“The Dental Profession Speaks with One United Voice”
Dr. Chad Gehani, who in 1975 came to the US from India and in the fall of 2019, just months before the start of the COVID-19 pandemic, was elected the 156th President of the American Dental Association, has a remarkably calm demeanor. This character trait was useful to him when he had to navigate without compass the challenge of the pandemic as the leader of the dental profession in the US, which he did mostly remotely from his private practice in Jackson Heights, Queens.
His presidency was remarkable for this, especially if you consider that he started as a cleaning man in New York City, before he went on to graduate as an Endodontist from Columbia University College of Dental Medicine. Or perhaps the extraordinary background of the first foreign born dentist to become President of a 161,000-member organization was precisely what provided him with a steady hand to lead the ADA in times of trouble.
Be as it may, Gehani is fully vested in the profession; if any proof was needed beyond his many academic and professional credentials and achievements, in the US and in India, his wife, children and many nieces and nephews across the globe are dentists. So dentistry for him is not just a profession, but something also deeply personal. In fact, he stood up to make sure that the world accepted that Dentistry is an essential service, and that there should be parity between Dentistry and Medicine.
That is why he believes Dentistry should speak with “One United Voice” for the entire profession, nationally and internationally, which is the reason I wanted to interview him.
In what ways has the Covid-19 pandemic changed your practice / institution?
The COVID-19 pandemic has dramatically changed my practice since we had to learn and work following social distancing guidelines to keep my staff and patients safe. Use of PPEs throughout the office all the time, screening patients on the telephone 24 hours prior to appointments, taking temperature of patients and all dental personnel, social distancing, spacing appointments to prevent overlap of patients, no magazines in the office are now new norms.
“The pandemic is an opportunity to shift from surgical intervention to prevention.”
A little way back, when I was ADA President, I instituted a series of measures to combat infections in dental settings throughout the United States. On March 18, 2021, I had a telephone meeting with the Surgeon General of the United States, where I had to justify why I had decided to allow dentists to do dental emergency treatments as opposed to closing dental practices completely. We had restricted the dental office to emergency care to avoid long lines at the hospitals for dental emergency situations. We established partnerships with the CDC, FDA, NIH, Department of Health and Human Services, and I was in touch with all the State Dental Associations in the country, as well as many different international dental organizations, to discuss and implement policies to help dental practices be as safe as possible and open as soon as it was secure to do so.
What are the positive and negative aspects of this change?
Dentists are very much trained in dealing with infection control from the time they join the dental school as students. We deal with bacteria and virus all the time. We dealt with the AIDS crisis in 1980 very successfully. This time again, it was another opportunity to improve our profession.
The positive aspect of this change is the improvement of our safety measures. And probably as important and positive is that the COVID-19 pandemic is an opportunity for the dental profession to shift from an approach focused on surgical intervention to one emphasizing prevention. Embracing non-surgical, non-aerosolizing caries prevention and management will be critical in this endeavor. The profession has always supported community prevention measures such as water fluoridation. In the future, the dental compensation model will be based on providing preventive measures, instead of more expensive restorative procedures.
In 2000, the United States Surgeon General’s Report on Oral Health made it clear that oral health is part of overall health and well-being. We need to fight for parity of the Dental Profession with the Medical Profession. The public and the policy makers have clear understanding that the dentists are the doctors of the mouth. The progression of oral disease can cause pain, infection, and sepsis, and treatment is expensive. In addition to primary prevention, in early stages oral disease can be reversed or arrested with appropriate oral hygiene, fluoride exposure, dental sealants, changes in diet, and other measures. Prevention is a positive cornerstone in public health.
The negative part is that we will have a shortage of dental auxiliary personnel. It is becoming increasingly difficult to hire dental assistants, and we will be dealing with more regulations. Dental practices will be negatively impacted financially, which in the long run can cause access to oral care issues. Our cost of doing business has been going up and will continue to increase, while our professional fees will remain the same.
Are patients aware of the biosecurity measures you have in place?
Yes, patients are aware of them. And they appreciate them because they feel more secure when they see procedures like how we use advanced sterilizers to clean devices, and how we treat surfaces with special products to avoid the possibility of infections.
What are the effects of the pandemic in the processes of teaching and learning?
