If you were to concoct the worst possible job during coronavirus, it would probably look a lot like that of a dental hygienist.
Every day, dental workers spend hours in close proximity to peoples’ mouths, polishing and cleaning teeth with tools that spray saliva everywhere—a main reason why the CDC is currently recommending that dental offices postpone all non-emergency procedures, such as cleanings. According to the Department of Labor, dental workers are among the people most at risk of contracting COVID-19 at work, ranking even above some other health care workers. A separate analysis listed dental hygienists in particular as one of the highest-risk jobs, more than dentists themselves.
It’s not hard to imagine why—dental hygienists are usually the people who do the actual teeth cleanings. Still, as states consider reopening their economies against the warnings of public health officials, dental hygienists are being asked to return to work to perform unnecessary procedures despite advisories that suggest the opposite. Last week, the American Dental Hygienists’ Association called on governors who were lifting restrictions to support the CDC’s recommendations to continue to postpone elective procedures and to make sure hygienists have access to the necessary protective gear if their offices do reopen.
But dental hygienists across the country are still being called back in. Julie, a hygienist in Georgia, told VICE that she’s heard a lot of dentists pressuring hygienists to go back to work and considers herself lucky because her bosses have not yet done so.
“We can lose our jobs if we don’t go back to work. And since Governor Kemp opened up the state, if we don’t go back to work then we lose our unemployment benefits. So it’s either we put our lives at risk or just barely hold on financially to feed our families,” Julie said. “It’s a really messed up place to be.”
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The issue isn’t limited to states that are reopening. One dental hygienist in California, who requested not be named out of fear of risks to her job, told VICE that she has been called back in to do cleanings—sometimes seeing eight patients in a row—despite the fact that the state’s department of health is directing dentists to postpone all non-emergency procedures. Her husband lost his job and she’s nervous that refusing to go into the office would disqualify her from the unemployment benefits she’s getting, even though the state is still sheltering in place.
“Dental hygienists are one of the most exposed and highest-risk professions,” she said. “Why are we rushing this? Even a restaurant worker isn’t working within a foot of somebody’s open mouth.”
As a salaried professional class, dental hygienists are better off in various ways than many low-income workers right now. But many dental procedures produce spray that could include virus-containing particles. The virus is thought to spread primarily through respiratory droplets, while aerosol spread of the virus is currently uncertain. Evidence also suggests that the virus can spread between people who are asymptomatic, meaning that patients could come into the dentists’ office feeling fine, without knowing they are carrying the virus.
“If someone has the flu and they came in, it’s not like I’m going to clean their teeth,” Julie said. And coronavirus is a “different ball game” altogether given how silently contagious it is, she added.
The possible dangers are clear. The CDC itself notes that “caring for patients requiring Airborne Precautions,” such as those who have or are suspected of having COVID-19, “is not possible in most dental settings as they are not designed for or equipped to provide this standard of care.” When dental workers do have to conduct necessary emergency procedures, the CDC recommends that they use the highest level of personal protective equipment possible, including N95 masks and face shields. Front line health care workers in hospitals across the country are already facing shortages of this type of equipment. Preserving protective gear is one of the reasons why the CDC is recommending a limit to dental procedures.
But in states like Georgia, which began reopening on Friday, Governor Brian Kemp is allowing dental offices to resume normal practices even as his executive order states that they should be “in accordance with the Centers for Disease Control and Prevention guidelines”—the very guidelines that contradict the idea that dental offices should resume non-emergency procedures.
Given that dental practices are reopening, a later executive order announced that they must adhere to the American Dental Association’s interim guidance for minimizing risk of COVID-19 transmission. The Georgia Board of Dentistry has punted the issue to individual dentists, stating that “determinations regarding individual patient care must rest solely with the individual practitioner.”
The lack of central decision-making means that dentists, faced with conflicting information from all sides, must decide for themselves whether to open or not. Some private practices are certainly feeling the economic squeeze of their small businesses being closed down. But dental hygienists and dental assistants—who work for dentists—have even fewer choices. If their boss calls them back into work for non-essential procedures, they could risk both their own health and those of their patients by going in. Yet if they refuse to return, they could risk losing both their jobs and their unemployment benefits.
The dental hygienists VICE spoke with emphasized that they are health care workers, which means they have an ethical mandate to protect the safety of their patients; many feel that going back to do non-emergency procedures conflicts with that mandate. And, like dentists, dental hygienists can be held legally liable if the necessary safety precautions are not in place.
But unlike some other health care workers, such as nurses, dental hygienists don’t have a national union to turn to. They also often work in small offices, which means that they don’t even have the administrative infrastructure of a hospital to consult if they think their boss is putting them and their patients’ health at risk.
“It’s so blatantly unethical to be treating patients [for non-emergencies] right now,” the California hygienist said, “and to be more concerned about the practice and the business than patients’ and employees’ health.”
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