treatment at the same time (i.e. are you the only patient, or are there many people in various rooms at the same time?)
- what the COVID situation was specifically where I am (getting worse? getting better? for me I was most concerned about making sure I wasn't going in the two weeks after Thanksgiving, Christmas and New Years when people would be getting together)
- what the dentist's office situation was both inside the office (i.e. what kind of masks and ventilation they are using, do people wait in a waiting room or do they wait individually outside?) and in the larger building (i.e. who else shares the office building, do you need to take an elevator, that kind of thing)
- risk factors of the people in the office if you know them (small town here so I knew my dentist's lifestyle and knew it was pretty safety-conscious both in and out of the office)
- and yes, do you have insurance, is it linked to your job, is that job situation tenuous?

I am a hates-the-dentist person who has been to eight (eight!) dental appointments over the past four months and it would not have been my choice (by contrast I've been to the supermarket twice in that time) but I was in a situation like Lyn Never's partner and I have to say I was impressed by both the dentist and his staff's understandings (in two offices) of COVID protocols and their patience with my seemingly-endless questions. Obviously YMMV but I hope this can help you make the decision that is correct for you.
posted by jessamyn at 5:46 PM on January 22, 2021 [1 favorite]

If they don't ask you to be tested before you go, assume that nobody else has been either.
posted by benzenedream at 5:47 PM on January 22, 2021

I would take a look at When I took a stab at your risk, based on your location and my last trip to the dentist, it came out higher than I’d be comfortable with if I didn’t have an emergent problem. If you think you have something cooking, I’d consider going and being aggressive about treatment (read: LATER, TOOTH) because making the same trip again, in pain, is going to be pretty shitty. But if it’s preventive care, I’d punt it for the moment.

Anecdote to indicate empathy and credibility: my pandemic time has accompanied by the process of slowly and painfully losing a tooth. I have been to the dentist 7 times since March without getting Covid. Without the various rounds of antibiotics I could easily have gone septic and died. So it’s a difficult calculation!

In conclusion: good luck, and fuck teeth.
posted by chesty_a_arthur at 5:50 PM on January 22, 2021 [2 favorites]

I mean, fuck Covid more! At least teeth have an upside.
posted by chesty_a_arthur at 5:51 PM on January 22, 2021 [1 favorite]

I would not go to the dentist now.

I went to the dentist for a routine check-up and cleaning and ended up regretting it. They took a lot of precautions, but in the end my impression was:

(a) the appointment wasn't urgent because there was nothing wrong with my teeth;

(b) they were ignoring CDC/WHO guidelines by not postponing care that could be postponed;

(c) they wanted to work more than they wanted to do the safest thing.

At the time, (b) was absolutely true but I didn't realize it until after the visit. As for (c), that's the impression I got from chatting with the dentist himself, who seemed to recognize that the disease was serious but still seemed to be ... justifying himself? Justifying why he was still doing routine visits? I honestly do not trust dentists to have a politically neutral view of the risks.

It all seemed like a pretty unnecessary risk at the end.

Current guidelines seem to be wishy-washy on whether you should postpone non-urgent care, but it seems to me like it's saying to dentists that we don't want to tell you to postpone it, but there are risks and you should postpone it. The pandemic is now worse.

Your risk assessment might be different. I've sometimes gone much longer between visits than is recommended without issue, just because I sometimes fail to be an adult. To me, being late on routine dental care does not seem like a big deal. I have pretty good teeth and no indications of a problem so waiting until next year probably would have been completely fine.

The question for you is probably what you think the risks of postponing your care is vs. the risks of exposure to Covid.
posted by Kutsuwamushi at 6:40 PM on January 22, 2021 [1 favorite]

Another thing to possibly consider - if your dentist doesn’t seem to have the right precautions in place, is there another safe dentist that takes your insurance nearer to where you live, so you wouldn’t need a subway ride?
posted by umwhat at 7:04 PM on January 22, 2021 [1 favorite]

I just postponed a cleaning because with things a bit hot right now it seemed an unnecessary risk, while I had a filling about 8 months ago that I don't regret getting.

