How Northern California dentists are surviving the business bite from coronavirus

The pandemic’s economic toll on the health care industry hasn’t spared the dental sector.

Kevin Cabugao, D.D.S., a dentist with three practices in the North Bay, said one of his biggest ongoing issues is being able to afford enough personal protective equipment.

“To this day, we're still getting gouged,” said Cabugao, who has offices in Vacaville, Fairfield and American Canyon. He said a box of gloves went from being about $6 to more than $30. “A lot of us dentists were like, ‘OK, what do we do to compensate for this?’”

Cabugao took a route other dentists have taken. He began to charge patients a fee to help cover the cost, but it didn’t go well and was abandoned.

“So to this day — and it's a problem with a lot of dental offices too — we're still trying to figure out ways to be profitable while paying gouge-like prices for protective equipment,” he said.

Cabugao said his revenue is down between 25% and 30% since last year because of new safety protocols, including spacing out time between patients and enhanced cleaning of the rooms.

“We get it. Everyone's having a hard time and there's just there's so much going on right now with COVID-19 and how it's affecting everybody's personal savings,” he said. “We're doing our best to be understanding about it as a whole too.”

When shelter-in-place orders took effect in mid-March, a number of dental practices closed at least through May, said Richard Nagy, D.D.S., president of the California Dental Association.

“We only saw emergency patients, which was a significant reduction in patients you would see in your practice,” Nagy said. “We did a lot of telehealth calls with patients who were in need during that time because of protecting the amount of PPE at the time, as well as getting a handle on making sure it was safe to be in the dental office.”

As more PPE became available and guidance for protocols came from the CDC and state Department of Public Health, the industry began to ramp up again. In addition to doing temperature checks and screening questionnaires, dentists have instituted additional safety measures, primarily around minimizing aerosol sprays.

“We’re actually recommending no water sprays, don't use the Cavitron during a cleaning and don't polish,” Nagy said. The Cavitron is a state-of-the-art ultrasonic scaler that hygienists use to help break up and flush away plaque and bacteria from under the gum line.

“Dental offices since May are now back anywhere from 70% to 100% of what they used to do a year ago,” Nagy said. But there’s also about 15% of patients who are so afraid of getting the novel coronavirus that they avoid going to the dentist for routine preventive care, he added, citing data from the American Dental Association’s Health Practice Institute.

“What we find is that these people are putting themselves at a greater risk by not going for their preventive dental health care, because dental infections can actually lead to some serious medical problems,” Nagy said.

But there’s good reason to not be afraid to go back to the dentist, he added.

“We've been known as the experts in infection control for offices since the AIDS epidemic back in the mid-80s,” Nagy said. “Dental offices have had the highest level of infection-control standards since then and, subsequently, we just amped them up in terms of making sure everyone's in face masks and wearing a face shield.”

Ana Amaya, D.D.S., is a periodontist and dental implants specialist in Kentfield who also sits on the board of the California Dental Association, representing Marin County as trustee.

She had to close the hygiene department of her practice from mid-March until June 1, but otherwise stayed open because of the nature of her specialty, which focuses on prevention, diagnosis and treatment of gum disease and structures around the teeth.

“It’s really important that we keep these patients in continued treatment because it's a cyclical disease, and we don't want them to get off track and then have issues,” Amaya said. About 80% of her patients have come back, with most postponements being for hygiene appointments.

As a CDA trustee, Amaya helps guide dentists in Marin County with changes in protocol and regulations, and works closely with Nagy.

“We met 21 times between March and October,” Amaya said, all via videoconference. “We normally meet four times a year.”

Amaya also is involved in championing the California Dental Association’s new recruitment campaign launched late last month, called Smile Crew California.

We felt that with this pandemic, there is a whole slew of people who have lost their jobs, primarily in the retail and hospitality industries. … We thought this was a great opportunity, a win-win situation for both them and the dental community. So that’s why we did it. Richard Nagy, California Dental Association, on the new recruiting campaign Smile Crew California

The campaign is aimed at promoting dental-assisting careers and touting the field as recession-resistant and a practical way to start a career in health care, according to Nagy.

“We've identified that there is a huge shortage of dental assistants,” said Nagy. “We felt that with this pandemic, there is a whole slew of people who have lost their jobs, primarily in the retail and hospitality industries. … We thought this was a great opportunity, a win-win situation for both them and the dental community. So that’s why we did it.”

Cheryl Sarfaty covers tourism, hospitality, health care and education. She previously worked for a Gannett daily newspaper in New Jersey and NJBIZ, the state’s business journal. Cheryl has freelanced for business journals in Sacramento, Silicon Valley, San Francisco and Lehigh Valley, Pennsylvania. She has a bachelor’s degree in journalism from California State University, Northridge. Reach her at or 707-521-4259.

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