As new facts and information about COVID-19 (coronavirus) continue to develop, you may be wondering what it will mean for your dental practice. In accordance with the America Dental Association (ADA), the California Dental Association (CDA) instruction, and the Center for Disease Control and Prevention (CDC), labs.dental would like to extend some helpful advice.
Safety is our biggest concern
As health care professionals, our collective actions now will determine the spread of COVID-19. As such the CDA has strongly recommended that dentists practicing in California voluntarily suspend nonessential or non-urgent dental care for the next 14 days.
However, one thing is for certain: this virus cannot eliminate the need for dental care and it is important that dentists are still available to patients with urgent needs. That being said, here are some much needed answers to questions about running your practice during this stressful time.
You may be wondering…
Should my office provide face masks to patients while they wait for treatment?
Face masks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others.
If your waiting room is small or crowded where there is less than six feet of available space between patients, patients can be offered the option to wait in their cars and be notified via phone call or text when it is their turn to be seen.
Should masks be only single use?
CDC’s guidance for single-use disposable facemasks has not changed. These masks are tested, and regulated by FDA to be single use. CDC’s position is that a new facemask should be worn for each patient. CDC’s specific guidance for facemasks is on page 41 of the Guidelines:
Wear a surgical mask and eye protection with solid side shields or a face shield to protect 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.
It is important to note that these disposable masks should not be washed for the purpose of reusing with patients.
What do we do about the shortage of masks?
While the FDA has stated that it is monitoring the domestic and global supply chain for potential disruptions or shortages, the agency also encourages healthcare facilities to report any supply disruptions to deviceshortages@fda.hhs.gov.
If you do not have adequate supplies to meet regulations, you should reschedule patient appointments when required PPE is replenished for your office.
What other policies and practices should my office follow to minimize the chance of exposure?
Some common sense practices recommended by the CDC and the ADA include:
- Employers encourage employees who report symptoms of acute respiratory illness to stay home and not return to work until they are free of symptoms for at least 24 hours without the use of fever relieving or symptom altering medications.
- If an employee appears to be sick upon arrival to work, they should be separated from other employees and sent home immediately.
- Employees cover a cough or sneeze with a tissue and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
- Employees wash hands often with soap and water for at least 20 seconds. If soap and water are not readily available, an alcohol-based hand sanitizer with at least 60% alcohol can be used.
- 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 your handpieces after each patient.
- Have your patient rinse with 1% hydrogen peroxide before each appointment. Coronavirus is vulnerable to oxidation; this will reduce the salivary load of oral microbes.
- Clean and disinfect public areas frequently, including door handles, chairs, and bathrooms.
- Employers place posters that encourage coughing and sneezing etiquette and proper hand hygiene at the entrance to their workplace and in other areas where they are likely seen.
What is the procedure for screening patients?
- CDC recommends healthcare facilities, including dental offices, screen patients before proceeding with an appointment. Information to take note of:
- Any individual who exhibits or reports signs of acute respiratory illness such as coughing, fever and shortness of breath.
- Recent travel to any locations that have a Level 3 Travel Health Notice for COVID-19. Verify when the patient returned to the United States. If the patient reports that at least two weeks have passed since their return from one of the identified regions and no symptoms have presented, the dental office can proceed with the appointment. When local, state or federal public health officials declare the disease is at the community level, screening for travel is not necessary.
- Close contact with an individual officially diagnosed with COVID-19.
If any of the points above are displayed, dentists are advised to postpone treatment until it is safe. Dentists may also send a notice advising patients who are experiencing acute respiratory illness to remain home and reschedule appointments. Contact your local health department immediately if you suspect a patient has COVID-19. Visit https://www.naccho.org/membership/lhd-directory for information on how to contact your local health department and https://www.cste.org/page/EpiOnCall for information on how to contact your state health department.
What if a patient has the virus, but urgently needs dental treatment? How do we proceed to provide care?
According to the ADA, if a patient with a confirmed case of COVID-19 requires urgent dental treatment, the dentist and the patient’s medical providers should work together to determine the appropriate precautions on a case-by case basis: this coordinated approach is critical in order to ensure that the risk of potential spread of disease among patients, visitors, and staff is kept as low as possible.
Because dental settings are not typically designed to carry out all of the Transmission-Based Precautions that are recommended for hospital and other ambulatory care settings, dentists and medical providers will need to determine whether the facility is an appropriate setting for the necessary services for a potentially infectious patient. It may be necessary for treatment to be performed in a healthcare setting that offers the additional protections that should be maintained in these cases.
Since coronavirus can spread via aerosol transmission, should my staff be using scaling instruments or hand pieces any differently than we usually do?
Every procedure and every patient is unique. Appropriate personal protective equipment should be available when instruments that produce an aerosol are used and it’s a good idea to consider using high speed evacuation in those cases since aerosol spread is one way that coronavirus can be transmitted. Of course, since no single answer can apply to every possible situation, dentists and hygienists should use their best professional judgment to determine what instrumentation should be needed for a particular procedure.
What if I have an employee who recently traveled abroad?
It is recommended employers consult with legal counsel before requiring an employee who recently traveled to China—or through any region where there has been an outbreak of the virus— to stay home from work to ensure the employer is not violating the Americans with Disabilities Act or any local, state or federal anti-discrimination laws.
Should I update my sick leave policy?
Employers should ensure that state-mandated paid sick leave policies are compliant, flexible and consistent with public health guidance and that employees are aware of these policies. CDC also encourages employers to maintain flexible policies that permit employees to stay home to care for a sick family member and be aware that more employees than usual may need to stay home. In the event of a potential staff shortage, employers should prepare alternative staffing plans to ensure as many of their facility’s staff are available as possible.
According to the CDC, employers should not require a healthcare provider’s note to validate an employee’s illness because healthcare facilities are likely overwhelmed and unable to provide such documentation in a timely manner.
Find the ADA’s full statement here: https://success.ada.org/en/practice-management/patients/~/~/media/C770325EBEF943D1A711B56DF63BD6D6.pdf
Find the CDA’s full statement here: https://www.cda.org/Home/News-and-Events/COVID-19-Coronavirus-Updates
*This article contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. This material has been made available on this website as a way to educate dentists on best practices surrounding the coronavirus. We believe this constitutes a ‘fair use’ of any such copyrighted material as provided in Section 107 of the US Copyright law. Fair Use is a use permitted by copyright statute that might otherwise be infringing.