Dentists are charging patients a fee to help cover the rocketing cost of personal protective equipment that has left some practices “struggling to survive”.The cost of protective suits, medical masks and hoods, as well as office renovations such as glass screens and air purifiers, in order to combat the spread of Covid-19, is giving dentists financial pain.Helen Christopher, chairwoman of the Bermuda Dental Board, said the cost of providing dental care had “practically doubled” as Bermuda struggled to access PPE supplies amid high international demand and soaring prices.“We also have to see a lot fewer patients per day with the guidelines to maintain social-distancing, which means we may be seeing half the patients we usually do, which means half the income to cover the increased costs,” Dr Christopher added.“This means many practices are struggling to break even reopening right now.“Add to this two to three months of forced closure and zero income and we have an essential healthcare profession struggling to survive.“We have been talking with the Government about relief, looking at ways to minimise the increase in cost to patients, and talks are in progress with insurance companies, asking them to pay towards the cost of PPE.”Dr Christopher said the Dental Board had published local guidelines based on international research that required dentists to use much more PPE than normal during the pandemic. Janie Brown, of Par-la-Ville Dental in Hamilton, said the massive costs of the pandemic had plunged her and her practice into debt. In a letter to all clients, Dr Brown said individual practices would determine the PPE fee, which she estimated would range between $20 and $50 per patient.In an interview, Dr Brown said: “There’s a worldwide shortage of PPE, especially N95 masks. A few months ago, they cost $1.50 each; now they cost $15 to $20, and that’s if you can get your hands on them.”Dr Brown has purchased seven CAPR hoods, which cost between $2,500 and $4,000 each. She spoke of the personal financial strains on herself and her nine employees.Dr Brown said: “The business ran out of money about 1½ months into this and I started using my own savings to buy the air purifiers, antimicrobial furniture, to update the office doors, the glass partitions and it goes on. There isn’t enough to pay the staff at the end of the month. I could have brought back some of the staff, but then who do I pick to lay off?“I had a meeting with the staff and told them they could all have their jobs back, but I might not be able to pay them.“I could pay them more than the unemployment benefit, but I would have to owe them until the business gets back on its feet. They all said they wanted their job back.”That agreement from staff was essential in allowing the practice to reopen, she said. “What really frustrates me is that public seem to be hung up on the idea that all dentists and doctors are wealthy: the majority of us are not,” Dr Brown said. “I live in a townhouse and drive an 18-year-old Toyota Yaris. We’re not rich and that stigma of us ‘getting rich off the backs of Bermudians’ has got to stop.”Dentists cannot exercise social distancing in their work and are exposed to the tiny aerosol droplets that can transmit the virus. Hence, medical-grade PPE is essential for staff.Dr Brown said the droplets could remain in the air for some time, so there were lengthy intervals between patient appointments.She said: “My job right now is not to do harm to my patients or employees and that means being incredibly strict with staff about protocols put in place. I spent a full week training them before we opened up.”Patients wait outside the office and their temperature is checked before they are allowed in. “It will be a good year before we can recover from this,” Dr Brown said. “It’s a very stressful time for all of us and we’re trying to support each other.” Carmen Rabain, of Coral Dental, based on Queen Street, Hamilton, agreed that PPE was a significant issue for dentists.Dr Rabain said: “We are having a hard time accessing supplies and they are very expensive.“Individually, I’ve gone out of my way personally to make sure my office is supplied and covered well, so it is able to function.“It’s a challenge. It certainly affects how our businesses run and how many employees we can keep employed.”