corona

Governor Carney issued yesterday the fourth and fifth modifications to his State of Emergency declaration, closing all non-essential businesses in Delaware to help control the spread of COVID-19. This order goes into effect tomorrow, Tuesday, March 24, 2020, at 8:00 AM and will remain in effect until May 15 or until the public health threat is eliminated. As defined by this most recent order, dental offices fall under ambulatory health care services, which are considered essential and are, therefore, allowed to remain open. Despite this designation, OSHA still defines dentists at very high risk for exposure, especially during aerosol-generating procedures. Considering this information, the DSDS maintains its most recent recommendation:

It is strongly recommended that all Delaware dentists limit their practices to urgent/emergency care only until April 6, 2020.

Please review the ADA guidelines for urgent/emergency vs. non-emergency treatment, as well as appropriate infection control guidelines should you need to provide dental treatment (see below).

As always, we will continue to monitor the situation, both locally and nationally, and provide members with frequent updates as we continue to manage this pandemic.

Sincerely,

Dr. Cath Harris

Cathy Harris, DMD
DSDS President

Emergency or Non Emergency? ADA Offers Guidance for Determining Dental Procedures

In a statement issued on March 16, the American Dental Association (ADA) called upon dentists nationwide to postpone elective dental procedures for three weeks in order for dentistry to do its part to mitigate the spread of COVID-19. Concentrating on emergency dental care only during this time period will allow dentists and their teams to care for emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.

The ADA recognizes that state governments and state dental associations may be best positioned to recommend to the dentists in their regions the amount of time to keep their offices closed to all but emergency care. This is a fluid situation, and those closest to the issue may best understand the local challenges being faced.

The following should be helpful in determining what is considered “emergency” versus “non emergency.” This guidance may change as the COVID-19 pandemic progresses, and dentists should use their professional judgment in determining a patient’s need for urgent or emergency care.

1. Dental Emergency

Dental emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection, and include:

  • Uncontrolled bleeding
  • Cellulitis or a diffuse soft tissue bacterial infection with intra-oral or extra-oral swelling that potentially compromise the patient’s airway
  • Trauma involving facial bones, potentially compromising the patient’s airway

Urgent dental care focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments. These should be treated as minimally invasively as possible.

  • Severe dental pain from pulpal inflammation
  • Pericoronitis or third-molar pain
  • Surgical post-operative osteitis, dry socket dressing changes
  • Abscess, or localized bacterial infection resulting in localized pain and swelling.
  • Tooth fracture resulting in pain or causing soft tissue trauma
  • Dental trauma with avulsion/luxation
  • Dental treatment required prior to critical medical procedures
  • Final crown/bridge cementation if the temporary restoration is lost, broken or causing gingival irritation

Other urgent dental care:

  • Extensive dental caries or defective restorations causing pain
  • Manage with interim restorative techniques when possible (silver diamine fluoride, glass ionomers)
  • Suture removal
  • Denture adjustment on radiation/oncology patients
  • Denture adjustments or repairs when function impeded
  • Replacing temporary filling on endo access openings in patients experiencing pain
  • Snipping or adjustment of an orthodontic wire or appliances piercing or ulcerating the oral mucosa

2. Dental non emergency procedures

Routine or non-urgent dental procedures include but are not limited to:

  • Initial or periodic oral examinations and recall visits, including routine radiographs
  • Routine dental cleaning and 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

Infection control issues during patient assessment:

dot Patients with an acute respiratory illness should be identified at check-in and placed in a single-patient room with the door kept closed.
dot Seek to prevent the transmission of respiratory infections in healthcare settings by adhering to respiratory hygiene/cough etiquette infection control measures at the first point of contact with any potentially infected person.
dot Offer a disposable surgical mask to persons who are coughing; and provide tissues and no-touch receptacles for used tissue disposal.
dot Ill persons should wear a surgical mask when outside the patient room.
dot Dental healthcare personnel assessing a patient with influenza-like or other respiratory illness should wear disposable surgical facemask*, non-sterile gloves, gown, and eye protection (e.g., goggles) to prevent exposure. Since recommendations may change as additional information becomes available it’s a good idea to check the CDC website for COVID-19 updates.
dot Patient and dental healthcare workers should perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after possible contact with respiratory secretions and contaminated objects/materials.
dot Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental
 
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