Due to the COVID-19 pandemic, most dental offices have suspended their activities. Scheduled visits were postponed, and sudden visits were preceded by a long epidemiological interview. Now the offices are reopening and some patients are unpleasantly surprised by the new price lists. We talk to Dr. Emma Kiworkowa, the owner of the Villa Nova clinic and dentist Anna Jankowska-Sasak, about how the COVID-19 pandemic affected the reality in dental offices.
- Dental offices across the country introduce the so-called epidemiological fee, which can be up to PLN 300
- Dentists say they have been forced to increase the cost of their services and are therefore often faced with unpleasantness and even hatred
- Dentists explain that they had no way out – the epidemic soared the prices of personal protective equipment, such as masks or disinfectants
- Dentists are one of the occupational groups most at risk of infection. Are they afraid to go back to work? – Certainly some doctors have concerns and do not decide to return to their duties at this point. Please remember that we are only people, and the situation that we found is new and unknown for many of us – says Dr. Emma Kiworkowa
Magda Zmna, Medonet: Can patients really expect increases for procedures performed in dental offices?
Emma Kiworkowa: Yes. The vast majority of dental offices have been forced to introduce changes to their price list, including the so-called epidemiological fee, which ranges from PLN 50 to even PLN 300. It is well known that people whose work is based on physical contact with others are most at risk of contracting the COVID-19 virus. According to statistics compiled by the New York Times, dentists, dental hygienists and dental assistants are professional groups that are at the highest risk of various diseases and infections. This risk is related to the specificity of our profession. The SARS-CoV-2 coronavirus spreads by droplets, and we perform face-to-face treatments in the mouth, where we are in contact with the patient’s saliva all the time.
You are at risk all the time.
Emma Kiworkowa: Exactly. The role of dentists in preventing the spread of the COVID-19 coronavirus is extremely important because we are in direct contact with patients practically throughout our working day. Organizing care ensuring full personal protection of doctors, staff and patients is our highest priority on a daily basis, not only during a pandemic.
And this care costs money, right?
Emma KiworkowaDental practices and clinics have approached the topic of extra costs in different ways. Some of them increased the prices for all services and thus the cost of additional personal protective equipment was taken into account. On the other hand, some places have not decided to increase prices, but have introduced an additional so-called epidemiological fee. This resulted in a division of patients into those who understand the situation and after presenting them in a transparent manner the reasons for charging the fee – they accept it and those who deny it.
Therefore, doctors often face unpleasantness, and even hate in social media. Probably the situation would be different if PPE were to be used in only a few situations. Currently, however, we are obliged to use them in every case, and all staff must be secured, regardless of whether the patient presents for treatment, e.g. filling, or just for a check-up.
Before the pandemic, dentists were also required to protect themselves during procedures performed in front of the patient. Disposable gloves, masks, and helmets were commonplace. So what is the reason for this increase in service prices and how long will it last?
Emma Kiworkowa: Due to the introduced procedures and orders of the Ministry of Health, we are obliged to use special masks, additional protective aprons or suits, caps or even footwear protectors until these recommendations are lifted by the government. Unfortunately, the dentist community in Poland did not receive state support for the purchase or even partial coverage of the costs of the above-mentioned personal protective equipment, which are obligatory today. The Supreme Medical Chamber offered the only, known to me, form of support for dentists, offering the doctor several pieces of FFP N95 masks, several surgical masks, goggles or a visor at a time.
It is a drop in the ocean of needs, but I believe that any help should be appreciated. The Polish Dental Society sent a letter to the Ministry of Health with a request to allow clinics that provide services during a pandemic to be supplied with state resources or to provide equipment recommended by the Ministry of Health at an adequate price for the product. We are still waiting for an answer.
For the time being, surgeries have to stock up on protective equipment on their own. And please take into account the fact that during the pandemic, the prices of protective products increased several times. In order not to be groundless, let me give you specific numbers as an example:
- FFP3 mask – the price at the beginning of the pandemic ranged from PLN 120 to PLN 180, currently it fluctuates between PLN 25-40 per unit (before the epidemic, the price was – PLN 8);
- three-layer surgical mask – at the beginning of the pandemic, the price was PLN 4,40 per unit, now this amount has decreased to PLN 2 (before the epidemic it was – PLN 60);
- protective apron – currently the price is PLN 15-20 per piece (before the epidemic – PLN 4-9);
- jumpsuit – cost from 150 to 40 PLN per piece
- gloves – the price for a box of 200 gloves is PLN 60-80 (before the epidemic – PLN 30);
- protective caps and shoe protectors cost 1-1,2 zlotys (20-30 grosz before the epidemic);
- surface disinfecting liquids – 5 liters cost PLN 199 (before the epidemic – about PLN 80).
