For Adam and Barb Curtis, owners of Cambridge Family Dental, Minnesota Sedation Dental, Braham Family Dental, and recently Isanti Family Dental, being able to continue to see emergency patients has been something they’ve worked hard to do amidst the current pandemic.
“I attended the Cambridge Community College and the University of Minnesota in Minneapolis and then graduated from the University of Minnesota School of Dentistry in 2006,” Adam said. “We started Cambridge Family Dental from scratch with seeing just one patient on our first day in 2011 and over the years have added on and grown to where we are now.”
While in college, Adam met Barb, 22 years ago, and together they moved to the Twin Cities where Adam applied for dental school and Barb worked toward getting into the dental hygiene program.
“Adam and I always knew we would want to work together when we were both done with school. I miss working directly with patients, but now that I am on the back-end of the businesses I love working with our amazing staff to help Adam run our businesses,” Barb said.
In the 10 years the Curtises have been in business they’ve never imagined operating the way they are now, with so many precautions and unable to schedule routine appointments.
“We have many plan B’s in case of emergencies, like if one of the dentists get injured, sick or pregnant. We had contingency plans in case of fire, flood or natural disaster, but a pandemic is not something one can really do much about until the nature of the pandemic is known,” Adam said. “In dentistry we have a thing called Universal Precaution. This term means in order to be safe, we must look at each patient as if they have every disease in the book. When you work each day practicing Universal Precautions, it forces you to know where the dangers lurk. Where the needles are that might poke you, which procedures require extra gloves, or extra masks. We train on these situations; however, we never have trained for these type of shortages.
“I remember back in the ‘80s when the HIV pandemic scare hit. It was the first time that my dentist started to use gloves. I am sure, at the time, it was strange to him, but as his patient, it felt like he was afraid of me! Now, when I am seeing patients during this pandemic, they watch me very carefully to see what kind of PPE (personal protective equipment) I use, how long I wash my hands and if I use a mask while talking. I am used to patients being apprehensive at the dentist, but this pandemic is adding a whole new level of fear in going to the dentist,” Adam added.
From a hygienist perspective, Barb agreed there are the same struggles.
“As dental professionals we have yearly training on OSHA and infection control requirements that we need to follow in our offices. The standard of care is to always assume someone is sick or has a disease of some kind. We are working and have always worked inches from peoples’ faces while creating aerosols, even while we clean teeth,” Barb said. “So we honestly never thought a pandemic and PPE shortage would take us by surprise. We are already so prepared and cautious. But, like with anything in life, there is always new things to learn and grow from. This will definitely change the way we have done things up to this point as a profession and it will help us reflect on new things we might need to prepare for in the future.”
During the first couple of weeks of the stay-at-home order, the Curtises and their staff met and prepared for the changes ahead.
“The week that the shelter-in was installed, started out with a big staff meeting. In that meeting we laid out the guidelines of how we needed to prioritize which patients we needed to see, so that if our governor shut the state down, our patients would not be in a danger of something getting worse,” Adam said.
“The Board of Dentistry is our governing body; they are in essence the people that police the dental profession. As the governor initiated the shelter-in, it is the Board of Dentistry that we turned to for direction to determine what was allowed and what was not. A big reason we were to be shut down was to conserve PPE. The idea was that if dentists are continuing to see patients, we would be using more and more of the limited PPE that needed to go to hospitals and critical care,” Adam added.
The Board of Dentistry asked dentists to inventory their personal protective equipment on hand and to make donations to local hospitals.
“We donated our surgical masks (loop masks) and other PPE equipment to the hospital, local hospice centers and nurses and I assume many of the local dentists did the same. However, as we started to give away our PPE, the amount of people that were calling us needing emergency dental care kept on rising and rising. In other words, many dentists gave away their ability to see many of their emergency patients because they no longer had any PPE left,” Adam said.
Lacking the “essential worker” label, the Curtises were faced with tough decisions and the inability to see all of the patients needing appointments.
“At first, the shutdown was to be just two weeks. We were instructed then that only absolute emergencies that were life and death could be seen. Dentists were not put on any ‘Essential Worker’ list and it felt like we were just to be dental antibiotic ATMs. This did not sit well with us,” Adam said. “Antibiotics are just Band-Aids; they are meant to reduce the amount of bacteria that is present and buy some time until the patient can get in to have the dental work completed. The problem with just giving out antibiotics is that antibiotics are not going to help a child if they have fallen and knocked a tooth out. Antibiotics are not going to help a critical care nurse who cannot sleep because her tooth hurts every time she lays down. Antibiotics are not going to do anything for cancer patients that have to get a tooth removed in order to get their next round of chemotherapy.”
Realizing the gap in services and allowed services, they contacted the Board of Dentistry.
“These are all situations that we saw the first week of the shelter-in. These patients were begging for help, but we were not labeled as essential and the situations did not fall under the guidelines set initially by our Board of Dentistry,” Adam said. “We emailed our Board of Dentistry after the first week and received more details that we are indeed essential and that we are to act as ethical professionals by doing what we needed to do to keep people out of the health care system. We called up our patients that needed critical care and got them in to provide the care that was necessary. Since then, we have been performing extractions, root canals, emergency exams, fixing broken dentures, re-cementing crowns, placing crowns if the temporaries will not stay on, and in general helping anyone who needs a dentist.
