Effect of COVID-19 in Orthodontics | YMyHealth

Tyler Rathburn, DMD, (right) wearing all of his protective gear to see patients during the first year of the COVID-19 Pandemic.

For Tyler Rathburn, DMD, having a passion for orthodontics runs in the family, and his was ignited at a young age. Orthodontics was pretty much the topic of discussion at the dinner table every night during his childhood, as both his mom and stepdad, whom he practices with today, would always talk about their patients.

Growing up, orthodontic assistants would pick him up after school and take him to the office where he would spend the rest of the afternoon trying to ‘help’ his parents as best he could. Once he was in high school and later in college, he spent his summers working with them and actually helping out in the lab.

So, when it came time to choose a career, it came down to one central thing, Rathburn said: “My parents always really liked their job. They never, ever once complained about it, and I think that speaks really well of this profession.”

He went on to earn both his DMD degree for Dentistry and his certification in orthodontics at the Medical College of Georgia.

Just as he was hitting his stride in his fifth year of practice at Atlanta Orthodontics Specialists, the COVID-19 Pandemic hit, turning the practice of orthodontics as he knew it into a totally different experience.

Changes in Orthodontic Practices Due to COVID-19

New Safety Measures in Orthodontic Offices

To start, the changes Rathburn and his fellow orthodontists had to make were pretty dramatic.

They had to turn their normally open bay office into a socially distanced one, with empty dental chairs placed between every chair with a patient and placed large dividers between chairs. Beyond the different set up, two of Rathburn’s most noticeable daily changes were in his own attire and the use of masks by staff and patients alike.

“Probably the biggest day-to-day change is that I wear scrubs now. Before the pandemic I used to dress up, wearing a shirt, tie, and slacks most days. But with COVID around, you did not want to have ties and stuff hanging over patients’ faces,” Rathburn said. “I’m not sure that scrubs do a whole lot infection control wise, but I think they were the easiest thing because you could clean them off and wash them a lot easier, or dry clean them. They certainly make my morning ritual a lot easier too!”

Orthodontics was always a little bit more casual in terms of infection control, he shared, because there’s not as much blood and guts, and air/water spray as you have in dentistry. For that reason, masks were not first nature to many orthodontists, even while taking a look at patients’ mouths and talking with them. But Rathburn was an exception to the rule. Pre-pandemic, he was one of the few doctors in the practice who would consistently wear a mask.

“I rarely ever get sick, but I felt like for the first two or three years I was in practice I was sick constantly with working on kids. I had multiple fevers and coughs and ailments that I don’t normally have. It builds your immune system pretty rapidly,” Rathburn said.

By year three, he started wearing a mask when treating patients and the difference was dramatic. He luckily has not gotten sick like that ever since.

Yet today it continues to be very rare to find orthodontists not wearing a mask now when working with patients. In the first two years of the pandemic, they were much more diligent about mask wearing, even wearing double masks and face shields in the first year, but precautions and the guidance on which ones to take, as we all know, is ever changing.

“Now, things have gotten a little bit more back to normal I would say in terms of pre-pandemic practice, except we’re still in scrubs,” Rathburn said. “Our masks are a lot better controlled, but a lot of the COVID era changes that we had to make have kind of subsided as we’ve learned more.”

Changes in Scheduling and Appointment Procedures

Since COVID hit, Rathburn and his colleagues have tried to reduce the volume of people in the office at the same time. The initial idea being that this would reduce the potential for spreading COVID-19. To do this, they decreased the number of non patients (parents) in the back of the clinic at the same time, unless they needed to see something specific. They also began decreasing the number of in-person visits.

“One thing that was nice actually was that we did implement what we call the virtual consultation and that’s actually worked out really well for our patients,” Rathburn said.

Increased Use of Telehealth in Orthodontic Consultations

Before the COVID-19 Pandemic, a patient at Rathburn’s practice would have an initial exam of their teeth and records along with images that would be taken. Following that Rathburn and his colleagues would have a chance to study the case, and then patients would be invited back for another office visit. There, they would sit in a room with treatment coordinators who would review the step-by-step sequence for orthodontics treatment, the timing each phase would take, and what the fees would be, Rathburn told me.

Those second visits both for adults getting orthodontics and for children, especially those who were not the first in their family to get treatment at the practice, were given consultations via Zoom instead. Rathburn and his patients were not alone.

By August 2020, 23% of dental providers across 20 US states were seeing patients using telehealth, according to a report from the DentaQuest Partnership for Oral Health Advancement.

For many practices, the virtual visit has stuck. Now, Rathburn said, they do it routinely for everyone unless they request to come in, and he feels that this new way of doing consultations for the orthodontics treatment plan after the initial exam is actually one that works out better for most people since they do not have to take the time to drive to the office.

Tyler Rathburn, DMD, is an orthodontist at Atlanta Orthodontics Specialists with his parents Drs. Michael Stewart and Melisa Rathburn.

Disruptions in the Supply Chain

At the pandemic’s start, the field of orthodontics along with most of dentistry was considered a nonessential business. So, it was difficult to get materials in place to practice safely. This included gaining access to N95 and KN95 masks. They simply couldn’t find them.

“We ended up buying some from a friend of ours from an oral surgery group that had an extra box because you couldn’t find them at the beginning of the pandemic because everyone in the whole world was trying to get them,” Rathburn said.

They also got creative using their 3-D printers normally used to produce models of teeth and retainers, to print N95-like respirator models combined with HEPA filters (like the ones used in vacuum cleaners), for some of their dental colleagues in the area who couldn’t find masks and could not practice without one.

Dentists stayed open on an urgent care basis to take care of patients, who for example, had an infection on a molar that could cause pain, swelling, and fever. For orthodontics, it was different.