The effects of the pandemic were the unexpected challenges in which we had to rapidly adapt to new procedures and guidelines where interactions were limited due to social distancing.
As a teacher at New York University and at the Flushing Hospital, we were only performing emergency dental procedures, thus our ability to give full scope hands-on training was limited. Certain patients, like orthodontic patients, needed to be handled more carefully and teledentistry became the alternate way of practice.
Do you think technologies such as AI and VR can improve practice on patients?
Artificial Intelligence has a great scope in improving our service to the public. As a leader in the dental profession, I have always encouraged expanding on AI. This is our future, this can improve service to the public, who are going to feel more comfortable, and it will also help decrease their anxiety during a dental procedure.
The COVID-19 pandemic has thrust alternative modalities such as teledentistry to the forefront of policy considerations. Teledentistry supports the delivery of oral health services through electronic communication means, connecting providers and patients without the usual time and space constraints. Teledentistry’s unique ability to connect disadvantaged, primarily rural communities and the homebound with dental providers makes this method particularly well-suited to address lack of access during and after the pandemic.
Teledentistry can be used for education, consultation, and triage, allowing providers to advise patients whether their dental concerns constitute a need for urgent or emergency care, whether a condition could be temporarily alleviated at home, or whether treatment could be postponed. When many dental offices are closed and people are largely staying at home, communication and information via teledentistry can help lessen the burden of people seeking dental care at overwhelmed emergency and urgent dental care settings. In more usual circumstances, teledentistry can also be used to facilitate access to preventive services and oral health education, where members of the dental team can provide such services in community settings, such as schools, without onsite dentist supervision.
“I am very proud that I was the President of ADA when our public and our profession needed guidance, and I was able to serve.”
Before COVID-19, many states inhibited the use of teledentistry through legislative barriers and limited public and private insurance reimbursement. Compared with dentistry, many medical and behavioral health providers have less restrictive regulations and insurance reimbursement policies concerning telehealth. A Washington Post report was clear: “Telemedicine was largely ready for the influx.” Teledentistry, on the other hand, was forced to play catch-up. Emergency reimbursement changes prompted by COVID-19 have brought relief, but post-pandemic, we recommend that legislators, regulatory authorities, and third-party payers consider making permanent the temporary modifications to teledentistry policies to support increased access to oral health.
How do you get now dental info about congresses, courses, clinical advances?
I get dental information via web pages, social media, and webinars. Thankfully, now many meetings are being held in person.
How often do you watch / participate in online lectures thru Zoom or Webinars?
I usually participate in online lectures every week. As ADA President, our board meetings were virtual, we met about 20 times via Zoom, and I had more than 50 videoconferences with the top health and dental government and private institutions in the country, and with many international organizations, as well as with the media, to explain the measures that we adopted to fight the SARS-CoV-2 virus to maintain the safety of dental practitioners, their staff, and the public.
Are these online lectures still useful or have they reached their saturation point?
The online lectures are still useful since they are supportive to everyday practices. The situation is still very fluid, and the only way we can transmit information to all stakeholders is through online activity.
What’s now most important for you from a professional standpoint?
The most important thing is to provide the best care available in a safe environment, while also maintaining a professional and friendly demeanor towards them.
I am very proud that I was the President of the American Dental Association when our public and our profession needed guidance, and I was able to serve. I led and I served with utmost conviction and dedication because we demonstrated that the Dental Profession is United, and that we speak with One United Voice for the entire profession.
NOTE: Dr. Chad Gehani, who practices in Queens, New York, was President of the American Dental Association from 2019 to 2020. Past President of the New York State Dental Association, Past President of the Queens County Dental Society. He is clinical associate professor in Endodontics at New York University, Chairman of Department of Endodontics at the Flushing Hospital. He is a Fellow of the International College of Dentists, American College of Dentists, and the Pierre Fauchard Academy. He was awarded the Ellis Island Medal of Honor, which recognizes Americans who dedicate their lives to the community, and received the Distinguished Service Award from the Pierre Fauchard Academy, New York Section. He also has received the award of Excellence from the New York State Dental Foundation for Community Service.
Javier M. de Pisón is Publisher and Editor of Dental Tribune Hispanic and Latin America.