16 Aug 2020

How does COVID-19 affect dentistry and what can we do to survive?

During the CAPP Live Stream Dental Meeting last April, acting moderator of the online conference, Dr Çagdas Kislaoglu interviewed Dr Christian Coachman on dentistry in the COVID-19 pandemic period.
How does COVID-19 affect dentistry and what can we do to survive?

In March 2020, when the COVID-19 disease had just become an official global pandemic, CAPP began a series of online accredited educational programmes to support dental professionals across the world during the lockdown period. On 16 April, at the second planned scientific programme, the organisers included an interactive interview between conference moderator Dr Çagdas Kıslaoglu and conference speaker Dr Christian Coachman, with a focus on the COVID-19 pandemic in dentistry. 

Dr Çagdas Kıslaoglu is an international renowned aesthetic dentist from Turkey, well known for the smile and face makeover shows streamed on national television focussing on one-day smile design makeovers. 

Dr Christian Coachman is a Brazilian sixth generation dentist. His family line has worked in dentistry for 170 years, as verified by Guinness World Records. Not only did he qualify as a dentist from the most recognized dental school in Latin America, the University of São Paulo Dental School in 2002, he has a double degree, having also graduated from the same institution as a dental laboratory technician in 1995. In 2018 he was in the top 19 of the Most Influential People in Dentistry by Incisal Edge magazine. He is a member of the Brazilian, European and American Academy of Aesthetic Dentistry, becoming the only dentist to have been invited to be a member of these three prestigious organisations.

Welcome online Dr Christian Coachman live streaming from Madrid, Spain during the COVID-19 period where we are on lockdown and connected globally, greetings from Istanbul, Turkey. How have you experienced the past month since the global pandemic became a reality?
Dr Christian Coachman: Thank you for the kind introduction and a thank you to CAPP for organising this interview and live stream during COVID-19 period. We plan to discuss important and useful topics with good insights in a tough moment for our profession, and for our planet. We will do our best to remain positive and to utilize our time in smart ways, glad to be here. 

The current pandemic forced us to close our offices with many dental professionals becoming depressed and worried. Having unplanned free time, many started watching online videos, webinars and began self-improving through online education, including myself. In your view, how did the crisis affect dentistry and what can we do to survive?
This is the most important question we are all asking ourselves as dental professionals. There is no way we can answer this question without understanding that we can take advantage of this time to improve as persons and as human beings. Unfortunately, things are completely out of our control. Nothing is certain. Our leaders and authorities cannot provide us with direct answers since they themselves do not know as well. The only thing we can do is to accept the current situation and embrace that tough times are still ahead of us, in terms of our business. Understanding this is out of our control, we may be harmed and hit by this crisis in either a large or small way, but we need to look at the things which are still in our control. One thing we have absolute control over is, to invest in ourselves and take advantage of the moment, to become better human beings, better persons, and ultimately better dental professionals. At this moment, we need to focus on two things in my opinion, our health, and our relationships. Perhaps a bit philosophical however these are the things which matter in life. Regardless of what happens next, even if the worst is to follow in terms of business, we do not know if our business will survive three months from now and that is the truth. Owners in dentistry are not sure they will survive, if they will be able to stay open and how will this hit us financially? We just do not know. We really believe that this will be over and that more people will survive financially. As owners we need to prepare ourselves to succeed regardless of what happens next. Even if the worst occurs, closing down our business, or starting from scratch, looking for a different job, or whatever you might do to cope to increase your chance of succeeding in the near future, you will need your health and your relationships. With health, I focus on physical and mental health – becoming stronger physically and mentally so we can face whatever happens next. We should also strengthen our relationship – we must start with family and friends because we need them more than ever during these moments. Even in the professional environment, strengthening our relationship means keeping in contact with our existing patients and staying connected whilst generating useful content for them. Keeping things rolling even though we are not seeing our patients. We must show that we are ready, that we are working hard to be available as soon as possible for the patients. Improving relationships with your suppliers, with your landlord, with people that you owe money to, with the bank, with your account manager, people that provide education, with your colleagues and with your community. Just invest in your relationships because regardless of what is going to happen, the better your relationships are, the bigger your chances are to succeed, no matter what happens.

