Dear SCDA Members:
This past Tuesday, the ADA reported that 33 states have dentists going back to work. In those states, approximately 1/2 of the practices, on average, have done so. The ADA has also reported that most practices have opened at 28% of their normal volume. This means that many states will be facing the same problems others are already experiencing and hopefully will cause the issue(s) to become big enough to force the attention to cause action.
The biggest issue is still Personal Protective Equipment (PPE) and remains the #1 concern of all dental offices who are returning to work. Not only masks, but the shortage of gowns is now becoming a huge issue.
Your SCDA continues to spend countless hours exploring every avenue related to PPE. Some facts that we continue to learn are that:
  • The shortage of masks has caused a huge counterfeit market, often referred to as the gray or black market. The ADA and the Centers for Disease Control (CDC) have released information regarding the counterfeit mask market and key components you should look for before purchasing any product.
  • Some local hospitals have offered to sterilize N95 masks. The SCDA encourages you to inquire with your local hospitals about these services.
  • The ADA has updated their version of the Return to Work Toolkit which includes Spanish translations of the forms and useful information about the counterfeit mask market.
On a positive note, thanks, at least in part, to the efforts of the ADA, FEMA has placed Dentistry as #4 on its priority list. Dentistry now follows Hospitals, Long Term Care Facilities, and First Responders. We expect this ranking will allow dental facilities to be near the front of the line for PPE, if government entities are provided FEMA supplies, or if companies are asked to follow guidance for distribution. Additional good news is that some third-party carriers have begun to accept the PPE code D1999 and are supporting reimbursement.
We also continue to shadow discussion about the OSHA/CDC shadow that creates an uncertainty. It may help to clarify that OSHA Guidance for Dentistry Workers and Employers released on May1, 2020 contains guidance, not regulations or requirements. A standard (or regulation) is a regulatory requirement. Employers must comply with all OSHA standards (regulations).
OSHA guidance does suggest each dental facility perform a Hazard Assessment to consider:
  • Incidence or prevalence of COVID-19 in the area;
  • Overall health and age of the patient;
  • PPE available to staff;
  • Aerosol production that will occur during any necessary procedure; and
  • Available aerosol reduction mitigation methods, including rubber dam and high speed evacuation.
The CDC also has language which seems to conflict with Governors guidance to return to work appropriately. Keep in mind that the CDC does not have regulatory authority over the operation of dental practices. Dentists should regularly consult State Dental Boards and the Regulatory Agencies for specific requirements. It is worth mentioning that Maine Senator, Susan Collins, directly asked the director of CDC about updates for dentistry. The CDC Director replied that they would be written but did not commit to a date.
Ultimately, our message is the same this week as it has been, minimize the risk of transmission by being fully informed of the new infection control guidelines with new protocols, limit aerosol producing procedures to those that are medically necessary and reduce aerosol with established tools such as a rubber dam, hissed evacuation, etc.

We are all probably feeling overwhelmed and exhausted with weight of the responsibilities that fall on us as the leaders of our practices.   Hopefully, sooner rather than later science will catch up with practice, and we will have more knowledge and confidence in what protocols and precautions are truly necessary.   Please let us know if you are struggling to find answers to questions that we aren't addressing yet.
Julia Mikell
SCDA President

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