How 3 dentists remained nimble and resilient during the COVID-19 disruption

Toni Oliver, DDS, and Valerie Harada, DDS, have something in common: Both are fortunate to have worked, or are currently working, with their fathers. When he opened his practice in 1975, Richard Silvera, DDS, was also lucky to have his mentor and role model in the same building, his prosthodontic professor from the University of California, Los Angeles (UCLA).

We are in a challenging and unprecedented time for dentistry. We examine how three Western Los Angeles Dental Society (WLADS) professionals educated themselves, created new protocols, and implemented changes to mitigate risk and safely practice in this pandemic.

Valerie Harada, DDS. All images courtesy of Teresa Yang, DDS.

Dr. Harada, a 2009 graduate of the Dugoni School of Dentistry, works in a family general practice in Culver City, CA, with her father. She is a third-generation dentist and said, "A lot of patients still have fillings and crowns that my grandpa completed!" Her father, Ken Harada, DDS, served as a president and trustee for WLADS, and her grandfather, Harold Harada, DDS, was a past California Dental Association (CDA) president.

Dr. Silvera, whose wife (Andreia Minasian Silvera, DDS) is a dental anesthesiologist, is also in general practice with an emphasis on aesthetic, reconstructive, and implant dentistry. Although his office is in a high-rise building, he has installed multiple high-volume ceiling exhaust fans and air purifiers to "make [the airflow] closer to outdoors."

Dr. Oliver, also a UCLA School of Dentistry graduate, began practicing with her father in 1986, two years after finishing dental school. They have been in Torrance, CA, for the past 16 years. Her dad, Joseph Oliver, DDS, a previous president of WLADS, officially retired last year.

"When the governor ordered the shutdown, I was frightened," Dr. Oliver admitted. Like all business owners, she worried about covering her overhead without incoming revenue. She diligently navigated the maze of Paycheck Protection Program (PPP) loans. All three dentists took advantage of CDA webinars and other free online content. Dr. Harada relied on the Kois Center and the UCLA School of Dentistry where her husband, Marc Hayashi, DMD, is on the faculty. All of them dealt with supply chain problems in their hunt for personal protective equipment (PPE).

Toni Oliver, DDS.

The doctors used the downtime to reconfigure their offices. Besides air purification units, they installed plexiglass partitions and additional evacuation systems. Dr. Silvera installed a video doorbell and opener. He routinely uses a disposable nitrous oxide hood and scavenger. Dr. Harada has added an ultralow-volume fogger, hypochlorous acid cleaning, and an electrolyzing water unit. Both she and Dr. Oliver employ ultraviolet (UV) lights.

All three have become reacquainted with the rubber dam and are getting accustomed to the new normal of constricting N95 masks, face shields, and isolation gowns.

Some have experienced staff challenges. Dr. Oliver dealt with a staff member who had to supervise online learning with her minor child and another who had to be quarantined. Dr. Harada's office sent letters to all employees detailing the precautions and changes ahead and held staff training meetings.

The dentists continued to communicate with their patients in the form of letters, emails, and texts.

"This pandemic has challenged us to continue to learn," Dr. Harada said. Dr. Oliver felt that the interim emergencies-only period provided a "dress rehearsal to where we are now." She said that a huge amount of preparation went into reopening, and things are running relatively smoothly.

Richard Silvera, DDS.

Despite all the new protocols, "we are all extremely happy to be back," Dr. Oliver said.

"I truly believe we have the best patients," Dr. Harada added.

Dr. Silvera recalls the shelter-in-place period, where he cherished the close family time: "Good dinners, talk, and ping pong."

Since the gradual reopening, Los Angeles has seen COVID-19 infections spike. Public health guidelines continue to evolve. While PPE is easier to obtain now than earlier in the pandemic, it is still more expensive and frequently difficult to get. The real possibility of extended school closure, online learning, and childcare needs will challenge staff, patients, and our own families. Even as the rules shift, we hold on to the fact that we dentists are still in the game. We must remain nimble and resilient in these uncertain times.

Dr. Harada, the newest dentist in this trio, said, "As long as everyone takes the utmost precautions for the safety of their patients, co-workers, and themselves, we will continue to thrive."

Teresa Yang, DDS, started two practices from scratch and sold them both. She currently serves as a trustee at the California Dental Association and is a member of the CDA Foundation Board. She is also the editor of WestViews at the Western Los Angeles Dental Society. Her general interest articles have been published in online literary journals and on humor sites. She can be reached at [email protected].

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