Dentists across Northland expect a backlog of patients once New Zealand moves into alert level 2 as they were only able to do emergency procedures for the past month and a half.
Dr Amanda Johnston, president of the Northland branch of the New Zealand Dental Association and general dental practitioner in Whangārei, said the dental care they were able to offer under levels 4 and 3 was less than ideal and dentists were keen to reopen.
"In alert level 4 and 3 dentists were restricted to emergency and urgent care. We were encouraged to keep patients at home, speak to them by phone or email, and figure out if we could manage their dental situation using prescription or advice over the phone – which is not an ideal way of treating dental issues," Johnston explained.
Getting people to take photographs of their teeth and send them to their dentist was one of the makeshift methods practitioners used to assess their patients.
"We would also have a good chat with them and ask them if it's uncomfortable, is it stopping you eating or sleeping, is your face or mouth swollen – those are the things that make it an emergency."
Everything else had to be put off until level 2.
She estimated that about six practices across Northland were routinely seeing patients for "really basic care" and roughly the same number were answering patients' queries and doing telephone triage.
The rest of the practices were closed.
"If we had to provide any emergency care, we needed extensive PPE [personal protective equipment], which was very difficult to access."
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Even before Covid-19 arrived in New Zealand dentists were aware of a worldwide PPE shortage, according to Johnston.
"We alerted the Ministry of Health to the fact that we were being limited to the amount of masks and gloves [we] might be able to order in the future."
She said because the numbers of Covid-19 patients were so far lower than anticipated, PPE stock was still available, however, she hoped the supply issue wouldn't drag into alert level 2 and beyond.
Dentists routinely use a lot of PPE and are trained excessively in cross-infection control.
Johnston hopes that for routine care under level 2, standard PPE requirements would be enough.
As far as business is concerned, it's been a massive hit for dentists, who have earned little income during the lockdown.
Phil Worsley, general manager of New Zealand dental group Lumino, pointed out that dentists were not offering emergency services to make money.
"We need to offer the service to keep people safe – that's why we're doing it. We're only manning the practices when there are patients.
"But yes, we're missing our revenue completely. There's obviously staff who are unable to work, and we are pretty desperate to get back to work under level 2."
With several surgeries, Lumino's Kerikeri Dental Centre is one of the larger Lumino practices out of seven in Northland. Only two surgeries are operational during lockdown level 4 and 3.
Worsley said dentist Dr Simon Leith extended the opening hours to Saturday because of the high demand for emergency treatment.
Leith was the only dentist of the Kerikeri practice working, together with two dental assistants – no hygienists, no receptionist or any other staff, but because of demand another was added in the past weeks.
"The key thing for us was the health and safety of our patients and staff," Worsley said.
That included managing the flow of people so there was no contact and overlaps between patients, stringent infection controls and cleaning protocols, and taking no walk-in patients.
Worsley said only staff who volunteered to work, were safe and well, and were able to keep their families safe, had been working throughout the lockdown.
Looking at the existing draft guidelines from the Dental Council, Worsley said it looked as though dentists should be able to do most of their regular procedures again "but we are waiting for those to be finalised".
Dental care under level 2 would include routine check-ups, fillings and hygienist appointments.
"We're busy planning to start up under level 2 and contacting patients to bring them back into practices as soon as we can."
Worsley said there was a big need for people to get their dental treatment. He anticipates an uplift of patients for the first few weeks but couldn't say what would come after that.