On a typical day at the IU School of Dentistry (IUSD), about 1,000 people come and go in the clinics and classrooms. Today, as the world copes with the COVID-19 pandemic, the hallways and clinics at Indiana’s only dental school are empty. Students, faculty, and staff are required to work from home. Elective dental procedures will be rescheduled to dates still to be determined.
Yet a bright light remains on in the southeast corner of the Fritts Clinical Center, as the dental school Emergency Clinic is open to serve Hoosiers with acute oral pain and infection. It’s one of only a few clinic buildings open to the public on the IUPUI campus.
Since Governor Holcomb enacted the stay-at-home order on March 25, 2019, about 20 faculty and staff members commute on eerily quiet streets and highways to operate the state’s only dental emergency clinic. Led by Dr. Michael Sovanich, clinical assistant professor, the dental school Emergency Clinic staff provides care for 10-20 patients daily, three or four days a week. Endodontics residents are on call for emergency root canals, and oral and maxillofacial surgical residents are caring for emergency surgeries at IUSD, University Hospital, and are on call for other hospitals. Pediatric dentistry faculty and residents are caring for children’s dental emergencies at Riley Hospital for Children.
“This is a story of many heroes,” said Dr. Harvey Weingarten, associate dean of Clinical Affairs. “Multiple people, all playing essential roles, have come together for a common goal – to treat the citizens of Indiana.”
To protect patients and staff, infection control has been a primary focus, which is not new to dentistry, Dr. Weingarten said. Before patients can enter the IUSD Emergency Clinic, a dental hygienist greets them with a thermometer and screening questions to determine if they have flu-like symptoms. If the answer is yes, they are referred for medical care.
Like every other health care provider, IUSD has a limited number of the N95 surgical masks recommended by the Centers for Disease Control. When the COVID-19 virus began making its way across the globe, vendors were quickly depleted, shutting down the supply chain. However, with ingenuity, tenacity, and the good old golden rule, the dental school has found enough to keep the Emergency Clinic operating for now.
Dr. Weingarten received an unexpected gift of 200 N95 masks from St. Francis Health, the order of the Sisters of St. Francis of Perpetual Adoration, a convent in Mishawaka, Ind., where Dr. Weingarten has been the convent’s dentist for about 30 years. Endodontics Chair Dr. Kenneth Spolnik faced down the ire of building contractors when he showed up at a Lowes the moment the store opened, and bought out its N95 masks. And the dental school has donated any personal protective equipment (PPE) it could spare to medical providers at IU Health.
“This work not only helps the patients we serve at a very stressful time for them, but it is an important way to keep dental patients from seeking care at area hospital emergency departments, saving PPE and the time of the nurses and physicians on the frontline taking care of COVID patients,” said Dr. Carol Anne Murdoch-Kinch, IUSD dean.
The dental school’s frontline staff say working in the Emergency Clinic has been a great experience, although physically taxing. “If you think clinic attire is hot on a normal clinic day, the N95 masks take it to a completely different level,” said Dental Hygiene faculty Twyla Rader. “These masks are much tighter on the face, and breathing is confined.”
Ken Burgess, director of IUSD infection control, researches and tests methods to sterilize the N95 masks to extend their use, with assistance from IUSD researchers who validate the science. “We are reprocessing our N95 masks using ultraviolet germicidal irradiation light and adopting the University of Nebraska Medical Center protocol. This process allows us to disinfect each N95 mask up to three times after use and extend our supply,” Burgess said. “We owe a great deal of thanks to our Sterile Processing Department and housekeeping staff who have stepped up and volunteered to cover the limited shifts to ensure that the instrumentation used in the Emergency Clinic and our building remain sterilized.”
Yet, despite the rigorous infection control procedures, staff may still be at risk.
“We still remain on our toes, knowing that no test is perfect, and we could still very well be exposing ourselves,” said dental assistant Lindsey Wittell. “At that point, we have to remember why we’re here.”
The dental school’s Emergency Clinic was specifically designed for accelerated ventilation. Located in the James J. Fritts, DDS Clinical Care Center, a new state-of-the-art comprehensive clinic that opened at the dental school in 2018, the Emergency Clinic was constructed with negative pressure operatories, which circulate air from the ceiling down to the floor and move it outside through special HEPA filter vents.
By developing and enforcing strict protocols, IUSD is performing at the highest level of infection control, sanitation, and cleaning, said Adam Smith, director of facility operations and auxiliary services. “Those on the forefront here at the school are heroes,” Smith said. “It’s tremendous what they’re doing, and we’re doing everything we can to support them.”
The clinical and sterilization staff who commute to the dental school on almost empty streets and highways report a special comradery has developed among them, similar to a “MASH” unit, Dr. Weingarten said.
“An awesome group of dental professionals, many of whom haven’t worked together before, are staffing the Emergency Clinic,” said Jennifer McKee, dental hygienist in IUSD Faculty Practice. “We’ve pulled together and rapidly created a new working rapport to care for patients who are extremely grateful that we remain open and successfully addressed their dental emergencies.”