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March 19, 2020

COVID-19 Update: Dental Office Closures

On March 16, the American Dental Association (ADA) and the New York State Dental Association (NYSDA) issued statements recommending that dentists postpone elective dental procedures for three weeks in order to mitigate the spread of COVID-19. On March 18, The Center for Medicare and Medicaid services also issued a recommendation that all nonessential dental exams and procedures be postponed until further notice due to the close proximity of the healthcare provider to the patient.  Both the professional associations and CMS recommend that dentists offer emergency dental care only during this time period to alleviate the burden that dental emergencies would place on hospital emergency departments. In response to these recommendations, many dental practitioners have instituted modified office hours or closed their offices altogether except for emergency cases.

The NY Insurance Law, which regulates commercial health insurance policies, defines an “emergency” as the sudden onset of a medical condition manifesting itself by symptoms of sufficient severity—including severe pain—that a prudent person could reasonably expect the absence of immediate medical attention to result in:

A. Placing the health of the person afflicted with the condition in serious jeopardy

B. Serious impairment to the person’s bodily functions

C. Serious dysfunction of any bodily organ or part of the person

D. Serious disfigurement of the person (NY Ins. Law § 3216(i)(9))

Many dentists have struggled with the definition of “emergent” or “urgent” in the context of their dental practices, wanting to follow the guidelines yet uncertain as to which patients should be treated in the office. Fortunately, the dental associations provided useful guidance.

Emergent

Dental emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection, and include:

  • Uncontrolled bleeding
  • Cellulitis or a soft tissue bacterial infection with swelling that could potentially compromise the patient’s airway
  • Trauma involving facial bones that potentially compromises the patient’s airway

Urgent

Urgent dental care addresses conditions that require immediate attention to relieve severe pain or the risk of infection and include but are not limited to:

  • Severe dental pain
  • Necessary surgical post-operative treatment
  • Abscesses or localized bacterial infections
  • Tooth fractures
  • Dental trauma
  • Dental treatments required prior to critical medical procedures
  • Final crown or bridge cementation if the temporary restoration is lost, broken, or causing irritation
  • Suture removal
  • Denture adjustment on radiation and oncology patients
  • Denture adjustments or repairs when functionality is impeded
  • Snipping or adjusting an orthodontic wire or appliances piercing or ulcerating the oral cavity

Non-Urgent

Routine or non-urgent dental procedures that should be postponed for at least three weeks include but are not limited to:

  • Initial or periodic oral examinations and recall visits, including routine radiographs
  • Routine dental cleaning and preventive therapies
  • Orthodontic procedures other than those to address acute issues (e.g. pain, infection, trauma)
  • Extraction of asymptomatic teeth
  • Restorative dentistry

Dentists must now establish a protocol for determining which patient needs to be seen on an emergent or urgent basis and must take extra care to implement stringent infection control procedures. It is not at all certain that three weeks will be long enough to stem the COVID-19 contagion, so dentists should think of planning for a possible longer period of limitation on their practices.

It’s recommended that dental practices post a link on their websites advising patients of the limitations and restrictions on appointments and keep the link updated as necessary. Moreover, patients who are seen should be prepared for additional screening procedures in the office to be sure they’re not infectious, such as reviewing and observing any symptoms, providing a detailed travel history, and taking a current temperature.

Dental offices should take precautions in their physical space, including treating patients in one designated room that can be thoroughly disinfected. Finally, dentists may even wish to consider whether a patient could be assessed or treated on a “drive-by” basis. For example, in the case of orthodontic treatment, snipping a wire might not even require a patient to enter the office.

The Center for Medicare and Medicaid services is now also recommending that all nonessential dental exams and procedures be postponed until further notice due to the close proximity of the healthcare provider to the patient.

Until the time when dental practices can return to normal operations, COVID-19 daily updates can be found on the New York State Dental Association website.

If you have any questions regarding the content of this alert, please contact Fran Ciardullo, special counsel, at fciardullo@barclaydamon.com or another member of the firm’s Health Care & Human Services Practice Area.

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