Interestingly the dentist and hygienist I talked to, when I asked about this specific thing, said funnily enough they'd had to take relatively few extra precautions because they already have really strict airborne and mouthborne disease prevention measures in place. They were wearing extra PPE and getting tested but other than that, they said the sanitation procedures in place there were already super rigorous. Of course they had reduced capacity and masks everywhere but in the chair... to me it seemed about as safe as an appointment like that can be. But whether that risk is worth it to you is a personal choice for sure.
posted by BlackLeotardFront at 7:08 PM on January 22, 2021

My dentist has been closing her office when local case counts and positivity rates cross a certain threshold, which means her office has been shut for most of the past year. She’s incredibly evidence-based (a big part of why I picked her), and she sends out incredibly reassuring emails citing data that shows that most routine dental care can be delayed for months without negative overall health impacts, and also offering availability for true emergencies. Now that she and her staff are scheduled for vaccination, they’re requiring rapid point of care COVID testing for all patients at the start of their appointment, for the window between the staff getting their first and wind doses of vaccine. I had a (much delayed) cleaning in September when local case counts were low and their PPE game was impressive.

But my take-home from all of that is that, barring an actual dental emergency, I would NOT do a dental appointment now (with the uptick in cases). Without some demonstration that a dentist’s office is taking a similar level of care as I see in my own dentist’s practice, I’d be looking for a new provider.
posted by amelioration at 7:12 PM on January 22, 2021 [1 favorite]

I realize this isn't a resource available to everyone, but I have an in-law who's a dentist who's been practicing throughout the pandemic. My husband was in the middle of a root canal (which is apparently a multi-appointment thing with temporary crowns etc) when the pandemic hit, so we had to make a decision relatively early in the pandemic.

What my in-law told me is, dentists were much better situated than GP doctors for the pandemic, because they regularly wear N95 masks and aerosolize all kinds of gross shit from your teeth and have to protect themselves from it. They have vacuum sucky tools that suck the aerosols down. When the pandemic hit, many dentists were told their N95 vendors would continue to provide them with their regular shipments, but they were not allowed to INCREASE their shipments. (Nobody needed an increase, dental appointments fell off a cliff.) He gave us some questions to ask -- about office cleaning, ventilation, PPE, etc. -- and we asked those, and we were satisfied that our dentist's protocols met my in-law's standards.

Unfortunately, my husband had some further damage to his teeth and had to go back to the dentist SIX TIMES during the pandemic. And my in-law has continued seeing patients throughout the pandemic. My husband, our in-law, and our dentist have remained covid-free AND our dentist has now already had both shots of the vaccine. My in-law has had one and gets his second sometime next week. (Dentists are front-line medical workers! Dental health is really important to overall health! Bad dental health can damage your heart!) My kids and I all went for cleaning in September after cancelling our regular cleanings in May.

My dentist's office was TOTALLY willing (even eager!) to answer ALL of our questions about their Covid protocols and decision-making, and if you haven't talked to them, you should definitely call them to do that.
posted by Eyebrows McGee at 7:44 PM on January 22, 2021 [1 favorite]

I would ask the dental practice what Covid precautions they're taking - specifically, what capacity they're operating at, if they have separate (and closed) rooms for patients, and what sanitation procedures they're following.

A relative who works as a hygienist is at a practice that sounds as safe as it can get - private rooms, full wipe-down/decon between patients, etc.

I, this summer, went to a new dentist out of definite need (my prior dentist is still closed since she didn't feel like they could property protect her team due to office setup of open room/no dividers). It. Was. Awful. I wish I'd asked more ahead of time - I just assumed from what I'd hear there were really strict precautions mandated. Other than having chairs in the waiting room blocked off, I don't think they did anything. The waiting rooms were over-crowded, the chairs were full, the receptionists were sharing food. If I hadn't desperately needed the cleaning to avoid further issues (I had post-partum gingivitis, had an appointment for last April that was cancelled so it had been a year - and fortunately the cleaning did resolve my issue) - I would have walked right out of there.

I've also seen chatter on my local FB groups asking about people's experiences, so independently of calling your dentist I would look up recent reviews on google/yelp, local FB, etc. to validate what they tell you on the phone.
posted by DoubleLune at 8:11 PM on January 22, 2021

they already have really strict airborne and mouthborne disease prevention measures in place.

I am not a dentist, but as far as I know most of those precautions were borne of HIV and hepatitis B transmissions from aerosolized blood from drilling. The precautions are a lot different for cases where you assume that the dentist can exhale and infect the patient (which, if you wanted to be 100% sure,would be a bunny suit).
posted by benzenedream at 8:29 PM on January 22, 2021

I'm interested primarily in where you would go for information to make this decision, rather than you telling me what you would do or what I should do.

I'd be looking at overall virus trends (more contagious variants are expected to become dominant sometime between March and May) and government response (vaccination campaigns in your area). It's a bit of a race as to who's faster: the urgency of your tooth health vs. the new variants vs. the vaccine.

I'd ask: what's your dental history like? If you're unlucky enough to need regular procedures beyond cleanings, now is probably not a great time to skip. You don't want to put yourself in a position where it's 4 months down the road, there's even more cases, and now you have to go because some dental issue got worse.

