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Dr. Salima Dadani, president and director of clinical care for Silver Valet Dental Care, sits in a mobile dental care van outside the Amica White Rock seniors residences, in White Rock, B.C., on April 20, 2021.DARRYL DYCK/The Globe and Mail

Paulette Dahlseide, a dental hygienist who runs her own practice in Cold Lake, Alta., recently looked through her finances for the past year and there was one cost that really stood out: the sharp rise in how much she had to pay for personal protective equipment.

A box of disposable masks that cost $6.99 before the pandemic now cost her $21.09. Disposable gowns, once $12.29 for a pack of 10, were now $41.09. And a box of 200 gloves that were $17.37 in 2019 were $85.99 in 2021.

“I knew it was high, but once I started looking at these figures I couldn’t believe it,” she said.

The business of running a dental clinic has changed during the pandemic. For many offices, revenue has returned to something like normal after Canadians started going back to their practitioners. But while revenue is steady for some, all offices are operating on slimmer margins, with higher costs, longer work hours and trouble hiring enough assistants to keep up with health protocols.

Managing patient flow became a key way of mitigating the risk of spreading COVID-19. Instead of scheduling clients back to back, appointments had to be spread out so there were as few people in the office at the same time as possible. As well, fallow time had to be built into the schedules between patients to allow for the sterilization of the space.

“The whole notion of having a waiting room is pretty much gone,” said Aaron Burry, deputy chief executive officer of the Canadian Dental Association.

In order to see the same number of clients, then, the work day for the dental office had to expand. Dr. Burry said the extra work hours led to the need for extra personnel.

According to Statistics Canada, employment in dental offices dropped 63 per cent in the first weeks of the pandemic, and has now bounced back to pre-pandemic levels of about 110,000 people. But there is demand for more hiring: Job vacancies for dental hygienists and dental therapists have grown 70 per cent from the fourth quarter of 2019 compared with the fourth quarter of 2020, with a jump of 79 per cent for dental assistants, for a total of about 3,100 open jobs across the country.

The employment gap for dental assistants, who are nearly all women, spiked during the pandemic, but has been growing for years. In 2019, the CDA and the Canadian Dental Assistants Association conducted a survey of assistants that suggested low pay and incidents of workplace harassment could be leading to a higher rate of turnover in the profession.

To deal with the added equipment costs, some professional groups have been able to pool the resources of their independent members. For example, the Canadian Dental Hygienists Association made a deal last year with Surgically Clean Air, a manufacturer in Mississauga, to supply air purifiers at $1,800 each. The devices speed up the churn of the air, cutting the fallow time of a room from three hours to mere minutes.

Not all places in the country have been as lucky on procurement. Chad Avery, a dentist in Yarmouth, N.S., and president of his province’s association, said many Nova Scotia offices had to rely on “fly-by-night” companies to source PPE in the early days of the pandemic. The provincial government helped for a while, he said, but now it’s again up to individual offices to get what they can. One of the new employees at his practice that was brought on for the pandemic is tasked, in part, with finding new sources for the PPE.

“The gloves I use, they were $18 a box before last spring, I think they’re about $110 now if you can even get them,” Dr. Avery said.

The changes to dental practices because of COVID-19 have opened some opportunities for entrepreneurs.

Salima Dadani, owner of Silver Valet Dental Care in Vancouver, said demand for her services at long-term care homes has gone up during the pandemic.

Silver Valet operates two mobile dental clinics that are built into Mercedes Sprinter vans. Each van has a team of three when it rolls out: a dentist, a dental assistant and a driver. When it arrives at a long-term care home, the patient is brought outside to the parked vehicle for treatment. The door of the van is left open between appointments to air it out, and the equipment is sterilized each night at a central depot.

“For COVID, it’s the best of both worlds,” Dr. Dadani said, because the dentists don’t have to go inside the care homes, and older residents don’t have to go all the way to a dental office.

For Ms. Dahlseide in Alberta, the pandemic has had the opposite effect on her mobile practice. In addition to her storefront in Cold Lake, she used to go to schools, many in nearby rural communities or First Nations, where parents faced barriers to send their children into town for dental care.

But with schools opening and closing as outbreaks came and went, administrators were reluctant to welcome anyone into the buildings that weren’t absolutely necessary. Between having to space out clients and the lack of school appointments, she said, her revenue has fallen in half over the past year. As well, many of the students she used to see will go much longer without oral care, which increases the risk of cavities and serious dental problems.

With business slower, it has given her more time to focus on her master’s research into inequities in how Alberta Métis are able to access dental care.

And the only other silver lining, she said, is that the longer appointment times in her clinic are allowing her to get to know her patients better.

“So that’s a positive,” she said, adding with a laugh: “It’s a costly positive.”

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