As dental practices resume operations, ADA offers continued guidance

27-05-2020

The safety of patients and the dental team has been and always will be American Dental Association’s (ADA) foremost concern. On March 16, the ADA was one of the first national professional health associations to recommend postponement of all but urgent or emergency procedures. This recommendation was intended to help mitigate the spread of the 2019 Novel Coronavirus, conserve essential personal protective equipment (PPE) for medical frontline colleagues, and avoid the need for patients requiring emergency dental treatment to go to overburdened hospital emergency departments.

The ADA’s March 16 recommendation that dentists restrict their practices to all but urgent and emergency care expired on April 30 and was not extended. Oral health is an integral part of overall health. Treatment of dental disease, as well as prevention, is important to help keep people healthy. The longer dental practices remain closed to preventive care and treatment for early forms of dental disease, the more likely that patients’ untreated disease will progress, increasing the complexity and cost for treatment down the road.

After extensive discussion with the ADA, the Federal Emergency Management Agency (FEMA) has elevated dentistry to #4 on the FEMA PPE priority list. FEMA recognises that dentists need PPE in order to treat emergency and near emergency dental cases in their offices rather than patients seeking that care from overburdened hospital emergency departments.

In April, while the U.S. Centers for Disease Control and Prevention (CDC) continued to develop recommendations for dental health care professionals, dental practices began reopening in states where government mandates began to lift. The ADA recognised that dentists across the country needed a science-based guidance and proactively formed a task force to do so. The ADA’s interim guidance, released in April, builds upon the already strong infection control protocols in place in dental offices and calls for the highest level of PPE available—masks, goggles and face shield—to help protect patients and the dental team when re-engaging in providing the full range of oral health care.

In addition, the interim guidance includes ways dentists and hygienists can reduce aerosols such as:

     • hand scaling when cleaning teeth rather than using ultrasonic scaling,

     • use of high velocity suction whenever possible and

     • use of rubber dental dams whenever possible

The interim guidance also includes many recommendations covering other patient interactions before, during and after dental appointments. Some considerations for office staff procedural changes and some suggestions for the office set-up are also included.

Before dental appointments

     • Dental office staff may call patients and ask questions about their current health status. They may repeat these questions when patients arrive to make sure nothing has changed.

     • Patients may have their temperature taken prior to any procedure.

     • Patients may be asked to bring and wear their own masks upon arrival at the dental office, particularly in states or cities that mandate the wearing of masks in public.

     • Patients may be asked to limit the number of people they bring to the appointment. That could mean leaving children at home under proper supervision or allowing older children who need dental care to go into the office alone while their parent waits outside during their appointment.

During dental appointments

     • Patients may be asked to wait outside until the dental team is ready to see them to reduce the number of people in the office and the time patients are around other people.

     • Inside the office, things that many people often touch, like toys or magazines, may have been removed.

     • The office may have hand sanitiser available for patient use.

     • Dental staff may wipe down items patients touch, such as pens, clipboards or furniture.

     • The computer keyboard in the dental operatory may have a disposable cover so it can be easily cleaned between patients.

     • The dentist and team members may be using different protective equipment than they’ve used at previous appointments such as different masks, face shields, gowns and goggles.

After dental appointments

     • Staff will thoroughly clean the areas where patients have been, using disinfectants that are effective against the virus that causes COVID-19.

This month, the ADA will release a guide and interactive checklist to aid dentists in assessing virus transmission risks in their practices, including factors such as local disease transmission rates, patient-and treatment-specific issues and facility considerations.

The ADA’s interim guidance and assessment guide and checklist for dental practices will be shared with the CDC as well as the Occupational Safety and Health Administration (OSHA). The ADA continues to recognise that local or state government decisions regarding closures, including restrictions on elective health care, supersede ADA recommendations.

Guided by the best-available scientific evidence, the ADA will continue to provide recommendations for the health and safety of patients and dental professionals.