No Longer “Business as Usual”

While overwhelming demands have been placed on the healthcare workforce, including physicians, nurse practitioners, physician assistants, nurses, and pharmacists, as this epidemic unfolds, dentists, dental hygienists, dental assistants, and those who comprise the dental supply chain should be thinking about how they can contribute to expanding health workforce capacity. Dentists and their team members are positioned to make important contributions in response to pandemics like COVID-19. They are highly skilled in assessment and diagnosis, surveillance, and infection control, and adept at administering injectables, making incisions and placing sutures, administering sedation, triaging patients, providing patient education, and managing anxiety.¹ This crisis gives dental professionals a chance to use their critical skills and time in a value-added way.

Also, with approximately 27 million Americans visiting a dentist each year but not a primary care physician,² this is a time for dentists to be creatively nurturing their practice to provide "whole-person care." The entire dental team-dentists, hygienists, and office staff-can be utilized to maintain connectivity with patients so they look forward to returning to the practice. Staying in touch with patients during this hiatus will help maintain the relationships you have cultivated over years and may ease their stress and enhance their overall physical and mental health.

Messages can be customized to target different segments of the practice. For example, developing "tips on dry mouth" may be useful for older adults who are on multiple medications for hypertension, or it may be beneficial to remind them how important their oral hygiene is for maintaining glycemic control. Different team members may appeal to different patient groups. Whether through phone calls, emails, or texts, communiqués should begin by inquiring about how the person is doing during this crisis. Showing genuine interest in more than their oral health goes a long way in engaging patients. The office may be able to offer them resources for whatever anxieties they may be experiencing; at a minimum, you have listened, validated their difficulties, and served as a source of support.

Another consideration is to partner with colleagues from other disciplines, such as nutritionists to develop a "healthy eating tips" handout to disseminate electronically. Or, the practice could collaborate with a nurse practitioner who is a certified diabetic educator to create an email reminder about the importance of oral hygiene, healthy eating, and exercise for diabetic patients in the practice. Emphasizing the links between your patients' oral health and overall health may serve as a reminder to them that their dental practice cares and how important their oral care is.

With dental services currently limited to emergency procedures (as of this writing April 13, 2020, and based on CDC guidelines), the risk of COVID-19 to both patients and staff must be minimized during such visits. Front office staff needs to triage all emergency or potential emergency visits, asking the patient questions about COVID-19 risk and offering virtual consultations/appointments. If emergency patients are without symptoms, they may receive dental treatment in the office with the use of infection control, personal protective equipment (PPE), sterilization, and surface disinfection. Employees should be wearing PPE in the office and stay home if they are sick. Patients should be scheduled so they do not come in contact with each other, and when they arrive at the office the staff should provide them a mask, ask them about their COVID-19 risk, take their temperature, and assess them for any symptoms. If a patient is exhibiting any COVID-19 symptoms, referral should be made to a hospital facility for dental care. Contacting emergency patients 48 hours after procedures is advisable to see if they are exhibiting any new COVID-19 or other symptoms.

Over the coming weeks and months, the status of the COVID-19 global health problem undoubtedly will change constantly. It is impossible to predict the eventual impact of this disease on dental care and office settings. As dental practices begin to reopen, standards of care that adhere to CDC guidelines will furnish effective approaches for providers and their patients in oral health clinical settings. The PPE that dentists and their teams wear will provide patients a reassuring sign as they enter the office for that first return visit.

Centers for Disease Control and Prevention, Coronavirus (COVID-19) webpage: https://www.cdc.gov/coronavirus/2019-ncov/index.html

American Dental Association (ADA) informational handout for dentists on COVID-19: https://www.ada.org/en/publications/ada-news/2020-archive/february/ada-releases-coronavirus-handout-for-dentists-based-on-cdc-guidelines

ADA's Interim Guidance for Minimizing Risk of COVID-19 Transmission: https://www.ada.org/en/publications/ada-news/2020-archive/april/ada-releases-interim-guidance-on-minimizing-covid-19-transmission-risk-when-treating-emergencies

ADA 2019 Novel Coronavirus (COVID-19): https://success.ada.org/en/practice-management/patients/~/media/32D2D1F13B3D4D919E67CFBC00AF71B0.pdf