I think an important question we've all been asking ourselves in this last month
or two is as a dental professional is "what can we do?" I think it's important for
everybody to be sure that they're accessing reliable information. we're so
fortunate that we have our professional organizations and our government
agencies who are providing that information and making sure that it's
the most timely and the most accurate. I would suggest checking in with the ADA
the CDC, NIH, and OSAP websites on a regular basis and if you hear something
that you're not sure is correct you can go and check those sources to confirm it.
we really need to avoid panic and rumors there's a lot of information being
circulated that is inaccurate and in a time like this that can be dangerous.
take the recommendations from your local state and federal public health
officials seriously and heed the numerous calls to temporarily suspend
all non-urgent dental appointments until this crisis is over and health officials indicate it's
appropriate to resume and they will give us the types of recommendations that
we'll need to resume our operations safely. so why do we need to stop
elective procedures? we can't reliably identify patients who are asymptomatically
infected, or who may be in that incubation period. so we all need to
limit our contact with people outside of our immediate circle for a while and our
immediate circle is generally considered to be our household contacts. many of our
dental procedures produce aerosols and aerosols are known to increase exposure
potential if patients are infected and the virus is present in their
respiratory fluids. we also know that supplies of PPE for treating sick people
in hospitals is currently critically low and if we use these for
non-urgent procedures we contribute to the risk of our frontline healthcare
workers being left unprotected and these shortages currently have no end date in
sight we're not sure when that supply chain will be restored.
the ADA came out with a great source and that helps us identify which types of
procedures we should continue to offer to our patients, the first are dental
emergencies. these dental emergencies are potentially life-threatening and require
immediate treatment to stop ongoing tissue bleeding alleviate severe pain or
infection, and they might include things such as uncontrolled bleeding cellulitis
or a diffuse soft tissue bacterial infection with intraoral or extra oral
swelling that potentially could compromise the patient's airway. it also
includes trauma involving facial bones that potentially compromise the
patient's airway. now urgent dental care which we also can provide focuses on the
management of conditions that require immediate attention to relieve severe
pain or risk of infection and to alleviate the burden on hospital
emergency departments. these should be treated as minimally invasive as
possible so that means you're avoiding music views of aerosol producing
instruments and devices and perhaps using temporary materials to control
caries that are causing pain to the patient. urgent dental care includes
severe dental pain from Popol inflammation pericarditis or third molar
pain, surgical post-operative osteitis, and dry socket dressing changes. it also
includes includes abscesses or localized bacterial infection resulting in
localized pain and swelling. it could be a tooth fracture that causes pain or
soft tissue trauma, an avul or luxated tooth from dental trauma and
treatment that was required prior to critical medical procedures. also final
crown of bridge cementations can be done if the temporary restoration is lost
broken or causing gingival irritation. you can also provide care to patients
who have extensive dental caries or defective restorations that are causing
pain and you can manage these when they have to restoration techniques whenever
possible such as solar diamine fluoride and glass ionomer.
suture removals can continue to be done as well as denture adjustments on
radiation and oncology patients and denture adjustments or repairs when
function is impeded and the patient can't eat. replacing temporary fillings
on endodontic access openings and patients experiencing pain and also
snipping or adjustment of an orthodontic wire or appliance that's piercing or
ulcerating the oral mucosa and biopsy of abnormal tissues should continue. the CDC
is providing constant guidance for us and how to safely treat patients and
safely be around other people when we absolutely need to to provide these
vital services. these CDC guidelines are found on their website and they should
be checked regularly because information and needs are emerging and these
guidelines change as those evolve. right now the current CDC guidelines call that
dental providers should not provide elective procedures in concert with the
ADA recommendations. if you must treat emergencies ask screening questions for
respiratory infection, and if the patient has a respiratory infection or is how to
contact with somebody who's been diagnosed with COVID-19 consider
referral to a medical center if available and if that's not possible and
the patient needs to be seen there's still some things that you can do and
we're going to talk about those. and there have also been some guidelines
that have come out from the CDC for optimization of PPE under the current
situation where there is a shortage of certain things such as surgical masks
this is only to be used in these critical emergency situations and it is
not to be used for routine dental care or when PPE is available. these measures
include things like using a mask for more than one patient in some situations
and hospitals they are needing to do this because there simply aren't enough
masks to treat all the patients. also during this time any available in ninety
five respirators should be prioritized for procedures that are likely to
generate respiratory aerosols which would pose the highest exposure of
risk to health care professionals and those are that is for patients who are
confirmed or suspected to have COVID-19, not for well patients. face mask protect
the wearer from splashes and sprays we should continue to wear face masks and
change them between each patient or more often if they become wet. respirators
which filter inspired air offer a greater level of protection, they protect
the respiratory tract of the wearer. examples of procedures that produce
respiratory aerosols are those likely to induce coughing and the CDC identifies
these as things such as sputum induction and open suctioning of airways they do
not address dental aerosols and those are not specifically mentioned in
respiratory aerosols. so this CDC guidance on optimization of PPE as I
said things like reuse of a surgical mask or a respirator is only after all
other administrative and work practice controls have been exhausted.
administrative controls do include things such as providing only urgent
care, limiting people that are in the facility, using telemedicine, and we'll
talk about that in a little, limiting the procedures in length and in
the spread of oral fluids and please visit the CDC website where there is a
full list of administrative and work practice controls that can be
implemented to optimize the use of PPE.