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Earlier this year, Fresno dentist Lou Cohen was a busy man — but for the time being, he’s cleaning his office instead of teeth.

That’s because he’s closed shop for the most part during the pandemic. The only patients he says he’s seeing right now are emergency cases like infections and lost crowns. That works out to only one or two patients a day.

While medical professionals are recognized as essential workers across the country, many health care providers who specialize in selective work are currently closing down their offices during the shelter-in-place directive, or otherwise aren’t getting patients. This includes dentists, who may be especially vulnerable during the COVID-19 shutdowns. 

The Centers for Disease Control and the California Department of Public Health have both put up guidelines for practicing dentists to more safely treat patients and lower the risk of spreading the coronavirus, but the close proximity to a patient’s mouth is a risk clinics are often unwilling to take. Likewise, the doctors themselves are nervous about catching the virus.

“I can wear a mask and really protect them from getting it with a face guard and all these things, but I think it kind of works both ways,” Cohen said. “I’m as fearful of getting it from them as they are of getting it from me.”

However, not all dentists in the Valley are shutting down. For Karl Pendegraft in Visalia, shutting down is not an option. Instead, he’s kept his doors open. He’s seen an overall drop in the number of patients — about a dozen a day instead of the previous 20 — but he’s still seeing people in his office. 

This hasn’t stopped him from taking strict precautions. He and his crew are wearing full personal protective equipment and have spaced out their appointments to accommodate social distancing guidelines as much as possible. According to Pendegraft, they have arranged their schedules that there’s never more than one patient in his office at any given time, hoping this will minimize any possible exposure.

The reason he’s still open, Pendegraft explained, is that unlike many other dental practices, his is much smaller, with only two treatment rooms and two employees. With fewer people and a smaller capacity, he argued that his risk of infection either for himself, his staff or his patients is much lower. Meanwhile, Pendegraft said that he feels a moral obligation to continue to work, not only for the sake of his business and his employees, but for his patients. 

“My philosophy is also this — people who are stressed, either metabolically, with health issues, or even with life stress — stress affects your immune system,” Pendegraft said. “If your immune system is depressed, infections crop up and take hold, and that’s how the COVID gets spread.”

Still, both dentists are feeling the financial pinch of fewer patients. Recently, Pendegraft had to let go of one his assistants, leaving him down to two employees. He added that he plans to hire her back as soon as the COVID pandemic passes. Meanwhile, Cohen initially had to furlough his four staff members, but thanks to a Payroll Protection loan, they are back on the roster.

On May 4, Fresno Mayor Lee Brand announced that the city had clarified its policy on a number of health services — including dental. Per the advice of the Fresno County Department of Public Health, dentists have been asked to consult the guidelines of the state. These guidelines include postponing routine procedures and surgeries and screening all patients. Performing procedures in an airborne infection isolation room for suspected COVID-19 patients is also advised whenever possible and use a powered air-purifying respirator with a HEPA filter, or an N95 mask.

But dentists and orthodontists around the Valley will continue to experience strain. And even after things open back up, Cohen believes recovery will be slow.

“I think when we open, we’re not going be as busy, and people have to be comfortable in order to go back into dentistry,” he said. “But I think there’ll definitely be a drop-off.