That is very true. Speaking out of experience, having gone through a similar situation where I finally opened my new clinic last month, I was forced to shut down after a day due to the lockdown. It was depressing and after two-three days of sitting at home, I finally decided to dress up, shave and come to my clinic and spend time to read articles and start to realise what I needed to improve. I reflected on what happened in the past and tried to gauge the things I did right and as a result I developed vast interest in knowing more about the Digital Smile Design (DSD) concept, something you are very familiar with. Please share your thoughts with us regarding DSD and reducing patients’ chair-time?
First, you mention the situation about your clinic. This is the attitude that we need to have. We cannot take on this situation with anger or look for someone to blame because the situation is unfair for all of us. These feelings do not help us. I have a similar situation with where we recently opened our new office in Madrid. We invested a lot of time and money in it. It has an auditorium, a new lab, everything the way we wanted it to be. We opened a few weeks before the lockdown and now occasionally, I also go to the office and do not allow myself to wallow in negative feelings.

In this regard, with the strategy that you mentioned, you were right. We must be wise when we go back to our normal business. However, things will not be the same. We should stay relevant and plan on our strategy. The first one, as you mentioned, is to be more efficient because dental procedures generate fear amongst dental professionals that they will be contaminated. At our DSD courses, we teach to combine procedures with new technologies to become more efficient and shrink the treatment time. We know that crisis speeds up the changes that are already in place. The things that we will see implemented after this crisis are the things that we already see as important before this crisis. All solution that we have been talking about, not in digital dentistry but based on experience, we can add biosafety on top of it. 

This is the topic that dentistry, in general has, kind of, neglected a little bit over the years. We were not paying attention and we were not specializing enough on the basic rules of biosafety. And this is going to become mandatory. In the beginning we are going to have to adapt, we are going to have to retain our staff, make physical changes in our office, invest in some remodelling, new equipment and increase the quality of biosafety. This is going to be key, because patients will want to feel safe, patients will ask tough questions and the dentists that are one-step ahead in this perspective will make their patients feel more safe which is why they will want to come back. 

Having listened some lectures discussing topics on life after the crisis involved opinions that once the crisis is over, people will not have money to spend on treatment, but I feel there are always some who think differently. There are some patients who call me and request to make exceptions for them even during the current situation. It is interesting how diverse people think. What are your thoughts on that? Will patients have the same spending habits? Or will the rich be always rich and poor always be poor?
Yes, I have been hearing the same contradictions. I think that the high-end world, the luxurious world, the rich world, we see that during a crisis, at recession moments in history, people with a lot of money, they spend less on things that makes them happy. Like in 2008, the average dentist suffered. They were postponing things that were not vital or essential. I do believe the tip of the pyramid (meaning the few doctors that take care of the very rich people) will probably feel the recession less. The second layer of dental offices will probably suffer. It does not mean that people will not want to rehabilitate their smile, but I believe that people will tend to postpone. People will look and compare dental offices, and this is a moment of reflection where a patient might go to a dentist who caters more to what really matters. Every crisis has its winners. We need to understand how to increase the chances for our dental offices to be amongst the winners post the pandemic crisis.

Dr Christian Coachman, so how can we increase our chances to be amongst the winners, post crisis?
Unfortunately, most of the things that would make us winners are the things that we should already be doing before the crisis. Now, in a desperate mode, it is going take a while to be that model dental office. I believe that there are two things that we can do as dental office owners. First is, become experts in office management, financial management, team management, leadership – the professional side of our business. Now if you are not investing much time or energy on that, this is the time you have to do that. Not only that you must be efficient on emergency, financial strategy for the next three months, but also, understand what the next six months will bring. Thinking outside the box to grow a little bit your income on things that maybe were not your main priority before. I believe that as we go back to work, we are going to have two very specific moments to consider. We are going to have a moment that is an crisis management moment, meaning do whatever you can to generate any type of income, trying as much as you can to break even, to survive, negotiate payments and create new revenue stream, do whatever you can to make some money and spend as little bit as possible. This is the challenge, spend as little as you can, but at the same time invest on key factors to prepare yourself to be different right around the corner. So, it is a challenging moment. That is why people say that crisis regenerate opportunities because you need to be very smart about where to invest in a right way.

Thank you for your time  Dr Coachman.