The pain was going to be worth it. Easter Brown opened her mouth as wide as she could as a dentist yanked out the seven teeth she had left. At 77 years old, she was finally going to get a full set of dentures. She went home toothless that day in February and waited for the call saying her new smile had arrived.
But when her phone rang in March, Brown was told that her dental clinic in the District was almost completely shutting down. The risk of dentists and patients spreading the novel coronavirus was just too high. They promised Brown would get her dentures when the clinic reopened. They just weren’t sure when that would be.
Ever since, Brown — already at higher risk during the pandemic because of age and asthma, already enduring a newly isolated life — has been talking and chewing with only her gums.
Her pain is shared by dental patients across the country, who are stuck in yet another consequence of the worsening pandemic.
In March, the American Dental Association (ADA) recommended that all dentistry practices close for everything except emergencies.
The organization realized that the most basic routines of dentistry, from close contact with mouths to the water-spraying tools that send fluids flying, were suddenly filled with risk. Because so many coronavirus carriers lack symptoms, it is impossible to know who is safe to treat and who can safely offer that treatment.
In early April, the ADA extended its recommendation until the end of the month. Now, the dental industry and its patients are beginning to grapple with just how long they can manage without each other.
“Patients are not happy; dentists are not happy. Dentists are worker bees, and we’re not working,” said Steven Guttenberg, president of the D.C. Dental Society. “And when we do work, we’re at greater risk of getting covid-19.”
The nation’s 200,000 dentists are deferring mortgages, applying for loans and laying off staff, desperate to save their practices. Their patients are calling in similar states of panic, with chipped teeth, decaying molars and receding gums, their aching exacerbated by free time and dread.
Together, they are navigating a question becoming only trickier to answer as the virus spreads: When every interaction is a possible exposure, what counts as an emergency?
'What do we do?'
Every morning, Brown opens a fridge full of food soft enough for her gums. She picks two eggs from their carton and boils water for her Quaker Oats. She has lived in her New York Avenue apartment since 1973. In her living room, there are five photos of President Barack Obama. In her bedroom, two more.
He has become, in these weeks of quarantine, her closest companion.
When her breakfast is ready, she scoops it up in little bites, like she once did feeding her three children, five grandchildren and two great-grandchildren.
When she was a child, she picked cotton beside her sharecropper father starting at 9 years old. In North Carolina, she wasn’t allowed to go to school with white kids, or go to their movie theater or eat their food. But when she first moved to the District, she worked for a white family. She had a husband and a record store on Georgia Avenue, though neither lasted long. Instead she spent her years working in cafeterias of government buildings, including, for seven years, the Old Executive Office Building beside the White House. She was there on the morning of Sept. 11, 2001, when the breakfast preparation was interrupted by screeching alarms and flashing lights. When she retired three years later, she received a signed photo of President George W. Bush.
Now she spends her mornings watching another president handling another crisis. When it gets to be too much, she changes the channel to “General Hospital.”
“I have seen a whole lot in my life, but I ain’t ever seen nothing like this,” Brown said.
Two blocks away, her dental clinic at the nonprofit So Others Might Eat (SOME), sat empty, all appointments canceled. With every patient call or referral comes a calculation: How much pain are they in? Do they have an infection? Swelling? Bleeding?
The ADA has issued guidance for patients and dentists, but for a clinic that serves the city’s most vulnerable people, the danger is amplified. Patients are more likely to wait to get help until they are experiencing a true emergency. They’re also more likely to have other health problems that put them at a higher risk of dying of covid-19, the disease caused by the novel coronavirus.
“The last thing we want to do is treat one disease and give them another,” said Berinna Doggett, SOME’s chief clinical officer.
And then comes the other calculation, the one to ensure that when the pandemic is over, Brown and other patients will have a clinic to come back to. Without Medicaid reimbursements, without the people who pay the sliding-scale fee, how long can the clinic stay open?
SOME has an entire nonprofit behind it. But three-quarters of dentists in the United States are small-business owners, whose income depends on the number of patients they see.
Raha Yousefi, who owns a general dentistry practice and a boutique periodontal firm in the District, treated up to 20 patients some days.
Now, there are zero. And zero income.
To pay the mortgages on her practices and the loans on her equipment, she furloughed dentists, dental assistants, hygienists and receptionists, telling them she’d do all she could to hire them back. Her husband, the practice’s business manager, applied for economic disaster loans. She video-called patients and showed them how to take their own stitches out. She emailed others, telling them how much she misses them.
“That’s what I keep thinking about,” Yousefi said. “When this is all over, can I still hug my patients?”
She and other dentists in the District keep calling Guttenberg with the same question: “What do we do?”
He has no obvious answers or timeline, only requests.
If they have extra personal protective equipment, donate it to a local hospital.
And if they are willing, sign up to volunteer at those hospitals as backup medical professionals for when the worst of the pandemic comes.
One place left to go
Another morning, and Brown opens her fridge again, noticing what’s left. Her children offer to go out and get what she needs. She’s on the board of We Are Family, a volunteer network that, before the pandemic, organized visits to more than 800 senior citizens in the District. Now volunteers are doing grocery runs, so the elderly don’t have to put themselves at risk.
But Brown, who can’t go to church on Sundays, bring food to her friends or see her grandchildren, has one place left she can go.
“My niece in North Carolina sent me this,” she says, strapping a surgical mask with a plastic eye shield across her face. She stuffs her hands into a pair of gloves. Then she rolls her shopping cart out the door, down the street and into the Safeway.
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