Many dental procedures considered ‘non-essential’ during COVID-19 crisis

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Photo: Naval Surface Warriors via Flickr

Dental providers across the U.S. are being urged to limit most services in response to the COVID-19 pandemic.

The Centers for Medicare & Medicaid Services (CMS) on March 18 recommended that clinicians and hospitals delay non-essential dental, medical and surgical procedures not only to reduce the spread of disease but also to conserve personal protective equipment (PPE) for frontline health care workers responding to the virus outbreak.

“Dental procedures use PPE and have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient,” the agency said. “To reduce the risk of spread and to preserve PPE, we are recommending that all non-essential dental exams and procedures be postponed until further notice.”

Citing concerns about COVID-19, the American Dental Association (ADA) in a March 16 letter also called upon dentists nationwide to postpone elective procedures for the next three weeks.

“Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments,” said the organization, which represents 163,000 member dentists. The group said that it would update the recommendation as new information becomes available.

The letter follows a March 10 statement from the Centers for Disease Control and Prevention (CDC) that advised dental providers to “consider postponing non-emergency or elective dental procedures in patients who have signs or symptoms of respiratory illness.”

“For procedures which are considered clinically urgent, dental health care personnel and medical providers should work together to determine an appropriate facility for treatment,” the CDC said.

But the California Dental Association (CDA) contends that practitioners are still confused about whether they should continue to work at all and, if so, how they should address questions about PPE use and treatment of patients with urgent needs.

The group in a March 19 statement to the media and members of state Gov. Gavin Newsom’s administration demanding “clear, unambiguous guidance for oral health providers and their teams during the COVID-19 crisis.”

“In the meantime, without clear guidance, CDA strongly recommends dentists only see urgent and emergency care patients if they have the supplies and PPE to do so. If a practice does not have the supplies or PPE, we recommend all emergency patients be referred to a hospital emergency department. As the state develops clear guidance, we will revise these recommendations accordingly.”

As dental services are curtailed and practices shuttered, the ADA joined with other dentists’ groups to request that dental offices with fewer than 50 employees be exempted from family and medical leave and paid sick leave requirements included in the new federal Families First Coronavirus Response Act.

“We respectfully ask you to consider using your discretionary regulatory authority to exempt small businesses, including dental offices, which are experiencing significant financial challenges during this difficult time,” the groups wrote in a letter to Secretary of Labor Eugene Scalia.

Among its provisions, the relief package requires employers with less than 500 employees to provide “more comprehensive paid sick leave and family leave benefits related to COVID-19,” Rachel Cohrs explained in a March 18 piece for Modern Healthcare. The benefits will be paid for by the federal government using refundable tax credits within three months.

“The Department of Labor may exempt companies with less than 50 employees, healthcare workers and first responders from the requirements,” Cohrs wrote. “Employers can also choose on their own to exempt healthcare workers and emergency responders.”

But the American Dental Hygienists’ Association, which represents more than 185,000 hygienists, has raised concerns about the potential exemption.

“Please ensure that dental hygienists are not prevented from receiving needed coronavirus-related employee benefits solely because they work in the health care field, or because they often work on a part-time basis or in a small office setting,” wrote the group’s president, Matt Crespin, in a March 20 letter to White House and Congressional leaders.

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