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In the light of the global COVID-19 outbreak, Portugal declared the national state of emergency on 18 March. So far, over 9,000 cases and more than 200 deaths have been confirmed in the country. Dr Miguel Stanley from Lisbon is a well-known key opinion leader in dentistry. In this interview, he talks about how the current crisis is affecting dentists in Portugal and worldwide.
Dr Stanley, what is the situation in your country in face of the SARS-CoV-2 crisis? What measures have been taken, and when were these put into place?
Portugal has declared a state of emergency; all businesses that are non-essential have been shut down, and for the past two weeks, the country has been pretty much closed for business. Naturally, people are doing their best to avoid social contact and only leave their houses for basic necessities, but much like everywhere, there are some people who are not respecting the rules. Also, our hospitals are underprepared, as I guess is a similar situation in most countries in the world. Police are stopping people in the streets and asking them where they are going in order to make sure that they are only travelling for vital situations. I don’t think any government in the world was prepared for this.
How have the confinement measures affected you professionally and personally? Is your office still open or, if closed, since when?
Obviously, it is devastating for any business to be shut down for such a long time. Some measures, such as offering loans, have been taken by the government to help small and medium-sized businesses, but even these will have interest to be paid back, of course. They have also created legal support so that you don’t have to pay the entire salary of your staff, but some taxes still have to be paid regardless. This is going to be devastating for a lot of clinics, and I cannot say that I am very confident about the coming months.
I chose to shut White Clinic down before these measures were made obligatory by the government. I felt that I had a duty to my staff, medical team and my patients to avoid the spread of the coronavirus. We are only seeing patients when emergency situations cannot be postponed or simply treated with medication. In the past two weeks, we have seen only four emergency patients. Our daily average is usually 40 patients.
On a personal level, I have had the opportunity to spend time with my wife and kids. I have totally cut down on traveling, as all my international lectures have been cancelled. However, I am still managing everything remotely with my team, as we have patients all around the world who need some form of management. I am also making sure my staff are doing well and that our suppliers and partners are all okay.
Luckily, so far nobody in my extended family or my team has showed any symptoms or tested positive, so thankfully isolation has worked for us.
“I felt that I had a duty to my staff, medical team and my patients to avoid the spread of the coronavirus”
Now that your office is closed for routine treatment, are you doing anything differently when treating your (emergency) patients compared with when it is open?
Here at White Clinic, we have always taken extraordinary measures to avoid cross-contamination. We practise Slow Dentistry, and as such, we don’t see more than one patient per hour and sometimes even fewer than that. We have worked in this way for more than 20 years. The rationale is that it takes roughly 10 minutes to properly disinfect the room in between appointments. We have been doing this religiously since day one, making our clinic a very safe space. The only extra precautions that we are currently taking are that we have invested in air purifiers that also disinfect the air and we wear full-face visors and double face masks, as well as full-body surgical gowns, and dispose of everything safely immediately afterwards. We also try to avoid aerosols as much as possible.
During this crisis, how have you utilised your time in your work situation and in relation to your patients? Could you share a little about your personal life and the effect on the things you enjoy and usually have little time to do?
To be honest, I feel that my smartphone has never been more active. I think that everybody is using social media three times more, and so I am getting a great number of messages on almost every single platform. I always feel pressured to reply. To be honest, it’s quite stressful to get so many messages! A lot of it is good stuff, though, and people are just trying to reach out and connect. I try to be a beacon of positivity for everybody, so I am happy to do it. I have always tried to make time for my family and usually turn my phone off when I am at home, but during this difficult time, I have had to balance both. I have a 2-month-old baby at home and a daughter who is almost 3 years old, so my hands are full.
I have managed to do one thing that I had been wanting to do for a long time, and that is to start online webinars, using my Miguelstanley.com platform to offer education. For a long time, I have been wanting to kick-start the Miguel Stanley Academy. Initially, I had planned for it to be situated in the clinic, so that dentists could come and see how we do things here, but the fact that we are all indoors and banned from travelling led me, together with my team, to establish this online. There will be a lot of new things coming soon.
“I am almost certain that, in the future, patients in developed countries will put safety ahead of cost in most circumstances”
Do you know how the confinement measures have affected the national dental market?
I think everybody is very scared about the near future. I am not even talking about the next six months. I am not sure whether the dental market will recover for quite a long time. Nobody has any answers on this matter, but I am sure that everybody is taking a big hit. I think this will affect our business in more ways than one. Life after this will look different. I follow some dental groups online, and people are beginning to get angry with many of the measures taken by the government and the lack of support for small businesses. I think that a great number of clinics were not properly prepared and were already facing a lot of difficulties before the crisis, and these might suffer the most.
No one knows how long this crisis will last. Whether it is short-lived or lengthy, do you think that it will change your business and the profession as a whole?
Yes! I am hoping that, in the future, clinics that were practising dentistry that was placing patients at risk will no longer be functioning. I recently wrote an article titled “Toxic dentistry?” for Dental Tribune International. I am almost certain that, in the future, patients in developed countries will put safety ahead of cost in most circumstances. The current trend for many people is to seek the best price for a specific treatment. I think that now they will think twice and be particularly careful to make sure that the clinic that they choose will offer proper safety measures as well.
I am just sad that it took something like this to make the public open their eyes to the incredible difficulties dentists face every day to fight cross-contamination. That is why, at the Slow Dentistry Global Network, we aim to help dentists identify all the steps that need to be taken to ensure patient safety and, of course, the safety of their team, and promote this to the general public.
One might hope that, in face of such a crisis, it would be appropriate to reflect and maybe change the way we live our lives for the better. What do you think? What changes would you like to see happening?
More compassion. More generosity. More kindness. More support for the elderly and the weak. I also hope that governments understand how ridiculous certain wars are. It is time to come together as a species and not just as nations with individual ideas for the future. I also hope that we listen to reason and reduce mass consumption of things that pollute our planet. And, more than anything, I pray that 5G is banned. I am very scared about this incredibly dangerous and unknown technology that could affect all of us. It is time to stop playing with nature and start taking better care of each other and of our plan.
Dr Miguel Stanley is the clinical director of White Clinic, based in Lisbon, Portugal, and founded 20 years ago. He is a passionate advocate for high-quality dental care, and his career has consequently been focused on restoring smiles with his interdisciplinary team, using state-of-the-art technology, software and materials, according to a strong sense of ethics and in pursuit of minimal invasiveness to better protect his patients. This is the reason that he created the No Half Smiles treatment philosophy and Slow Dentistry, both aimed at improving the patient experience and the overall quality of care. Based on his training in implant dentistry, cosmetic dentistry and functional occlusion, Dr Stanley has developed an advanced biological cosmetic dentistry approach to his work that incorporates the full scope of action of modern dentistry. He spends most of his time managing his longtime team and learning about new technologies in dentistry.
Editorial note: This interview is the first part of a series asking dental professionals all over the world to share their experiences during the COVID-19 crisis.