I'd ask: when do you expect it to be safer than right now to go to the dentist? That would be when more people have been vaccinated but the new variants haven't become dominant yet. Conservatively, you have about a month. After that, it seems likely that new variants will result in another peak, before vaccines take over and prevalence finally goes down. When that happens is anybody's guess.

I'd ask: what are your sources of risk here, and how can you control them? Seems like there's two main ones: the dental providers, and the other patients in their office. There is some risk of how to get to/from the appointment safely as well.

Have your dental providers gotten their second dose of the vaccine yet? Are they going to within the next month? That's an important piece of information, and you can find out by asking them. I'd say there's a strong case for waiting until they're fully vaccinated (i.e. 2 weeks after their second shot), assuming that happens before March.

What are their precautions like? Find that out too.

If you get the first appointment of the day, you basically don't have to worry about other patients' exhalations at all. If that's not possible, earlier appointments are still better than later.

For transit, you have a wide variety of options, including wearing a better mask and choosing a less-risky method of transportation. (In a cab? Ask to open the windows.)
posted by danceswithlight at 9:36 PM on January 22, 2021

So, I went to the dentist a few months ago. I'm going to tell you some of what I considered for that decision. There are probably other things I would consider if I was doing that now, or if I lived in NYC.

-I hadn't been to the dentist in over a year, as my previous appointment (at a different office) was during a lockdown that banned nonemergency dental. I expected to need some work, not just a cleaning.
-I chose a very small dental office (less exposure to other people) that was recommended by a friend with a science background who had been there post-pandemic.
-I asked on the phone about what their procedures were. The receptionist was able to answer this question with no hesitation and in great detail. I probably don't even remember all the precautions but it was something like: patients must turn in paperwork outdoors and wait in their car, place personal belongings in a locker, use a special mouthwash on entering, all rooms have individual air filters with a capacity to cycle the room air every 20 minutes, between patients UV-C sterilization is used for 20 minutes including in the bathroom where the patients use the mouthwash. There was also an air-sucking device to go near your head while in the chair. Of course patients required to wear masks, temp checks, etc.
-I don't have great teeth, and wanted to use some of my insurance allowance before it expired
-Case rates were on the lower side in my area at that time.
-I don't have great teeth, and considered it much better to take care of any work that might need to be done at that time instead of waiting until I did have an emergency. (Which might leave me with fewer choices for where to get care, happen when case rates were higher, etc)
-I wanted to get the work done before allergy season, especially since if I'm lying on my back during allergy season I tend to get a cough from postnasal drip. Problematic at the dentist at best, and as a potential covid symptom might prevent me from accessing care. (Or make my only options a place that doesn't care if they take patients who are coughing)

I got my cleaning but much more importantly I got xrays and treatment on a couple of teeth that were likely to go bad at some point. I wore my own safety glasses to to dentist.

I don't know if you have ever had a dental emergency. In addition to very high levels of pain (there is a reason emergency dentists buy ads to run in the middle of the night -- sleep is impossible), infection can result without treatment, and an infection in your face can easily spread to other areas that are much more problematic.
posted by yohko at 11:44 PM on January 22, 2021 [1 favorite]

When I had a long postponed cleaning, the hygienist noted that dental offices have long experience in keeping patients safe going back to the aids crisis.
posted by SemiSalt at 5:35 AM on January 23, 2021

A little anecdote about the risk of NOT going: I had a routine appointment last March that got pushed to July, in the meantime a small cavity became Problematic causing much more severe sinus issues that now need treatment. So instead of one quick dentist trip last spring, I'm enjoying hospital visits and possible surgery in the second wave. Bad risk calculus!
posted by Freyja at 7:29 AM on January 23, 2021

The most important thing is to find out what the dentist is doing. One friend's dentist is a COVID denier who does not always wear masks while treating a patient, let alone take other precautions. My dentist in contrast not only is careful with masks etc., but also has a HEPA air purifier in every room, to reduce the risk of aerosols from a previous patient. Since he's not a fool, our friend has now switched dentists.
posted by chromium at 10:37 AM on January 23, 2021

Did you call your dental office and ask about their covid precautions? That's what I did with mine and I was very satisfied with the answer, from having patients gargle with peroxide and get wiped down with disinfectant when coming in, waiting outside, to the hygienists changing scrubs between every patient to fumigating (or whatever the word is) the whole office 3x per day, wiping down the chair, etc afte every patient. But I live in a place with a lot less infections than NYC.
posted by at 6:22 PM on January 23, 2021

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