Slowly, but surely, dentist’s offices are reopening for routine cleanings and nonemergency procedures.

Since March many dentists — though considered essential in the state — had remained open only for emergency procedures while postponing nonemergency care under recommendations from the American Dental Association to help “flatten the curve.”

Gavin Uchida, owner of Blue Whale Children’s Dentistry in Kaimuki, opened his office for routine cleaning in late May, with new Plexiglas and guidelines in place.

Reopening was a calculated risk, he said, but one that he felt he needed to take in order to provide preventive care to his patients.

Photo Gallery: Hawaii dental offices are reopening for routine care

From a clinical point of view, preventive procedures are less risky than ones required to repair a tooth, he said.

“It’s not an easy decision,” said Uchida, who formerly served as dental director for the state Health Department. “I think it’s a calculation that every office has to make regarding minimizing any short-term risk related to COVID-19 and risk to patients, risk to staff and risk to yourself. You have to weight that against the long-term consequences of denying preventive care to your patient. If there are intermediate actions that a person can take to mitigate the risks and allow for the benefits, then sometimes that equation may equal out.”

Visits to his office are now spaced apart so there is no crossover between families. Although his wasn’t a high-volume dental office prior to the pandemic, the number that he sees is still much lower than previously.

“We’re seeing about half the number of patients we would normally see in a day so we can space out families,” he said. “Ideally, no family is crossing paths with another family. The first one will be in their car before the second one gets into the office.”

Patients are asked not to arrive more than five minutes early, and to be accompanied by just one parent instead of the entire family. They should also wear face masks upon entering, until ready to sit in the chair.

His staff is equipped with personal protective equipment as well, including masks, face shields, glasses, gowns and gloves, but not the full hazmat suit. The office is disinfected multiple times a day, and open only every other day.

“We’re minimizing procedures that kick up aerosols, if there’s a technique we can do to not have saliva and water vapor floating through the air,” he said. “We’re changing some procedures and delaying things we can delay.”

Megumi Chong of Mililani, the mother of two, ages 12 and 7, was relieved to be able to get them in for their routine cleanings at Blue Whale without delay.

“All the safety procedures were in place, so I felt really safe, and my kids, too,” she said.

Coming from Japan originally, she said they were accustomed to wearing masks.

Vanessa Choy, a dentist with an office on Makaloa Street, had been fielding emergency calls but reopened in mid-May for routine cleanings.

She felt routine care was important for her patients’ dental and overall health.

“Routine care is important,” she said. “It’s important to diagnose bigger problems as well as ones that may be going on.”

Choy is following Centers for Disease Control and Prevention, Occupational Safety and Health Administration and American Dental Association guidelines.

All patients go through a screening questionnaire, including questions about symptoms and travel in the past two weeks, prior to scheduling an appointment.

The appointments are staggered so fewer go into the office at a time. Also, they are asked to wait in their car until their appointment time, as well as to wear a face mask when entering the office. There are chairs in the waiting room — spaced apart more than 6 feet — but pretty much everything, including magazines, has been removed.

Upon arrival there will be hand sanitizer, a temperature check and another questionnaire.

“It does take a little longer, but it’s in place for everybody’s safety,” said Choy, adding that patients have been understanding of the changes. “It’s really for their safety and the safety for our dental team.”

Kim Nguyen, executive director of the Hawaii Dental Association, said the situation is constantly changing.

She said the association was working with the Hawaii Emergency Management Agency to ensure dentists are top priority for receiving personal protective equipment.

On Wednesday the ADA offered guidance on steps for staff to take if they have had contact with a patient who later tests positive for COVID-19. A hazard assessment guide is available at hawaii dentalassociation.net.

Many dental offices took a hit from coronavirus- related closures, according to the association, which estimated a loss of more than 500,000 dental jobs nationwide in April. However, the ADA found more than a third of dental practices nationwide had opened the first week of May, compared with 3.4% in late April, offering signs of recovery.

“In every profession, every industry, we’re all having to figure out what this new work, live and play and practice environment will look like for us when we’re ready to return to work in the community,” said Nguyen, “Regardless of what’s going on, our members are very keen about ensuring their patients and dental team members are cared for. They know oral health care is important. We’re all trying to figure out what this new world will look like.”

Lisa Forbes, president of the Hawaii Dental Hygienists Association, said hygienists are definitely concerned about having adequate personal protective equipment upon returning to work. The association has about 200 members but represents all hygienists in the state.

A coalition is also seeking federal authorization for licensed dentists to screen patients by conducting point-of-care testing.

“Hygienists are No. 1 at risk of contracting COVID-19 in the workplace because we create aerosols directly in our face,” Forbes said. “We’re within 1 to 2 feet of patients and in their mouths, with water vibrating, and that aerosol is pretty much in front of us. … There’s really no social distancing for dentists.”

Numerous offices reopening do not have adequate PPE since there is a shortage nationwide, she said. If some hygienists do not return to work and opt out, then they risk losing their jobs and not qualifying for unemployment.

On the other hand, she said many hygienists do want to get back to work.

“We do love our patients and want to get back to work,” she said, “but want to do it in a way that we feel safe going into work. That’s really the main concern for us.”