How long can a cavity wait? And other questions about routine procedures in COVID-19 limbo

Maybe you have a dark spot on one tooth that looks suspiciously like a cavity? Maybe you are used to getting Botox injections to keep wrinkles from forming on your forehead? Or maybe you benefit from weekly physiotherapy appointments to cope with chronic pain?

For seven weeks you've been wondering when you will be able to get these treatments again to prevent things from getting worse — or losing the progress you had made pre-pandemic.

CBC News reached out to several industry insiders to ask about on-hold services such as dental work, fertility treatments, physiotherapy, tattoo work, Botox injections, and eye care.

Here is what we found out about the consequences of putting off appointments, what you can do at home as a stopgap measure, and what in-person care may look like once restrictions are lifted.

Teeth

The British Columbia Dental Association (BCDA) says there is no easy answer for how long a person can wait to have a cavity filled — it depends on the health of a patient's gums, the size of the cavity, and how well the person takes care of their teeth.

On March 16, the province directed dentists to limit their practices to emergency care only. Since then most dentists have been working with patients over the phone or virtually to manage dental pain or infections, according to the BCDA.

"There is no question that the restrictions on routine dental services combined with extensive self-isolation and extra snacking has had a negative impact on the dental health of some patients," the association said in an email.

The association recommends people at home focus on thoroughly brushing and flossing each day. "Remember to brush longer, not harder," it says.

Putting limits on sweet, sticky and starchy foods — as well as sweetened beverages — can also help keep teeth cleaner.

If you do eat these foods, the association recommends brushing afterwards, or at least rinsing your mouth with water.

Physio

The Physiotherapy Association of B.C. says some clients are suffering from missed appointments at their local clinics for ailments such as chronic pain caused by arthritis or other injuries.

"Someone going without that care for a while can have quite a big difference on their quality of life," said Jeremy McAllister, a clinical physiotherapist based in Chilliwack.

McAllister also works as a consultant for those wanting to use digital applications to enhance the care of their patients. He says the industry has used the pandemic to show the type of care it can offer virtually.

"Physio is often thought of as a hands-on profession, and it is in many cases, but if we only had one tool to use it would often be that rehabilitation tool in the great majority of cases."

What he means is that through virtual appointments, applications and other digital tools, physiotherapists are able to instruct clients on exercises and activities to treat their ailments and pain at home.

It's also easier now to claim physio expenses for online care. McAllister says more insurers are covering virtual care and there is hope it will continue post-pandemic.

Delayed eye exams

B.C. Doctors of Optometry, which represents more than 600 optometrists, says routine eye exams can be safely delayed for about six months as long people have no new symptoms, recent history of eye disease or a systemic disease such as diabetes.

Dr. Johnathan Lam, president of the association, says frequent hand washing, not rubbing your eyes, and wearing eye protection in any activity that has a risk of injury are the best ways to keep eyes safe. 

"Home maintenance and gardening are two very common sources of eye injuries," he wrote in an email to CBC News.

Optometrists have been responding to emergency problems such as sudden vision loss. Lam says protective measures are in place to keep patients, eye doctors and their staff safe from the coronavirus in these instances. By provincial order, no elective eye surgeries have been performed for more than a month, however.

B.C.'s medical services plan is providing new telehealth benefits so people can consult with optometrists online, Lam said.

Help conceiving

While there are no rules around getting pregnant during the pandemic, for couples needing help to conceive, medical interventions have been put on hold. 

Sonya Kashyap is the medical director at the Genesis Fertility Centre in Vancouver, which works with about 1,000 clients a year wanting IVF.

In vitro fertilization is a process where an egg is combined with sperm outside the body before being implanted in a woman's uterus. 

Kashyap says none of the centre's patients were caught out mid-treatment when the pandemic was announced. The centre, along with others in B.C., are not offering IVF to respect physical distancing guidelines. 

Kashyap says most clients understand and are patiently waiting to return, but the longer the pandemic goes on, the tougher that becomes for some clients, such as those who are older.

"People who wait a long time, their patience may wane," said Kashyap.

During the pandemic, the clinic has been working with people remotely to focus on their mental wellness, family connections and overall health.

Botox

Botox, a botulism-based toxin, has become one of the world's most common cosmetic procedures.

Vancouver's Dr. Jean Carruthers pioneered the use of Botox in the early '80s and now has more than 1,000 patients who come for injections every three to six months to smooth wrinkles and erase frown lines.

But when the WHO declared the coronavirus a pandemic on March 11, Carruthers closed her office to treatments. She says patients will eventually see a change in their appearance.

"If you had a nice smooth forehead before, you're going to see lines and wrinkles again," she said.

Carruthers says some of her patients are anxious to get back to treatments and have called her office to say they are worried about their appearance.

She says people can try to extend the efficacy of their last treatment by trying not to frown or squint. Some people have been using tape or silicone patches on their faces overnight to help keep lines on their face from forming.

"Frankly though, nothing works like the real thing," said Carruthers.

Other things you can do at home include skin care routines that boost collagen, and wearing sunscreen — along with sunglasses — when going outside.

Tattoos

Seven weeks with a half-completed tattoo may be an eyesore for its owner, but there is no harm in waiting to have it completed, according to Craig Gilbert, a senior manager at Adrenaline Tattoo and Piercing.

Gilbert says Adrenaline closed its doors on March 16 and that most reputable tattoo studios across the province have done the same.

Since then, staff have been corresponding with clients to answer questions about their tattoo work. He says there is no consequence to having a tattoo on hold for a couple of months.

He said a tattoo usually takes three weeks to heal so most clients with multi-session works are used to waiting in between appointments.

Gilbert says he has been surprised by the number of people who have contacted his studio about new tattoos, which are not being done.

"We'll all just have to wait a little longer," he said. "All reputable shops are shut, so I'm pretty proud of our industry, given the fact many may go out of business."

Getting back to normal

British Columbia is set to announce its strategy and timeline this week for easing restrictions put in place to combat COVID-19.

All practitioners who spoke to the CBC for this story have plans to resume operations once they are given the green light.

These include limiting the number of people in their spaces, using personal protective equipment for staff and patients or clients, undertaking increased cleaning and even taking peoples' temperatures upon arrival.

The preparation work for what may be B.C.'s new normal in the weeks to come is being done they say, to instill confidence in workers and those coming to see them.

"You may be anxious your Botox wore off, but you will be more anxious to go to a crowded office," said Carruthers.