Dentists know quite a lot about pain.
They are, after all, accustomed to talking to patients who are enduring the intense ache of an infected molar or abscessed incisor.
But the coronavirus pandemic complicated matters for Oregon dentists.
For about six weeks this spring dentists, when talking with a prospective patient, had to consider factors other than whether they had an opening in their schedule.
From March 23 through May 1, an executive order issued by Gov. Kate Brown required dental clinics to postpone elective and non-urgent care. The purpose of the order was to conserve personal protective equipment to ensure an adequate supply for hospitals treating COVID-19 patients.
The executive order offered some guidance.
Dentists could treat patients if they believed that delaying the procedure for at least three months “would put the patient at risk of irreversible harm.”
The order defined irreversible harm as, among things, threat to the patient’s life or irreversible harm to the person’s physical or mental health.
Dr. Stuart Hills, a Baker City dentist who operates Hills Family Dentistry with his wife, Dr. Meggan Hills, said some cases were relatively simple.
If a patient’s cheek looked to be holding a walnut, for instance, it was clear that leaving that patient untreated could lead to the sort of irreversible harm cited in the governor’s executive order.
“Swelling is obvious — you can see signs of infection,” Stuart Hills said.
But pain is different.
“Obviously we can’t feel somebody’s pain,” he said.
But Hills said he saw no evidence of people trying to skirt the executive order by feigning pain — not that anyone was going to be able to pretend to be in agony just to get a quick exam and a free toothbrush.
Hills said that while the executive order was in effect, he didn’t see any patient who presented with an obvious problem that needed urgent treatment.
“We did pretty much only see people who were in pain or had swelling,” he said.
And there weren’t very many of those.
Hills said the couple’s practice slashed its schedule from 32 hours of patient time per week to about 4 hours — an 87.5% drop.
“We cut back to just Monday mornings to see emergencies,” he said.
That schedule was usually sufficient to accommodate all patients whose tooth trouble qualified under the governor’s executive order, Hills said.
Other Baker City dentists had a similar experience while the restrictions were in effect.
Dr. Justin Bingham at Baker Dental Group said that on a typical day before the executive order, he would see 10 patients and the practice’s dental hygienists would perform cleanings on about eight others.
But from late March through the end of the executive order May 1, Bingham said he treated patients for serious issues, such as infections, abscesses and painful fractured teeth, on two days a week.
“I typically would try to do them Tuesdays or Thursdays,” Bingham said.
He said he usually treated two or three patients each day.
“It was a huge reduction, a huge drop,” Bingham said.
Eastern Oregon Dental also treated only patients dealing with emergency issues while the executive order was in effect, said receptionist Baylee Marks.
Stuart Hills said that in addition to dealing with patients who called the office during the 6 weeks of restrictions, Hills Family Dentistry also reviewed all scheduled appointments on a weekly basis and phoned each patient to see if their situation might meet the standard for immediate attention under the executive order.
He said he also consulted the American Dental Association, which compiled a list of conditions that qualified as dental emergencies or urgent care.
These included such problems as “tooth fracture resulting in pain or causing soft tissue trauma,” “abscess, or localized bacterial infection resulting in localized pain and swelling,” and “severe dental pain from pulpal inflammation.”
Hills said that just before the executive order took effect he performed a root canal on a young patient, but had yet to place a crown.
He said he always crowns a tooth following a root canal because without a crown the tooth is susceptible to fracturing, which usually requires the tooth to be extracted.
Hills said it was clear to him that outcome would qualify as “irreversible harm” under the executive order, so he placed the crown rather than postpone the procedure.
Although Brown lifted the restrictions on dental procedures May 1, her executive order called for dental offices to avoid rescheduling appointments before June 15, so at the time Hills had to consider the potential for the patient’s uncrowned tooth to fracture over the next 3 months.
Hills said he also talked with some patients who are preparing to retire and had scheduled non-urgent procedures, such as caps because their insurance coverage would be lapsing upon retirement.
Some of those patients had to reschedule their appointments, and Hills said he’s not sure whether they all were able to extend their insurance coverage.
Since the executive order restrictions ended May 1, Baker City dentists said they’ve seen a significant increase in patients — but not to pre-pandemic volumes.
In some cases that’s because the practice is limiting the number of people in their offices to make it easier to comply with social distancing.
“We’re not as busy as we typically are but that’s because we’re choosing to scale it back a little bit until things kind of slow down with the virus,” Bingham said. “We’re happy to be treating patients again.”
Marks said appointments at Eastern Oregon Dental are down about 20% from the level before the executive order.
Hills said that although he was expecting a surge of patients due to the backlog created during the restrictions, the practice is still a bit short — roughly half a day’s worth of appointments per week — of what it had been before mid-March.
“We’ve been pretty constant,” he said on May 19. “Kind of back to normal.”