I could go on like that for a long time. The above examples are only the basic protection measures that every dentist, hygienist and assistant must have in the workplace. And yet this is not the only cost associated with the introduction of new epidemiological procedures. In addition, it should be taken into account that we incur many hidden costs that are in fact invisible to patients “with the naked eye”.
What are these costs?
Emma Kiworkowa: More and more clinics decide to buy special bactericidal and virucidal lamps. In order to ensure proper care in the time of a pandemic, facilities where many doctors are employed, and thus more patients are admitted during the day, decide to create a new job, which is the so-called patient caregiver.
A person in such a position is responsible for measuring the temperature and collecting an interview about the patient’s health before he goes to the doctor’s office, and for example indicating a specially designated place where the patient is waiting for an appointment (so as to stay in the zone without contact with other patients).
Another issue is the extension of the visit time, incl. so that all the procedures recommended by the Ministry of Health are complied with, or, for example, that the medical staff has time to properly prepare the space and protective clothing. Consequently, the number of patients that can now be admitted has decreased compared to what was possible before the epidemic.
In a word, dentists have to adapt to the new reality. How are they preparing to go back to work?
Anna Jankowska- Sasak: Most doctors are looking forward to going back to work and back to their duties. Due to top-down restrictions, many patients were forced to discontinue treatment. We are now prioritizing those who cannot wait any longer because of the effects of failure to treat them.
Returning to work is also associated with a higher risk of infection. What security are used in the branches?
Emma Kiworkowa: The dentist profession is every day, not only during an epidemic, directly exposed to various types of infections. It is related to the previously mentioned specificity of the dentist’s work. What many patients do not realize is that a physician is always obligated to treat anyone as potentially sick in order to protect themselves, colleagues and other patients. This is one of the basic principles that has been instilled in us since the beginning of our education. This approach remains the same.
In the current situation, we are simply required to apply the additional safeguards that are required during an epidemic. Are doctors not afraid of infection? Certainly, some doctors have concerns and do not decide to return to their duties at this point. Please remember that we are only human and the situation we find ourselves in is new and unknown to many of us. However, I think it’s a small percentage.
When it comes to dental services, they approach the issue of security in different ways, as the recommendations received from the Ministry of Health are relatively fluid. Please remember that dental offices apply many safety rules, not only during an epidemic. Additional protections are, as I have already mentioned, masks with a special filter, protective aprons, caps, shoe protectors, visors or goggles.
Personally, I have made a decision to equip my clinic with a special air disinfection system using ultraviolet UV-C lamps with air ozonation function, in order to provide my employees and patients with even greater comfort and a sense of security. What is new from the patient’s perspective is definitely a body temperature test, the obligation to disinfect hands several times, an additional medical interview or special consents for the procedure. In addition, we use mats disinfecting shoes, we have properly prepared the lobby, creating communication routes and separating zones for patients in order to minimize contact with other people.
The first patients are already arriving at the clinic. How do they react to the new sanitary regime?
Anna Jankowska- Sasak: Patients react differently. This is mainly related to the new procedures in force in the clinic, as well as additional fees. Most patients understand the situation. Even if there are any concerns, after the first contact with the new realities of the clinic’s work, they quickly gain confidence that we have taken all measures to ensure their full safety during the visit. Of course, there are patients who do not want to contribute to the additional costs that the dentist has to bear. There are also those who simply choose not to treat them.
The trust that has been developed earlier also pays off to a large extent. If a given facility responsibly approached the subject of compliance with the procedures also before the epidemic, and patients felt safe there, they have nothing to fear in the current situation.
We recommend:
- Letter to MedTvoiLokony: Dentist in times of coronavirus epidemic
- Coronavirus in Poland. Where to go to the dentist during the COVID-19 epidemic?