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Dentists to Resume Non-Urgent Care Under New Department of Health Guidance

by on May 10, 2020 5:46 PM

After weeks of only being permitted to perform emergency procedures because of the COVID-19 pandemic, dentists and orthodontists in Pennsylvania can now perform non-urgent care provided they follow specific protocols, according to revised guidance issued by the state Department of Health on Friday.

"Each dental provider should apply their clinical judgment along with their knowledge of the incidences of COVID-19 cases in their area, the needs of their patients and staff, and the availability of necessary supplies to assess whether to re-engage in the provision of non-urgent and non-emergent dental care," the guidance states.

Dr. Nicole Carnicella, a dentist who owns Centre Dental Care in Bellefonte, said that it's important for individuals to continue receiving dental care, especially in light of the coronavirus.

"Dentists in general are concerned with prevention, nutrition and overall wellness, which is vital in the face of a virus without a true vaccine," Carnicella said. "Not to mention, all dental diseases can only be treated temporarily with medicinal measures."

Issues such as cavities, gum disease and infections all need to be treated mechanically in-person and can have more serious consequences if they are left untreated, she said.

"Dental infections often result in a cellulitis," she said. "People die from cellulitis, and yet, we dentists have been told to manage these conditions medicinally, which is far from ideal."

Aerosol-generating procedures such as those that produce large droplets of water should not be performed, the revised guidance says, except as a last resort when clinically necessary and when appropriate personal protective equipment for infection control, per Centers for Disease Control and OSHA guidance, is available for all practitioners.

Before arrival, all patients should be screened for COVID-19 symptoms, such as a temperature of 100.4 degrees or more or cough. Social distancing must be maintained within in the practice and patients need to wear a mask when not undergoing treatment. The health department also said stringent requirements are in place for treating dental patients who have or are suspected of having COVID-19 and those patients should be treated in a hospital if the dental practice does not have the appropriate equipment and facilities.

The guidance does not state specific routine dentistry that can or cannot be performed, though does state PPE should also be available for dental hygienists, who do cleanings.

"What is allowed will include orthodontic work, such as getting wires moved, root canals, and other procedures," a health department spokesman said in an email.

The guidance lifts the prohibition on non-urgent treatment, and Carnicella said what procedures can be performed and whether hygienists can see patients to do cleanings are at the discretion of the dentist, provided they follow the CDC guidelines and have necessary PPE.

Carnicella said she has been doing emergency care for her own patients and for hospitals as a remote dental location for their emergency rooms.

"We have been seeing ER patients for eight weeks, generating aerosols if needed, without incident," she said.

Carnicella plans to open her practice on Monday morning following CDC guidelines. Dentists know how to deal with infected aerosols, she said, if they have the appropriate PPE. That, however, is now more challenging for dentists in general to obtain. The health department and Pennsylvania Emergency Management Agency are not prioritizing dental practices for PPE, so they have to get it on their own, and Carnicella said the items are now more difficult and more expensive to acquire through normal supply chains.

"Extra PPE would be greatly appreciated for all dentists in our area," she said.

While treating emergency patients, Carnicella said she has had to turn away many patients deemed non-urgent but who still had serious issues.

"Our practices from a 'business' standpoint will survive thanks to the help of the CARES Act," she said. "However, our practices from the standpoint of health care professionals, are failing miserably. Patients with oral health care needs, whether it’s an embarrassing broken front tooth, which can be as painful as a broken bone, or bleeding gums, which can have an effect on blood pressure, diabetes, preterm pregnancies and stroke risk, or an infected tooth which can cause a cellulitis, no one else can treat dental patients other than a dentist, and in most cases we need to physically see the patient."

The revised DOH guidance says that tele-dentistry should continue when possible because patients may be able to be treated virtually with antibiotics and pain medication.

But Carnicella said that is not a replacement for treating an issue.

"We believe in prevention, and we believe in not ignoring minor problems which could turn into painful, debilitating, expensive problems if we wait," she said. "We believe in treating the problem, safely, and not putting a Band-Aid on the problem with dangerous antibiotics and addictive pain meds."

Geoff Rushton is managing editor for Contact him at [email protected] or find him on Twitter at @geoffrushton.
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