With private dental offices closed, JGH provides safety net for dental emergencies

From out of nowhere, a nasty toothache strikes. Over-the-counter pain relievers aren’t much help, so you need professional attention right away. Unfortunately, your dentist’s office is closed during the coronavirus (COVID-19) pandemic, so where can you turn?

Your potential lifeline: the Department of Dentistry at the Jewish General Hospital, one of only a handful Quebec facilities designated by the Ministry of Health to handle dental emergencies during the crisis.

Early in the pandemic, only three sites got the province’s approval for dental care: the JGH for adults, Sainte-Justine Hospital for children, and a healthcare centre in Quebec City. More recently, other sites have received the designation, including the MUHC and the CHUM.

Dr. Mel Schwartz, JGH Chief of Dentistry, says his department has not been asked to provide treatment for hospitalized COVID-positive patients, whose problems would be managed, wherever possible, with medication. Rather, the department acts as a safety net for members of the public, whose teeth need prompt attention in the absence of their own dentist.

In the initial phase of the crisis, private dentists were not obligated to close their offices. Although they were asked to stop providing non-essential treatments, they were still able to make themselves available for consultations about emergencies. Nevertheless, many shut down anyhow.

“Our services are in demand, primarily because many private dental offices are not functioning,” says Dr. Schwartz. “If someone with COVID is hospitalized with breathing problems and is put on a ventilator, that’s not the time for dentistry.”

However, he cautions that patients cannot simply arrive unannounced for treatment, nor can they call his department for an appointment. They must start by phoning their own dentist, who first has to determine whether the situation can be resolved with antibiotics or pain-relieving medication.

If treatment is considered necessary, the private dentist must get in touch either with Dr. Schwartz or the department’s receptionist. The private dentist must then be prepared to provide the JGH with a thorough medical history of the patient, plus any relevant x-rays, so that a decision can be made about what role, if any, the JGH can play.

With Dr. Schwartz working at home to triage the referrals, only one dentist is actually on site—Dr. Allan Lisbona, the department’s Director of Oral and Maxillofacial Surgery. Joining him is a skeleton staff, consisting of a senior administrative coordinator and several dental assistants and receptionists.

Extractions are the most commonly performed procedures, says Dr. Schwartz, but Dr. Lisbona is also available, if needed, to perform evaluations of patients who are about to undergo cancer surgery of the mouth or throat.

He emphasizes that while every effort is being made to provide treatment to those in distress, one of his objectives during the pandemic is to minimize the amount of dental work that his department performs, in order to lower the odds that staff will be exposed to the virus.

In delivering treatment, staff now have to avoid aerosol-generating procedures such as drilling, during which a thin mist of water and saliva—and possibly even droplets of blood—may fly into the air.

“Dr. Lisbona is extracting teeth every day,” says Dr. Schwartz, “but he has modified his approach, so that he doesn’t have to do any aerosol-generating procedures.”

Another consideration is the need for dental staff to wear personal protective equipment for every person who is treated. This means Dr. Schwartz must be certain that these patients cannot be helped in any other way.

“The hospital doesn’t have an endless supply of that kind of equipment,” he explains, “so I want to be sure it’s used for those whose need is the greatest.”

Providing treatment with aerosol-generating procedures is an option that the Department of Dentistry explored in March. However, this would have required the conversion of a portion of the facilities into a negative-pressure area—a renovation that could not be undertaken, because the teams that were needed for this work were in great demand elsewhere in the hospital.

Thus, in instances where drilling a tooth is essential—for example, for a root canal procedure—Dr. Schwartz refers patients to the Montreal General Hospital, which has a negative-pressure room for dentistry.

The service that the JGH is providing is a good example of the significant contribution made by hospital-based dentists not just now, but in general, says Dr. Schwartz, who is President of the Canadian Association of Hospital Dentists. Unfortunately, he adds, the value of this role is not always fully appreciated.

“Since the outset of this pandemic, I’ve been in contact with chiefs of dentistry in hospitals across the country,” he says. “From coast to coast, I’ve heard comments about a lack of recognition and insufficient resources for hospital-based dentistry.

“I’m hoping that once this crisis has passed and governments everywhere look back at what was achieved by the various medical specialties, they’ll gain a greater appreciation for what hospital-based dentistry accomplished during the pandemic within the public healthcare system.”