Editor's note: This is the third article of multi-part series examining the impact of COVID-19 on the lives of Fort Lee community members and organizations.
FORT LEE, Va. (May 27, 2020) -- Much has been said about the work and sacrifice of medical workers during the COVID-19 pandemic. There has not, however, been much talk about those working in dentistry.
That’s probably due to the fact that, since March, many dental facilities suspended regular operations and have only treated patients with emergencies.
Not true for the Col. Bull Dental Clinic here.
That facility, along with Mosier Dental Clinic on the Ordnance Campus, has been treating sick calls and emergencies in line with its civilian counterparts, however, it also is performing student examinations daily.
“With roughly 70 exams and our normal sick-call load, it ends up being roughly 80 patients a day,” estimated Maj. William Belknap, officer in charge of the CBDC.
That number is about half the normal patient workload pre-COVID. The continued exams are necessary for military readiness and to keep the student training pipeline moving. The number of patients was enough to cause concerns about infection amongst the staff.
“Initially, it was scary,” observed Lt. Col. Dentonio E. Worrell, commander of Fort Lee’s Dental Clinic Command, referring to uncertainties surrounding the virus at the onset. “We started hearing the media reports about the rising death toll, and so, you get concerned. I started to think about the staff.”
In late March, with the number of infections across the country on a fast climb, information about the disease was quickly evolving. As a result, fear and anxiety amongst the populace spread as quickly as the coronavirus itself. The CBDC was no exception.
“There absolutely was (fear),” Belknap said. “I wasn’t terrified, but I was concerned and cautious. It’s my job to remain calm with my employees – with my Soldiers – to show we’re taking the necessary steps. I wasn’t walking around in a panic, but it was scary because, you know, it was an unknown strain of virus.”
About 30 civilian and contract personnel were working at the clinic prior to the implementation of restrictions, and several were at risk for infection.
“Many of them relayed their fears,” Belknap said. “They let us know they weren’t necessarily comfortable seeing patients.”
Prior to the pandemic, the clinic handled 150 patients daily, performing examinations, restorative procedures, root canals and extractions among other work. It handled an annual throughput of roughly 10,000 military students requiring examinations to ensure they were “dentally ready” to deploy, according to Sgt. 1st Class Jonathan Rivera, senior dental noncommissioned officer.
Although the coronavirus caused a substantial reduction in patient load, a decision to furlough civilians was imminent due to safety concerns, Worrell said. They received stay-at-home orders in late March. That meant 10 military members would fill the vacancies. Worrell said their safety and security informed much of his approach to accomplishing the continued mission.
“We had discussions, and if any one of them told me they would be uncomfortable, I wasn’t going to hold that against them,” he said. “I still feel the same way….”
Knowing his words might be insufficient to quell Soldiers’ concerns, Worrell said he felt compelled to demonstrate he was confident about the working conditions.
“I jumped on the side of the (dentist’s) chair with them to show them I felt strongly about the extra precautions we had implemented,” he recalled.
The concerns about contracting COVID-19 are substantially less among the rank and file today. Open discussion, trust and mission acceptance helped personnel to move forward, Belknap observed.
“For our military, they knew better than anybody that the mission had to continue,” he said. “They’ve all bought in. People show up with good attitudes in general. They are working together really well.”
The staff recognizes the implemented safety measures to prevent the spread of COVID-19 are likely long-term. They include prescreening anyone arriving at the facility and providing face masks for visitors without them.
“Once patients are cleared and get back to the chair, the first thing we do is give them a hydrogen peroxide mouth rinse,” Belknap said of the chemical proven effective against other viruses. “That’s a new thing, something we were not doing routinely before.”
A “dental dam” is used for all restorative procedures. A thin sheet of latex or nitrile covers all but the operative area of the mouth. It prevents saliva from interfering with the procedure, keeps instruments from falling into the patient’s mouth and “reduces the amount of aerosols produced in the environment,” Belknap explained.
Aerosols are tiny droplets suspended in the air; a likely means of disease transmission.
In the area of “PPE,” doctors and dental assistants began wearing N95 masks, face shields and bouffants in addition to the scrubs, gloves and disposable gowns that have always been a part of their protective attire. Patients also are required to wear masks whenever they are not in the chair.
Additionally, the clinic enforces a strict social distancing policy and the facility is disinfected daily. With all the safeguards in place, Worrell said his initial worries about infection have somewhat abated.
“We’ve been at this for eight weeks or so, and I’m growing progressively confident in the fact that standard personal protective equipment and the protocols we use in (military) dentistry work,” he said. “I don’t think people have to be concerned or scared.”
Moving forward, Worrell said there’s an expectation the clinic will continue to operate under existing conditions.
“The big kicker for us is going to be how to incorporate our entire staff,” he said, referring to bringing back civilian employees. “It will be difficult to social distance, but the more I think about it, I believe we can, at least in the short term. We can divide them into two teams initially. One team reports one day and the other the following day. That way, we minimize the number of folks in the building at any given time.”
CBDC employees have been kept abreast of clinic operations and under what conditions they might return. Some of still are still uncomfortable with returning, Worrell noted. In the long term, a vaccine would be a game-changer because it could prevent anyone from getting the virus, dramatically decreasing disease transmission. So would herd immunity – a point at which 70 percent of the population gets the virus, recovers from it and builds immunity against it.
In the meantime, the mission will continue on a partial basis, Worrell confirmed. The permanent party population can assume it will be some time before elective and cosmetic procedures resume. For that reason, Worrell said it is imperative to maintain one’s dental health.
“At the end of the day, brushing and flossing will keep you out of our doors,” he said. “The other thing I tell folks is they must understand whenever they expose their mouths to sweets – or carbohydrates in general – they have the potential to impact teeth and gums. Rinsing the mouth with water after having anything starchy will help.
“That said, we are continuing to see people for sick call,” he further noted. “We understand (the implications of not providing) routine care … we’re going to have a spike in emergencies. We’re starting to see that already, and we’re getting after it to make sure we’re meeting the needs of our patients.”