Dear SCDA Members
Many dental offices are beginning their recovery process. Although, we are all in different stages of the process, I hope you are reaching out to your dental neighbors and colleagues to share successes and challenges as we break free of the inertia of "The Great Pause." We can all learn from each other.
This is the first letter in two months that is primarily focused on doing dentistry rather than government restrictions, actions and funding. Congratulations! We are beginning to see the light at the end of the tunnel.
So, what has the SCDA done for you this week? The majority of the effort has been done by the PPE Work Group. We have also handled a lot of calls from members who have run into bumps in the road as our employees come back to work and more patients are coming in for treatment.
Members call us to ask for help when they are dealing with some of the new problems many of us will face:
- What do you do if you find out an employee or recently seen patient has tested positive for COVID-19? That person should call SCDHEC. SCDHEC will put a plan into action. That person's personal health information (PHI) should be protected as HIPAA compliance applies in this situation.
- Why do we need to take a temperature for each patient and employee? Screening all patients and employees following ADA recommendations minimizes the risk of exposure to dental health care personnel (DHCP) and patients. You cannot guarantee a risk-free environment, but you can assure your patients and your employees that you are taking reasonable and recommended precautions.
- What if a patient has COVID-19 or COVID-19 symptoms and has a true dental emergency? In that case, the coronavirus symptoms take priority over the dental emergency. Refer them to a medical facility for COVID-19 evaluation.
- Is a fit test required if I wear an N95 mask? There are two types of fit tests, initial and annual. The annual fit test requirement has been temporarily suspended. The initial fit test is still required if you are required to wear an N95 masks. Currently, in dentistry, you are only required to wear an N95 mask if you are treating COVID-19 patients or patients with COVID-19 symptoms. With recommended screening protocols, you would not be treating those patients. The only the reason someone in the dental field would be required to wear an N95 mask is if their employer requires them to wear one. If you are not required to wear an N95 mask, but you choose to wear one, then you are not required to have a fit test.
- When can we do COVID-19 testing at or office? The ADA advises dentists not to administer COVID-19 tests in their offices. They caution that there are no commercially available tests that have proven to be reliable. The risks of false negatives and false positives create obvious problems. Following the guidelines for patient screening and PPE are the best ways to practice dentistry safely for now. The ADA is advocating for dentists to be approved to administer the tests in our offices once they become available and reliable. The ADA has developed CDT codes to be submitted to insurance companies to cover the cost of testing.
- Can I charge my patient for the cost of PPE? The cost of PPE is another economic challenge for dental practices. The national average estimate for PPE is currently an additional $24 per patient visit. A variety of factors will affect what your office's costs are. For example, PPE for a prophy exam will be less than the PPE for an aerosol producing procedure. The ADA is asking for 3rd party payers to either increase their allowable fees or allow dentists to file for PPE as a separate procedure code. We recommend you communicate your message to your patients and pursue 3rd party communication to find the best solution. We will continue to ask the ADA for updates.
If we continue to hear from our members, we will create an FAQ spot on our SCDA website to use as an easy reference. We welcome your communications for problems that you are facing or problems that you have successfully solved and would like to share with the rest of the membership.
In addition to being a resource for troubleshooting, SCDA's energy has been focused on PPE.
The mask supply shortage is our most pressing PPE issue. The PPE Work Group has been actively and persistently investigating many options for our members. Although we are still pursuing the elusive N95 NIOSH masks, we have accepted the reality that we will not be able to provide them for you within the next few weeks. The ADA has issued guidance to support the ASTM Level III mask as well as an authorized KN95 mask as good alternatives. The Work Group has been studying the KN95 mask market extensively. They have decided that FDA authorized KN95 masks manufactured by companies on the FDA approved list will be our best alternative. We believe that many members would prefer a level of protection beyond an ASTM Level III masks now that we are performing aerosol creating procedures. We will continue to search for supplies of both N95 and KN95 masks for our members.
Gowns are the newest PPE that faces a big challenge on the supply side. Disposable vs. reusable and autoclavable vs. washable. What level gown is needed for what procedures. It's a slightly similar learning curve as masks. It turns out that an abundance of fabric for gowns is made in the USA. The limitation on supply is having the fabric sewn into gowns. Most sewing of manufactured goods is sourced outside of the USA, and it is time consuming. Some local communities are discussing sewing groups who could acquire gown fabric. Our PPE Work Group is tackling this PPE topic from the commercial side along with the masks.
The ADA is also advocating that 3rd party payers waive the frequency limitation for periodic examinations and prophy appointments. At this time the ADA recommends that each dentist address this on a case by case basis for the patients it will affect. If your patient is allowed 2 cleanings per year, then you have no problem. What we want to avoid is a 6-week bald spot in our hygiene schedule 6 months from the end of March.
With the new ADA guidelines and Toolkit at our side, we can assert our confidence that dentistry is one of the safest places to be. We are adding a whole new layer of protection for ourselves, our employees and our patients. I hope you can answer any questions that are sent your way as confidently as I can. Most of the answers are there for you if you have used the tools provided to prepare and protect your office environment. If you can't find an answer to a question in your resources, send the question(s) to us.
Dr. Julia Mikell