Updated April 7, 2020: If you operate a dental office, you likely have concerns about keeping your patients and your staff safe during the novel coronavirus (COVID-19) outbreak—and you may have questions about what to do in the event of a dental emergency. The Doctors Company is committed to supporting your practice and sharing important information during this unprecedented time.
The American Dental Association (ADA) published a nationwide recommendation that dentists postpone elective procedures through April 30. Some states have converted that recommendation into a mandate: For instance, Florida’s Governor DeSantis issued a temporary mandate that prohibits dental, orthodontic, and endodontic offices from providing any “medically unnecessary, nonurgent, or nonemergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or well-being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”
To follow the ADA’s recommendation, make your patients aware that nonemergent and prophylactic care will be postponed until the emergency has abated. This recommendation—or in some states, prohibition—is based on concern for the current conditions caused by COVID-19, and the need to conserve medical supplies, such as personal protective equipment (PPE), for use in emergencies. Another consideration is the need to focus on caring for patients experiencing dental emergencies, so dental emergencies do not add to already volume-challenged hospital emergency departments.
The following are answers to questions you and your staff members may have in light of the pandemic, including information from the ADA’s frequently asked questions:
What can we do to prevent transmission in the office?
- Include temperature readings as part of routine assessment of the patient prior to performing dental procedures.
- Make sure the personal protective equipment being used is appropriate for the procedures performed.
- Use a rubber dam whenever possible to decrease possible exposure to infectious agents.
- Use high-speed evacuation for all dental procedures producing an aerosol.
- Autoclave handpieces after each patient.
- Have patients rinse with 1.5 percent hydrogen peroxide before each appointment. (COVID-19 is vulnerable to oxidation; this will reduce the salivary load of oral microbes.)
- Clean and disinfect public areas frequently, including door handles, chairs, counters, and bathrooms. Remove magazines, reading materials, toys, and other items that are not easily disinfected after being touched.
Can the same mask be worn for more than one patient?
- No. Guidance from the Centers for Disease Control and Prevention (CDC) for single-use, disposable masks, has not changed. The Food and Drug Administration (FDA) regulates them for single-use. It is not intended to be reprocessed and used on another patient.
- Wear a surgical mask and eye protection with solid side shields or a face shield to protect the mucous membranes of the eyes, nose, and mouth during procedures likely to generate splashing or spattering of blood or other body fluids.
- Change masks between patients, or during patient treatment if the mask becomes wet.
What questions should we ask patients in order to identify their symptoms and make decisions regarding appointment cancellation?
- The ADA has published the following three algorithms (and associated remarks) as interim guidance to facilitate the ability of dental professionals to triage, screen, and minimize the risk of COVID-19 transmission for dental patients and healthcare providers:
- Algorithm 1: Interim Guidance for Triaging Patients for Emergency and Urgent Dental Care (Updated 4/1/20)
- Algorithm 2: Interim Guidance for Screening to Identify COVID-19 Infection for Emergency and Urgent Dental Patients (Updated 4/1/20)
- Algorithm 3: Interim Guidance to Minimize Risk of COVID-19 Transmission for Emergency and Urgent Dental Patients and HCP (Updated 4/1/20)
- Appropriate questions to screen patients for COVID-19 could include asking if the patient has traveled internationally in the last 14 days or has been in close contact with another person who has been diagnosed with or is under investigation for COVID-19, and whether the patient has a cough, fever, or shortness of breath.
- Consideration should be given to referring patients who respond “yes” to any of the above questions to a hospital setting as the risk of transmission increases with such exposures.
- The ADA cautions that the above algorithms are guidance and not directives, and that they do not constitute legal advice or legal guidance. The ADA encourages dental professionals to stay up-to-date with laws, regulations, and guidance in their own state(s) and region(s) and to consult local legal counsel.
How should we maintain the practice’s physical environment?
- The CDC recommends using social distancing whenever possible as an effective way of decreasing the likelihood of transmitting COVID-19.
- Ask patients to arrive on time for their appointments, rather than too early, since that will minimize the amount of time they spend in the waiting room or reception area.
- Schedule appointments to minimize possible contact with other patients in the waiting room.
- Remove magazines, reading materials, toys, stuffed animals, and other objects that may be touched by others and that are not easily disinfected.
How should we handle a case of potential or actual employee exposure?
Follow the same procedures as with a patient suspected to have, or confirmed to have, COVID-19: Report the individual to your local health department and/or state health department.
How will a dentist avoid an allegation of patient abandonment?
Transparent communication is key. From a patient safety perspective, it is recommended that dental offices send a letter to all active patients to advise them of these ADA-recommended dental office practices during the COVID-19 pandemic:
- The office will follow ADA guidance that only emergent dental care will be provided, and all nonemergent appointments (including prophylactic care) between the date of notification and the expiration of the three weeks will be postponed by the dental office.
- Dental records will be made available to patients upon the dental office’s receipt of a HIPAA-compliant release. Dental staff will continue to answer the phones to respond to any questions that a patient may have and/or emergencies that a patient may experience.
- The dentist will be available for consultation via phone in the event of patient need.
Here is a suggested letter to be sent to patients.
In addition, be sure to document all conversations with patients who call to request nonemergent treatment.
ADA News, “ADA releases coronavirus handout for dentists based on CDC guidelines” (February 24, 2020) https://www.ada.org/en/publications/ada-news/2020-archive/february/ada-releases-coronavirus-handout-for-dentists-based-on-cdc-guidelines
American Academy of Periodontology/Perio.org, “COVID-19 Resources” https://www.perio.org/members/COVID-19 (contains comprehensive resources from CDC, WHO, ADA)
CDC, Coronavirus Disease 2019 (COVID-19), “Checklist for Healthcare Facilities for Supply of N95 Respirators for COVID-19/CDC.” (2019) https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html
CDC Division of Oral Health, “Dear Colleague Letter” https://www.adha.org/resources-docs/CDC_COVID-19_Update_for_Dental_Health_Personnel.pdf
CDC, Oral Health, “CDC Developing Guidance Regarding Responding to COVID-19 in Dental Settings” (March 10, 2020) https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html
Coronavirus Resources, “Read a message from AGD President Dr. Connie White” (March 16, 2020) https://www.agd.org/coronavirus
FDA, “N95 Respirators and Surgical Masks (Face Masks)” (March 11, 2020) https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks
Today’s RDH, Dental Hygiene, “Coronavirus: What Dental Professionals Need to Know about COVID-19” (March 7, 2020) https://www.todaysrdh.com/coronavirus-what-dental-professionals-need-to-know-about-covid-19/
U.S. Department of Labor, OSHA, “Guidance on Preparing Workplaces for COVID-19” https://www.osha.gov/Publications/OSHA3990.pdf