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ADA, recovery task force seek to address PPE shortages

Face mask guidelines leave decision to dentists’ best professional judgment

April 22, 2020

By Kimber Solana

Association staff and members of the ADA Advisory Task Force on Dental Practice Recovery are aware and working diligently in addressing members’ concerns over the limited availability of certain personal protective equipment items.
   
Photo of Dr. Kirk Norbo
Dr. Norbo
As dentists and their staff begin plans to reopen beyond emergency procedures — as some states ease stay-at-home orders in the coming weeks and months — substantial inventory of personal protective equipment is currently diverted to medical operations on the front lines of the COVID-19 pandemic.

“The task force is well aware of the PPE shortages nationwide at this point,” said Dr. Kirk M. Norbo, 16th District trustee and task force co-chair. “The face mask guidelines we have provided illustrate low and moderate risk scenarios accounting for limited access to PPE and allowing professional judgment of the dentist.”

Dr. Norbo said if N95 masks are not available then an ASTM Level 3 surgical mask with a face shield would be the next best selection.
 
“If masks with either goggles or face shields are not available, please understand there is a higher risk for infection; therefore, use your professional judgment related to treatment provided, aerosol production and the patient’s risk factors,” according to the ADA’s Interim Mask and Face Shield Guidance.
   
“At the height of the COVID-19 crisis, the U.S. Department of Health and Human Services designated hospitals, medical centers and first responders as essential categories for receiving PPE,” said Dr. Rudy Liddell, task force co-chair and chair of the ADA Council on Dental Practice.

Photo of Rudy Liddell
Dr. Liddell
The Federal Emergency Management Agency, Dr. Liddell added, was tasked with controlling the supply chain of PPE, especially N95 masks, so that those diagnosing and treating COVID-19 patients had what they needed.
   
“Current demand for certain PPE is reported by main dental distributors to be at least 10 times that of supply, without the addition of several professionals who use similar protective equipment, including dentists, hygienists, dental assistants, painters, construction workers, etc.” said Jim Goodman, senior vice president of the ADA Business Group. However, he added “that some suppliers and distributors are indicating that with the addition of several increases in manufacturing, both domestic and internationally, they are hopeful that supply of masks will catch up to demand in mid to late summer.”
   
The ADA is working with reliable domestic manufacturers, key dental distributors and others to increase access to PPE for dental professionals but access to masks and face shields, along with disposable gowns, are currently the hardest to procure, according to distributors.

“The ADA is advocating through relevant government agencies and individuals to make sure dentists, who are considered essential workers per the Department of Homeland Security, have sustained access to these PPE items,” said Mike Graham, ADA senior vice president of government and public affairs.
   
In addition, the ADA has urged dentists to be cautious about purchasing dental materials from the gray market, as they may not meet certain standards approved by the FDA and ASTM International. The gray market is a generic term that primarily refers to products that are traded or sold outside of the manufacturer’s authorized distribution channels.
   
Over 90% of dental practices led the way nationwide in reducing the spread of COVID-19 by closing, except for urgent and emergency procedures, which helped reduce strain on emergency departments and hospitals.
   
As dentists anticipate reopening their practices across the country, depending on circumstances in each geographic area in the coming weeks and months, they will need to be able to treat patients in the safest manner possible, the task force co-chairs said. ADA is also recommending that dentist stop donating their PPE at this time to help prepare themselves for re-opening with needed materials.
   
“Safety is of utmost importance so as the supply chain of appropriate PPE is trying to catch up, it is essential to be mindful of the amount of aerosol generated during certain procedures and use the best PPE available,” Dr. Norbo said.

Reinforcing that, the Occupational and Health Safety Administration has designated dentists and other health care workers who perform aerosol-generating procedures in a very high risk exposure category for COVID-19.   

For more information, including resources and guidance to help dental practice navigate the COVID-19 pandemic, visit ADA.org/virus.