Dan Gorenstein: When I went to the dentist as a kid, I’d throw up.

Every time.

I hated going. The whizzing pitch of the drill, the gritty paste.

Voice over: OK, let’s see what we have here. Open wide.

DG: It got bad enough, the dentist told my father I should skip meals before appointments.

As an 8-year old, the last place I wanted to be was the dentist’s office. 

And maybe, when COVID forced dentists to close their doors, 8-year-olds around the country rejoiced.

Kids cheering

DG: But for dentists, the pandemic put the financial squeeze on their practices and the oral health of their patients at risk — certainly no cause for celebration.

Today, we talk to one dentist about her ride on the COVID roller coaster — from shutting down to reopening and the missed appointments in between.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.

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DG : Stacey, if you would, please introduce yourself: Your name, your title, a little bit about yourself, and definitely say your last name slowly, so when I say it, I don’t I butcher it.

SVS: My name is Dr. Stacey Van Scoyoc, and the Van Scoyoc is my husband’s name. So you are correct, it’s a bit of a challenge. We typically go by Dr. Stacey and Dr. John.

DG: Stacey met her husband John in dental school in Chicago 30 years ago. 

She was a city kid. He was born and raised in Bloomington, a suburban town of about 80,000 people in the middle of rural Illinois halfway between Chicago and St. Louis.

SVS: Illinois is pretty much designated corn and soybean land. So that’s exactly what’s out in the fields around us. When we decided to come down here to live, I told him, “Let me just try it for a year. I just don’t know if I can live here because this is very different than living in a city.”

DG: When the couple first got to Bloomington, Stacey and John worked at the county’s children’s dental clinic.

They got the itch a few years later to open up their own practice.

SVS: We went to the bank, took out some money and as you say, quote unquote, hung up a shingle. With no cash flow, just survivability mode. What do we need just to survive?

DG: Stacey and John run what she calls a “bread and butter” practice, covering the basics but nothing too fancy.

In 20 years, their business has grown from a small office serving 400 people to treating 2,200 patients with a full-time staff of eight and annual revenues north of $1 million.

And at the beginning of 2020, business was booming.

SVS: We were having some of our best months that January and February, pretty much ever.

DG: As February turned to March, and COVID started dominating the headlines, Stacey braced herself for big changes at work. 

She was the vice president of the Illinois State Dental Society, and on a Sunday night, Stacey got on a call with other top dentists across the state to talk about how they should respond to this new threat.

SVS: I remember getting off the phone, it was close to midnight, and we put out the announcement the next day on a Monday and recommended that dentists across the state close their practices in order to preserve PPE for the medical professionals and just only treat emergency procedures. That was hard. It was really hard.

DG: In March and April, 97% of dentists nationwide said they were only seeing emergency patients or completely closed.

That’s according to research from the American Dental Association’s Health Policy Institute.

Researchers there have been surveying dentists throughout the pandemic, and it’s one of the best sources we have to understand how COVID has impacted the financial well-being of dentists and the oral health of their patients. 

In those early days, Stacey struggled with the knowledge that she was telling her colleagues across Illinois to shut down, potentially going several months without income.

SVS: I didn’t know how long this was going to last. I was optimistic that dentists were not going to have to shut down for months. But I didn’t know, and that’s what the fear was.

DG: She was also worried about her own business. 

Stacey handles the practice’s long-term budgeting, and with money just trickling in, she ran the numbers.

SVS: You know, how long can we go with paying staff out of our business savings? How long can we survive as a family out of our personal savings? It was to that level of making the decisions like we did when we first started our office 19 years ago. What do we absolutely need to have to live off of? And the decision was we needed to furlough everybody besides two staff members. The hygienist, the dental assistants and the two doctors, we all went on unemployment. 

DG: In April 2020, 45% of dentists said they were not paying any staff, and just 13% said they were paying staff fully.

Stacey says furloughing her team was one of the hardest things she’s ever done.

SVS: I felt sick to my stomach. Defeated. Like a failure because our staff, we’ve been working together for so long, they feel like a family, and I wasn’t able to continue to support them. So that hurt.

DG: Stacey was reeling.

She had gone from some of her most profitable months ever to looking for part-time work.

SVS: I make money and I support my family by putting my hands in people’s mouths and when that couldn’t happen, it’s like, “Well, what could I fall back on?” And that’s where I got scared. So I just called a friend, and I was like “Well, I’ve got a biology degree,” and he happened to work at the university and he had mentioned that they had communicated with him about having his lab be a COVID testing site, and I was like I can run some COVID tests if I need to. And it’s at least some source of income in addition to unemployment.

DG: COVID kept Stacey’s practice effectively shuttered for 10 weeks.

She didn’t get another job.

She did tighten the family budget and dip into their savings. It also helped that she received  about $300,000 in government loans through the Paycheck Protection Program and Small Business Administration.

92% of dentists surveyed by the American Dental Association, or ADA, said they got some sort of government assistance.

For Stacey,  that money meant that she was able to hire her entire staff back by the time they reopened.

When we return, the challenges and opportunities of post-lockdown dentistry.

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DG: Welcome back.

