Dentistry in the age of Covid

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”
— Charles Dickens, “A Tale of Two Cities”

For a Westchester County dentist, the opening of Dickens’ novel is an apt one. The pandemic caused the shutdown of our Harrison, New York dental practice, Advanced Dentistry of Westchester, for three months and made it more difficult to take care of our patients 24/7/365 in case of dental emergencies, which we have handled for the past 50 years.

The pandemic made it necessary for us to research and purchase the extensive equipment we use to create “surgically clean air” in each room, including external vacuum devices to remove and disinfect the aerosols created by dental treatment, fogging devices to treat each room (and ourselves between patients), and extensive PPE for our team. We have had to work in uncomfortable N95 masks, face shields and gowns. We have even gone to the effort of being certified as a Covid testing center for our staff and patients when the equipment is available. All of this pales in comparison to the devastation felt by those who have lost a loved one or had to close their business permanently, but it certainly represents the most challenging time during my 50 years in dental practice.

But just as in “A Tale of Two Cities,” there is another side to this story. We have had a significant increase in the number of new patients who will not travel to New York City for dental appointments and who are more comfortable with the extensive measures we have taken to create a safe environment for their dental care.

Is it safe to go to the dentist during the pandemic? Under the present circumstances, it is important to complete dental treatment in as few visits as possible, and thus our use of CAD-CAM to create crowns and inlays in one visit instead of two or three has become more important now than ever before. To reduce the number of dental visits, we also use our CAD-CAM system to place dental implants without extensive surgery or healing. Our use of lasers instead of a “drill” for many procedures eliminates the contaminated aerosol, which is also critical during the pandemic.

How Zoom meetings disrupted the dental industry

The pandemic has also changed people’s spending habits and priorities. Many people are tragically out of work and are struggling to pay for life’s necessities. For others who are still employed, they may have chosen to improve their health and appearance by taking care of dental treatment that has been postponed, instead of dining out frequently or going on vacation. In this age of wearing masks, you might think that improving your smile’s appearance would not be a priority. However, Zoom or Skype meetings focus closely on the face, and a worn, discolored or unattractive smile soon becomes obvious. It has led to a surge in patients wanting to address their smiles through cosmetic makeover enhancements, because their smiles are now center stage among colleagues and business associates in an increasingly virtual world. The rapid digital transformation has also led to a smile makeover transformation. While there are many apps that promise to put a filter on your smile or to brighten your teeth with an Instagram filter, live video cannot hide the imperfections in your teeth that you may not like.

Computer guided dentistry

As assistant director of honors esthetics at New York University College of Dentistry, I’ve had many referrals for cosmetic dentistry enhancement procedures. One of the techniques I pioneered was the use of a photograph and computer enhancements to show patients their proposed new smiles. We have modified this in response to the pandemic, allowing people to send us a good photo of their smile for computer enhancements without an in-person visit.

The art of cosmetic dentistry

There is a mathematic formula for the width, length, shape and position of teeth based upon the patient’s face and dental arch. With this altered photo, the patient can see his, or her, new smile and make any changes he would like. Once he is happy with the new look, the ceramist artistically creates the final result in a wax model. This “wax up” smile is used to guide the dentist in preparing the teeth if necessary and to create the basic shape of the temporary veneers or crowns. It is the artistic talent of the dentist that modifies these temporaries while the patient is wearing them for maximum esthetics. The patient gets to leave with this “try in” smile and live with it for days to make sure he loves the new look so there are no unhappy surprises. All that is necessary is for the dental ceramist to copy the try-in smile using artistically added shades and stains for a beautiful but natural look that is ready for a Zoom close-up.

Kenneth Magid, D.D.S., F.I.C.D OF Advanced Dentistry of Westchester in Harrison is also director of pre-doctoral laser dentistry and associate clinical professor at New York University College of Dentistry as well as the assistant director of honors esthetics there. He has appeared on national TV and radio shows to discuss high-tech and cosmetic dentistry, including on ABC and in The New York Times. Magid lectures throughout the United States and Canada and is a contributor to many medical journals on topics, that include minimally invasive dentistry, laser dentistry, digital radiography, air-abrasion dentistry, 21st century dentistry. and cosmetic dentistry.

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