“We have decided that serving our patients was not only the right thing to do, but it was our duty as licensed professionals to perform. Watching nurses, MDs and allied hospital staff risk their lives to serve the sick inspired us to do our part. In the state of Minnesota, 16% of all ER visits are for dental emergencies. We knew we could help. We knew that if we could see the dental emergencies before they got to the emergency departments, we would help the EDs conserve their PPE for just the people that were sick for nondental emergencies and help in our way to keep otherwise healthy people out of hospital. We contacted the EDs in the area and told them that we are not only seeing emergency patients but are also doing more than handing out antibiotics, we were doing the actual dental work. The response has been more than I had expected,” Adam added.
Since they’d donated much of their personal protective equipment to the hospital, the Curtises found they were lacking the equipment to be able to safely see all of the patients needing care, so they began to look into other avenues of gathering the needed equipment.
“When we realized that many of the local dental offices no longer had critical PPE, and that we were seeing 5-fold increase in the number of emergency patients, we had to get creative with our PPE. We turned to our local hardware stores,” Adam said. “We called all the hardware stores, paint stores, woodworking stores and Drywall stores looking for dust respirators and face shields that are used to keep oil, paint and drywall dust out of your face. These respirators are half-face rubbery masks that have replaceable canisters or cartridges that are labeled as N100 filters. Everyone knows about N95 masks. These masks are simple PPE that stop 95% of particles such as viruses, N100 masks stop 99.97%. We did not want to take up any N95 masks in our office, but we figured that if we used hardware store painting masks and hardware store face shields, we could keep our staff safe, continue to see emergency patients and not use up critical N95 masks that are desperately needed in the health care system.
“As more and more dentist decided to not see patients, the ones who were seeing patients saw a huge increase in the number of people who needed to be seen. Prior to the pandemic, on a typical day, my office would see three to five emergency patients. The last five weeks we have been seeing anywhere from 10-15 emergency patients a day, plus trying to do all the dental work as well,” Adam added.
Many of the patients seen have been new, and many from out of the area desperately seeking help.
“We have seen patients from Duluth, Sandstone, Ogilvie, Elk River, Zimmerman, Hinckley, Mora, Forest Lake, Bloomington, and of course Cambridge, Isanti and Braham. Just under 50% of all the patients we have been seeing have been new patients. These are patients that could not get their dental offices to call them back, or could not wait three weeks to get in, or have not been to a dentist in years and do not know where to turn for help,” Adam said. “We are not doing routine cleanings, routine fillings, cosmetic dental work or new cases of braces or Invisalign. We recently have been seeing our patients in braces again to make sure there are no complications and we are starting to see patients that have gum disease back in so that the disease can be kept in check.”
Not knowing what to expect in the beginning, the Curtises limited staff and are soon bringing those back willing to assist.
“We initially reduced to a skeleton crew, thinking that we would only hear from a few people a day about emergency dental needs. But we realized early on that there was a great need that has kept us busy from day one of the closure,” Barb said. “We decided to close our Braham and Isanti offices right away and funnel all emergency calls to our Cambridge office. This was to help reduce exposure to our staff and to reduce the amount of resources we would use up.”
“We went from a daily team of 34 to a team of four to six working in our Cambridge office during the pandemic,” Adam said. “My wife Barbra, Miranda who answers and handles scheduling, our Cambridge office manager Tammy, who does everything from answering calls to assisting me, and myself. We seem to all be running from one task to another. We have had times where all of us are on the phone with patients, while we have quadruple booking appointments. We are soon bringing more staff back who are willing to help. My staff are the only reason why we are able to see these dental emergencies and are true dental heroes.”
Barb echoed the importance of staff during this time.
“Our team has been absolutely amazing through this. It was a very emotional day when we announced to our staff that we were shutting our offices down. But, from the moment we told them that we would be closing down our normal operations, they have been supportive and giving encouragement to us. They are worried and concerned like the rest of us, but we have been trying to stay in touch with them regularly. They help us to keep moving forward. Many of them are very excited to get back to work, and right now we are coming up with our plans for when we can reopen,” Barb said.
To be prepared for the here and now COVID-19, the Curtises and their staff have made changes and are taking precautions while treating patients.
“We are letting patients wait in their vehicles instead of in the waiting room. We are taking patients’ temperature at the start of their appointments. We are asking our patients to fill out a COVID-19 questionnaire. We have removed all magazines, toys, iPads and remote controls from the waiting rooms. With our staff, we have been using face shields, half-face type of respirators, full sleeve coverage overcoats, and daily staff temperature checks,” Adam said. “Other accommodations include making sure we stay below 10 people in the office at any given time.”
The Cambridge office is staffed 8 a.m. to 2 p.m. daily.
“Our emergency voice mail service sends us a text and an email when someone leaves a message on our emergency line. We are texting or calling each emergency within 30 minutes of the call. We get five to 10-plus emergency calls each night that we respond to via text and calls. We are getting in most people the same day or the next day of when we get their call.”
For more information or to set up an appointment, call 763-689-5699.