After 2 and a half months of only seeing emergency patients, Stacey Van Scoyoc and her husband reopened their practice on June 1, 2020.

What really was different when you got back in a way you completely did not anticipate?

SVS: I would just say exhaustion, complete exhaustion. In a dental world, we schedule our patients 6 months in advance, so on day one we already had a full schedule and then we needed to have people who had missed and were wanting to come back in, trying to find spots for them, which ended up meaning we actually lengthened our days. We added Fridays and we added two extra part-time hygienists to come in. I was being a dental assistant or my husband was a dental assistant when I was practicing. You name it, we were doing everything.

DG: As patients streamed back into her office, Stacey saw the impact of those months of missed appointments.

Usually nothing major. Everything was just a bit worse — a little more plaque, a little extra scraping, kind of what you’d expect.

SVS: We might have had a 50 minute appointment scheduled for them. Well, now they need a 60 minute because it’s been an extra 3 or 4 months. 

DG: Stacey was lucky. 

Many practices did not see a flood of patients as soon as they reopened. 

People have been slower to return in big cities and to public health dentists like those who practice at federally qualified health centers.

Because of that patient volumes nationwide are still just 86% of pre-COVID levels, according to the ADA.  

And when people stay away for a long time, bad things sometimes happen. 

Like with one woman in her early 20’s who Stacey saw just a few weeks ago.

SVS: She had missed almost two years by the time that she came back in to see us. But she came in, she sat down and she was crying.

DG: The woman told Stacey that every time she touched her gums, they started bleeding. 

SVS: At home, she was trying anything she could. She was brushing, she was flossing. And of course, she was searching on the internet, looking for Dr. Google and Dr. Google told her she had periodontal disease. And so she seemed to think that she was going to lose all of her teeth.

DG: Stacey and her dental assistant tried to calm her down.

No luck.

Stacey had to pull in a dental hygienist, and the three of them together were finally able to get the woman to stop crying.

SVS: We just tried to reassure her and calm her down. And said we know what the problem is. This is because you need your teeth cleaned. You have buildup under here that you cannot get off with a toothbrush. You need us to get in there and clean it. Once this is done, you will see things are going to get better. You’ll be OK.

DG: Dentists are dealing with more than a spike in cavities and gum disease.

They’re witnessing COVID’s mental health toll.

Two-thirds say they’ve seen more broken teeth as the stress of the pandemic manifests in people’s mouths.

SVS: Many more people have been grinding and clenching. And typically in a week or in a month, I might see one patient that came in with a fractured tooth. Now it’s at least once a week.

Jen Psaki: Okay, just have a couple items at the top…

DG: On March 12, White House Press Secretary Jen Psaki told reporters that President Biden was issuing an executive order to expand the number of people who can give COVID vaccines.

Psaki: …to dentists, optometrists, paramedics, physician assistants, veterinarians and many more.

DG: Dozens of states had already OK’d dentists to give COVID shots, but Biden’s order opened the door to all of the country’s 150,000 dentists to get into the vaccine game. 

It makes sense; dentists give injections every day so they’ve got the skills, and dentists are another trusted health care provider who might be able to convince more people to get vaccinated.

And yet only 4% of dentists say they’re administering COVID vaccines.

Most say either they don’t have time or aren’t interested.

But not Stacey.

SVS: This was just something that I felt strongly that I wanted to be a part of and help our community get better as quickly as possible. And for me personally, whenever I’m giving a vaccine, I just feel like I’m helping save a life, whether it’s that person’s life or some other person that they may ever have some contact with.

DG: Stacey is not giving these shots at her practice.

Instead she’s volunteering at mass vaccination sites in her community.

Very few dentists are actually doing vaccines at their office.

Stacey says she’d like to, but she has to wait for the state dental society to put together a special training course.

And there are other challenges like storage, billing and waning demand.

But Stacey is hopeful that the government’s willingness to let dentists give COVID shots will open the door to giving more vaccines in their offices like flu shots and the HPV vaccine.

SVS: As a mother, I make sure my kids go to their doctors. No questions asked. They do. They get their immunizations. They go in. But for me, do I always go? No. And what we find out from our patients many times is that they don’t go see their primary care provider. So going to the dentist, some people really, they come in every 6 months. We have the opportunity twice a year to give them any of these vaccines if necessary, but right now, we’re just encouraging them to go to their health care provider.

DG: Stacey, final question, looking back on the last 15 months. What do you think will be the lasting impact of the pandemic on your practice and on you as a dentist?

SVS: You know, it reinvigorated me in terms of my profession because when you can’t do what you were trained to do, it brings a little bit of excitement back into your career when you are able to get back into it again.

DG: It felt good — instruments in hand, a person in the chair.

But the pandemic has helped Stacey see her time with her tools and patients is limited.

She’s begun to think about work beyond her practice.

SVS: Is there something else that I can do with my career too? You know, what else could I do with my dental degree? I haven’t figured that one out.

DG: Stacey, thank you very much for taking the time to talk with us on Tradeoffs.

SVS: Thank you very much, Dan.

DG: I’m Dan Gorenstein, and this is Tradeoffs.