Dental offices across the nation are facing the same issue: COVID-19. For dental professionals who perform aerosol-generating procedures, it is an exceptionally high risk to continue operations because of the new infectious disease. For the safety of health professionals and their patients, it is unavoidable to suspend routine dental procedures. The new virus has already changed the lives of millions and took the lives of thousands across the globe. In the last few weeks, COVID-19 has caused significant disruptions in the U.S., including in the dental world. As a result, the closure of dental practices became inevitable.
What Is COVID-19?
COVID-19 is a very infectious and contagious disease. It travels from person to person through droplets of saliva when an infected person coughs or sneezes. Others catch the virus by inhaling the droplets or touching a surface that contains the bacteria and then touching their face with unwashed hands. The novel coronavirus causes COVID-19 where the ‘CO’ stands for corona, ‘VI’ for the virus, ‘D’ for disease and 19 for 2019. The outbreak started in Wuhan, China, in December 2019. And before China announced the lockdown of the city, travelers had already brought the illness to different parts of the world. COVID-19 started spreading in many countries. On January 30th, the World Health Organization declared the coronavirus outbreak a Global Public Health Emergency. On January 30th, the CDC confirmed the first US case of human to human transmission. The following day, the United States also declared COVID-19 a public health emergency.
As of April 7, 2020, there are 1,348,404 cases of infection across the globe.
Dental Procedures and COVID-19
Dental procedures have unique characteristics and sometimes involve a large number of droplets and aerosols. This puts dentists, and their staff, at a high risk of getting infected and spreading the virus, according to an analysis of data by the Department of Labor. Air-powered equipment at dental offices flushes saliva and blood from the mouth into the air, and droplets of saliva are the primary source for spreading the virus.
‘human coronaviruses can survive on inanimate objects and can remain viable for up to 5 days at temperatures of 22-25°C and relative humidity of 40-50% (which is typical of air-conditioned indoor environments)’, and highlights the risk of ‘extensive environmental contamination’ from the use of ‘potentially infectious Aerosol Generating Procedures’ including ‘some dental procedures.’
What makes COVID-19 more dangerous is the incubation period of 2-14 days, which means a patient might be infected but unaware of it. Symptoms might appear as soon as 2 days, or it might take as long as 14 days, according to the World Health Organization. Even when the patients do not show symptoms, they might be contagious.
“The dental profession is particularly at risk, due to the possibility of aerosols produced by saliva droplets. These droplets can be inhaled, come into contact with skin or mucous membranes, and/or lodge on the surfaces of the dental office or other materials used during the dental appointment where hands can then be contaminated.”
– FDI World Dental Federation
The American Board of Dentistry and the U.S. Centers for Disease Control and Prevention recommend not seeing patients unless they need emergency care.
The American Dental Association previously recommended closing dental practices to all patients except for those who need emergency care until April 6, 2020. The new recommendation from the ADA is to keep dental offices closed to all but urgent and emergency procedures until April 20, 2020.
The virus survives on surfaces for different amounts of time, including metal and plastic surfaces in dental offices. It’s almost impossible to gear up dental personnel with enough personal protection equipment (PPE) to protect them, and it becomes increasingly challenging to disinfect rooms after each patient visits the office.
“It is important that dentists and dental teams thoroughly understand the risks of treating patients, the need to continue treating patients with emergency oral health issues, so they do not present to hospital emergency room departments, and the realities of what PPE is available to dental personnel.”
The ADA and many state dental associations have urged dental offices to treat only emergency patients; some states or local governments have mandated this.
“Postpone elective procedures, surgeries, and non-urgent dental visits, and contact patients prior to emergency procedures. Stay at home if sick and know steps to take if a patient with COVID-19 symptoms enters your facility.”
What Is Considered Emergency Dental Care?
Dental emergencies happen at any time and can even be life-threatening. Dental offices should remain open for such cases and resume doing oral surgeries, extractions of pathogenic teeth, and such. In most cases, emergencies are fractures and infections. For more information, read the Emergency Dental Care Guide.
“If a procedure can be delayed for 30 days without, in the clinical judgment of the dentist, running an undue risk of harm to the patient, it is non-essential.”
Mouthhealthy.com published the following list for patients to help them determine if they have a dental emergency:
- Bleeding that doesn’t stop
- Painful swelling in or around your mouth
- Pain in a tooth, teeth, or jaw bone
- Gum infection with pain or swelling
- After surgery treatment (dressing change, stitch removal)
- Broken or knocked-out tooth
- Denture adjustment for people receiving radiation or other treatment for cancer
- Snipping or adjusting the wire of braces that hurts your cheek or gums
- Biopsy of abnormal tissue
Additionally, the ADA published Interim Guidance for Management of Emergency.
Dental emergencies, according to the ADA, “are potentially life-threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection.” Conditions include uncontrolled bleeding, cellulitis, or a diffuse soft-tissue bacterial infection with intraoral or extraoral swelling that potentially compromises the patient’s airway; or trauma involving facial bones that potentially compromises the patient’s airway.
You might already have your calendar filled with visits, but you must cancel every appointment that doesn’t fall into a category of emergency.
The ADA suggests postponing the following:
- Routine dental cleaning and other preventive therapies
- Orthodontic procedures other than those to address acute issues (e.g., pain, infection, trauma)
- Extraction of asymptomatic teeth
- Restorative dentistry, including treatment of asymptomatic carious lesions
- Aesthetic dental procedures
Contact your patients through phone calls and reschedule all visits until after April 30, 2020.
Patients with COVID-19
There might be a dental emergency with a patient that has the new virus or has had contact with the infected. If that’s the case, then the dentist and their staff should use N95 respirators and surgical face masks/gowns as the Food and Drug Administration, the CDC, the National Institute for Occupational Safety and Health, and the Occupational Safety and Health Administration recommend.
Screen Patients over the Phone
If you suspect your patient has an emergency case, screen them over the phone first. Ask for symptoms and give directions through the phone if it’s possible. If, after screening them over the phone, you think the patient has a dental emergency, arrange the visit accordingly.
Use Software Applications to Evaluate the Emergency
A great alternative to office visits to evaluate a dental case is through software applications like Zoom, where you can see your patient through a mobile device or a computer. It’s not the same as your patients coming to your office, but it might be a way to have a clearer idea of the dental issue. And again, if after the screening you believe it’s an emergency case, plan a visit to your office.
Be Active on Social Media
Even though you have to close the office, it doesn’t mean you cannot engage with your patients anymore. Social media platforms are a great place to stay in touch with your existing and potential patients. Share health tips, and suggest ways they can keep their teeth healthy during the lockdown.
Improve Your Online Presence
Now is a great time to look at your website and social media accounts. See if all the information is up to date, and look for things you may want to change or update. Most of the time, you are too busy for this. So now might be the right time for you to take care of it!
How Dental Offices Can Cope with Financial Issues
Now that you need to close your door to patients and stop receiving money for your services, it’s important to help your business survive.
The American Dentist Association is waiting for clear guidance from the Small Business Administration on the ways to help dentists apply for Paycheck Protection program loans.
Small Business Association loans help smaller employers keep their employees on the job or re-hire them after the pandemic. The ADA continues to recommend that dentists consult with their financial advisors to determine if this loan would be the best fit for their practice. For Small Business Guidance & Loan Resources, click here.
Visit ADA.org/virus for the latest COVID-19 information.