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Dental practices remain open amid COVID-19 surge

ADA, state societies reinforce dentistry is essential health care

December 01, 2020

By Mary Beth Versaci

As COVID-19 cases again surge across the U.S., dentists may be worried about the return of restrictions they experienced in the spring, but as of Nov. 30, no states were asking dental offices to limit essential services, and the American Dental Association is also advocating for dental care to continue during the pandemic.

Photo of ADA President Daniel J. Klemmedson
Dr. Klemmedson
"At this point in time, the American Dental Association firmly believes dental care can continue to be delivered safely," ADA President Daniel J. Klemmedson, D.D.S., M.D., said in a statement Nov. 17. "Guidance recommended by the ADA and the Centers for Disease Control and Prevention continue to safeguard the health of the public. Dental care is essential health care. Regular dental visits are important because treatment, as well as prevention of dental disease, helps keep people healthy."

The ADA continues to monitor the developing situation and recognizes that local and state health departments, state dental societies and, in some cases, large urban local dental societies may make recommendations they believe are appropriate based on local conditions.

"In general, however, dentists and dental team members across the country have effectively implemented ADA and CDC recommendations, and dental practices should remain open to provide dental care to patients," Dr. Klemmedson said.

State responses

State dental societies have reached out to their members to clarify guidance from their state governments and assure them essential dental services may continue.

A shelter-in-place order issued Nov. 13 in New Mexico shut down nonessential in-person activities, but the language pertaining to dentistry remained essentially the same as it has for the last several months, according to a post on the New Mexico Dental Association's website. Dental offices could remain open, but dentists were encouraged to use their professional judgment when responding to the status of the pandemic in their area.

Following the two-week order, the state said it would enact a tiered response system on Dec. 2, allowing counties to lift restrictions after meeting certain health metrics.

In Washington, the state dental association received direct confirmation from Gov. Jay Inslee's office that restrictions related to social gatherings and other activities announced Nov. 15 and lasting for four weeks do not place any new limits on dental or health care delivery more broadly, according to a post on the Washington State Dental Association's website.

On Nov. 25, Mr. Inslee also released updates to a May proclamation that had reduced restrictions on and allowed for the safe expansion of "nonurgent" medical and dental procedures. The updates do not enact any additional restrictions or limitations on the delivery of dental or health care and instead allow health care providers to self-regulate their capacity for care based upon certain parameters, according to the state dental association. The updates will go into effect Dec. 3.

"As we continue to work our way through this pandemic, we must continue to exercise good judgment when determining how to provide necessary dental care within the context of our patients' needs, our area-specific COVID-19 disease burden, PPE supply, and the health care capabilities and capacity of our local communities," the Washington State Dental Association stated on its website. "A one-size-fits-all approach is not the right path going forward."

The state association had been actively involved in discussions with the governor's office, state department of health and other health care organizations about updates to the proclamation.

Dentistry is essential

The ADA House of Delegates passed a policy stating dentistry is essential health care during its virtual meeting in October.

Resolution 84H-2020 states oral health is an integral component of systemic health and explains dentistry is essential health care because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health.

It states the ADA will use the term "essential dental care" — defined as any care that prevents or eliminates infection and preserves the structure and function of teeth and orofacial hard and soft tissues — in place of "emergency dental care" and "elective dental care" when communicating with legislators, regulators, policymakers and the media about care that should continue to be delivered during global pandemics or other disaster situations, if any limitations are proposed.

The policy also states that state agencies and officials should recognize the oral health workforce when designating their state's essential workforce during public health emergencies, in order to assist oral health care workers in protecting the health of their constituents. Federal agencies such as the Department of Homeland Security and Federal Emergency Management Agency have already acknowledged dentistry as an essential service needed to maintain the health of Americans.

The American College of Emergency Physicians issued a letter in September supporting the ADA policy, stating it understands the consequences of neglected dental care and sees the resulting infections on a daily basis.

From March 16-April 30, the ADA called for dentists to postpone all but urgent and emergency procedures to help mitigate the spread of COVID-19, keep patients out of overburdened hospital emergency departments and conserve personal protective equipment. By the end of May, most state governments had lifted restrictions on dental offices.

COVID-19 rates and resources

A study from the ADA Science & Research Institute and Health Policy Institute found that fewer than 1% of dentists nationwide were estimated to be COVID-19 positive as of June. The study was published in the November issue of The Journal of the American Dental Association.

The authors of the study are continuing to collect infection rate data, and they have added dental hygienists to their ongoing survey, in collaboration with the American Dental Hygienists Association. Preliminary data suggest the monthly incidence rate among dentists has remained less than 1%. Conclusive data from a six-month period will be part of an upcoming publication.

The CDC also has not reported any documented transmissions of COVID-19 in a clinical dental setting to date, Dr. Klemmedson said in his statement.

Interim guidance from both the ADA and CDC calls for dental professionals to use the highest level of personal protective equipment available, including masks, goggles and face shields. To minimize aerosols, the ADA guidance also recommends dental professionals use rubber dams and high-velocity suction whenever possible and hand scaling instead of ultrasonic scaling when cleaning teeth.

Dentists can find ADA resources related to COVID-19 at ADA.org/virus, including the Patient Return Resource Center, which has talking points for dentists and their staff to use to help patients who have concerns about visiting the dentist during the pandemic.