The ADA is offering guidance detailing the differences between dental emergencies and nonemergency dental care as part of its efforts to curb the spread of COVID-19 and alleviate the burden on hospital and emergency departments. It also will provide a free on-demand webinar on March 20 based on questions it has received from its members about how best to provide care during the pandemic.
Emergency Vs. Nonemergency Guidelines
The guide supplements the ADA’s recommendation that dentists nationwide postpone elective procedures to do their part to mitigate the spread of COVID-19. Dental emergencies, according to the ADA, “are potentially life-threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection.” Conditions include:
- Uncontrolled bleeding
- Cellulitis or a diffuse soft-tissue bacterial infection with intraoral or extraoral swelling that potentially compromises the patient’s airway
- Trauma involving facial bones that potentially compromises the patient’s airway
The ADA notes that this guidance may change as the pandemic progresses and that dentists should use their professional judgment in determining a patient’s need for urgent or emergency care.
As part of the emergency guidance, the ADA added urgent care that “focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments.”
Examples of urgent dental care treatment, which should be as minimally invasive as possible, include:
- Severe dental pain from pulpal inflammation
- Pericoronitis or third-molar pain
- Surgical postoperative osteitis or dry socket dressing changes
- Abscess or localized bacterial infection resulting in localized pain and swelling
- Tooth fracture resulting in pain or causing soft-tissue trauma
- Dental trauma with avulsion/luxation
- Dental treatment cementation if the temporary restoration is lost, broken, or causing gingival irritation
Other emergency dental care includes extensive caries or defective restorations causing pain; suture removal; denture adjustments on radiation and oncology patients; denture adjustments or repairs when function is impeded; replacing temporary fillings on endo access openings in patients experiencing pain; and snipping or adjustments or an orthodontic wire or appliances piercing or ulcerating the oral mucosa.
“The American Dental Association recognizes the unprecedented and extraordinary circumstances dentists and all healthcare professionals face related to growing concern about COVID-19,” said ADA president Chad P. Gehani, DDS. “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.”
Nonemergency dental procedures, according to the ADA, include but aren’t limited to:
- Initial or periodic oral examinations and recall visits, including routine radiographs
- Routine dental cleaning and other preventive therapies
- Orthodontic procedures other than those to address acute issues such as pain, infection, and trauma
- Extraction of asymptomatic teeth
- Restorative dentistry including treatment of asymptomatic carious lesions
- Aesthetic dental procedures
The ADA also is partnering with the Organization for Safety, Asepsis and Prevention in providing a free on-demand webinar on March 20. Content for the program will be based on questions that the ADA has received from members looking for guidance while navigating the pandemic.
The questions will be collected and shared with two infection control experts: Eve Cuny of the University of the Pacific Arthur A. Dugoni School of Dentistry and Kathy Eklund of the Forsyth Institute. The speakers will review the questions and respond via a program that will be recorded and available for on-demand streaming later that day.
Cuny is the director of environmental health and safety and associate professor at the Arthur A. Dugoni School of Dentistry, where she also is assistant dean for global relations. She also is a consultant to the ADA Council on Scientific Affairs and is an expert reviewer for the Centers for Disease Control and Prevention.
Eklund is the director or occupational health and safety and the Forsyth research subject and patient safety advocate at the Forsyth Institute. She is an adjunct assistant professor at the Forsyth School of Dental Hygiene at the Massachusetts College of Pharmacy and Health Sciences and serves as a consultant to the ADA Council on Dental Practice.
A notice will be posted on ada.org/virus once the program is available. The ADA News will carry the information as well. There is no need to pre-register for the webinar. The ADA encourages dentists to visit its online resource center at ada.org/virus as well.