All in all, Rathburn’s practice was one of many businesses that decided to shut down shortly after the declaration of the Worldwide Pandemic in March 2020 and Georgia’s Governor Brian Kemp declaration of restrictions on nonessential businesses.

“I had a few patients who needed surgical treatment who kind of had to be seen. So we saw those patients, but it was one a day, maybe not even that probably,” Rathburn said. “Pretty much all we were doing for eight weeks was making retainers.”

They did not start up the practice full time again until May 2020.

Effect of COVID-19 on Orthodontic Patients

Patient Anxiety

While thankfully Atlanta Orthodontics Specialists never encountered any major COVID-19 outbreaks in their office, it did not calm the nerves of many parents and their child patients. Understandable, since there is no way of getting around having to remove your mask to be examined and worked on in orthodontics, making the potential higher for contacting an airborne virus.

The impact of a child getting COVID was huge because if they got COVID-19, regardless of the severity of their case, they were originally out of school for two weeks, then later on, a week. They could not be around any other family or travel if they had a trip planned, and parents had to miss work.

“We would have patients who were like, ‘Well, I’m traveling out of town. I’m not going to come see you because I need to be quarantined before I go, so I don’t test positive,’” Rathburn said. This sometimes would lead to delays in patients’ treatments.

Dr. Rathburn resizing appliances to perfect its fit in one of his young patients mouths.

Effect of Mask-Wearing on Orthodontic Treatment

When mandates to wear masks were introduced, their patients were pretty receptive about it. A year into the pandemic though, they started getting a few patients who had concerns. So eventually, they made the decision to make their office mask preferred. What was so odd to him, was that just like how the country was divided on masks, different parts of the city of Atlanta where their practices were located viewed wearing masks differently too.

“There are still medical offices in our building that require masks, but it just became so contentious and we're such a service industry in our profession, that it was not worth the fight,” Rathburn said.

Now, they have taken the masks preferred sign off their door because it was causing too much drama with everything, and the COVID-19 case numbers are much lower, but some people still do like to wear them. It was also a different experience for patient care to never have them see your whole face, Rathburn reflected.

Impact of COVID-19 on Orthodontic Professionals

Financial Impact on Orthodontic Practices

On the morning of March 16, 2020, when the American Dental Association rolled out their recommendation that all practices see patients only on an emergency care basis, Rathburn and his colleagues canceled their patients scheduled for that afternoon and then were closed from then on for two months. One of their biggest challenges was finding a way to continue to pay staff and employees during this time. A challenge shared by practices across the country.

A study in the American Journal of Orthodontics and Dentofacial Orthopedics that looked at the impact of COVID-19 on orthodontic practices found that of the more than 500 orthodontists surveyed, 93% had to use at least some of the programs within the Coronavirus Aid, Relief, and Economic Security Act to keep their practices afloat, and that COVID-19-related office closures resulted on average in a 50% decrease in orthodontic practices net revenue.

Rathburn and his colleagues found the loan from the Payroll Protection Program–something used by 98% of the orthodontists in the study–very helpful for their practice, losing only two staff members as a result.

Increased Stress and Anxiety on Orthodontic Professionals

Yet the uncertainty of infection-control protocols and the future financial outlook for being able to serve patients and practice in the field he loves, made life very stressful.

“In the first several months of the pandemic, it was hard to separate out fact versus fiction about what was going on with COVID. So, everyone was kind of flying by the seat of their pants.” Rathburn said.

He found the protocols about infection control were constantly changing and would be kind of vague, giving orthodontists little to no new information to go on. There was more guidance for dentistry, but he would find it would get outdated, then change, but not make a lot of sense. It was a very challenging way to practice.

“You want to take care of people, but you know, everyone’s on edge. Patients kept canceling because they were concerned,” Rathburn reflected. “On top of that, you have to think about running a business at the same time. It’s an airborne pandemic and you’re working on someone’s mouth, so you are hoping you have patients when the doors open back up after eight weeks.

Outside of work, he felt a little nervous and unsettled as well because in the midst of all of this his wife, who has asthma, was actually pregnant with their daughter. Fortunately, all went smoothly both for his own family and the practice, all which are thriving and have made it to the other side of the pandemic.

Dr. Rathburn and his family on a fall day in Atlanta.

Future considerations

While the height of the pandemic is now thankfully in our rear-view mirrors, there are lessons learned that Rathburn carries with him both in life and in practicing orthodontics.

Number one: Things are never certain.

“I went about my career in a pretty safe way, I thought. I walked into an existing practice and chose to work for my parents of all things. So, you would think you have a pretty safe job, but there are unforeseen things that happen that you are not going to be able to control,” Rathburn said. “Nothing really is safe, and so, you have to always be planning and looking ahead towards things that might be changing.”

In a similar regard, the medical and dental fields are very technologically heavy and it advances so quickly. It can be really hard to keep up. Look how much has changed in the past three years alone.

“The technology is so impressive and advances so quickly that you always should have to be trying to think three steps ahead to stay successful,” Rathburn said.

Number two: Realize what is most important and focus on those things.

For Rathburn, the pandemic reminded him, as he now reminds us that while our careers are important, they should not be the most important thing in our lives.

“I think we all get to a point in life where we would like life to be easy, and we're just kind of going about our daily business without a lot of challenges to your mindset, but unfortunately life has other plans. It could be COVID. It could be family issues or something else, but it's important to try to make sure we focus on the right things. You just can’t be complacent.”

This story is a part of YMyHealth’s COVID-19 Stories from the Field series. We will continue to share personal stories from millennials who are essential workers, caregivers, and those close to them, as long as the pandemic continues.

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