COVID-19 impact | Here's why a visit to your dentist after lockdown may pinch you harder

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K Chaitanya Ram, a dentist based in Visakhapatnam, hasn't opened his clinic since March 20. During normal times, Ram earns about Rs 80,000 per month but April has been a washout. He managed to pay salary of his chair side assistant from income generated via teaching at a local dental college.

Ram said things would get difficult in days to come. Apart from regular expenses such as rent of his clinic, utility bills, salary to chair side assistant, he also needs to buy personal protection equipment and disinfectants to protect himself and patients coming to his clinic from possible spread of COVID-19. While the costs are ballooning, there is no guarantee that footfalls at his clinic will normalise anytime soon.

Meanwhile, dentists in Visakhapatnam are contemplating to raise the fees by at least 30 percent on elective dental procedures.

"For dentists practicing in predominantly working class localities, it is difficult to raise prices," Ram said.

Most dental procedures are categorised as potentially high risk for COVID-19 transmission, as they produce aerosols and droplets mixed with patient's saliva.

People with dental emergencies like excessive inflammation and infection that can't be controlled by medication are being treated in hospitals following COVID-19 infection control protocols.

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According to the National Health Profile (NHP) 2018, out of over 2.7 lakh dentists registered with the Dental Council of India (DCI), the government employs only 7,239 dentists, or just 2.7 percent.

The majority of the remaining dentists are self-employed, running neighbourhood clinics. They provide employment to equal number of chair side assistants. Around three-fourths of the dentists are concentrated in urban areas.

Indian dental care market is estimated to be around $1.79 billion in 2020, with annual growth rate of 6.8 percent, according to German online market research firm Statista. On an average, an Indian spends little less than Rs 100 on dental care annually.

Analysts estimate that at least 20 percent of the dental clinics may have to be shuttered if the current situation persists beyond May.

"This virus primarily harbours in nasopharynx, mouth, and some even say that (virus) is thriving in salivary glands. The second aspect is that whatever instrumentation we use in dental scenario, most of the instruments are mechanised instruments. When you use on teeth it is a reduction process, when you are doing that aerosols are produced. They stay in the air and surfaces," said Prof Mahesh Verma, Vice Chancellor - Guru Gobind Singh Indraprastha University.

Verma in the past had headed both the Dental Council of India (DCI) the body that regulates dental education and  the professional body Indian Dental Association (IDA).

"We have been doing cases of HIV, but this particular virus is more scary as no one knows the consequences. So, it is impacting the dental profession the most," Verma said.

Verma said while there is an increase in cost of care, but raising procedure charges on patients isn't the best option as people are already suffering from economic hardship.

"We should charge people who can afford and take a humane approach for the rest," Verma said.

On opening the dental clinics, Verma said the dental community in coming days will discuss and chart out a plan on to train dentists and their assistants on COVID-19 infection control protocols and find out ways to optimise limited resources like PPEs.

"There are several guidelines issued by WHO, US CDC, Indian Dental Association and several others on how to create barriers for infection. The government is yet to issue any specific guideline on dental care - but we need more simple, uniform and easy to follow guidelines," Verma said.|

Verma, however, cautioned on starting elective surgeries soon.

"We will still have to postpone elective surgeries for some more time," Verma said.

Dentists warn that the lockdown will have serious impact on the oral health of the people as most people are postponing or managing their tooth conditions by taking pain killers.

"It's difficult to salvage the tooth once infection spreads. The only option left with us would be extraction of tooth," Ram said.