Practices are limiting care to urgent and emergency cases to limit exposure to the COVID-19 coronavirus, preserve personal protection equipment (PPE), and reduce the burden on the healthcare system. But practices might not be sure about what qualifies as urgent and emergency treatment—or what to do once these patients come into their offices.
Keith V. Krell, DDS, MS, MA, president of the American Association of Endodontists (AAE), recently reviewed the best practices that his organization is encouraging its members to follow with Dentistry Today.
Q: The major professional organizations are encouraging dental practices to only treat emergency and essential cases. What makes a case an emergency or essential, versus what can be postponed?
A: Oral health is connected to overall health. So if a patient has a dental emergency, it can be potentially life-threatening and require immediate attention from a dental professional. Postponing non-essential procedures will also allow dentists to focus on patients who need emergency care during this pandemic.
Patients should postpone all non-emergency dental examinations, including but not limited to routine cleanings, aesthetic dental procedures, and restorative dentistry.
Examples of dental emergencies include severe dental pain, dental infection symptoms such as bleeding and swelling, or a dental infection-related fever. If you are experiencing any of these, you should contact your dentist or endodontist immediately for an emergency appointment.
Q: How can dental practices most effectively screen patients when they call to determine whether they should be considered emergency or essential cases?
A: Dental practices should ask patients the following questions to gage the severity of the case:
- What are some current symptoms you are experiencing?
- Do you have a fever?
- Is your tooth sensitive to hot and cold foods?
- Are you experiencing bleeding or swelling in your mouth, gums, etc?
- From a scale of 1 (lowest) to 10 (highest), how much pain are you experiencing in your tooth?
- Is the pain spontaneous or provoked by temperature, chewing, etc?
- How long does it hurt when provoked?
Q: When these patients arrive at the office, what steps can practices take to screen them for potential infection?
A: Prior to scheduling appointments, patients should be asked screening questions about travel history and signs or symptoms of infection. This will help determine necessary precautions to be taken on a case-by-case basis. Additionally, patients experiencing signs of acute respiratory illness upon arrival should be given a disposable surgical mask and placed in a single-patient room with the door closed.
Q: Also, when these patients arrive, what can practices do to prevent any possible spread of infection?
A: To avoid the spread of infection when patients arrive or are receiving treatment, practices should:
- Ask patients to avoid bringing people who do not need a dental appointment.
- Have patients wait in their cars and be called in by cell phone, as crowded waiting rooms are also a risk.
- Have all staff, patients, and family members wash their hands or use hand sanitizer before and after all appointments.
- Strongly encourage patients to honestly answer all questions related to travel history and symptoms of infection so all necessary precautions can be taken.
- Rearrange waiting areas to provide for social distancing.
- Have patients requiring treatment use a mouth rise prior to treatment.
- If possible, should be screen patients for fever or elevated temperatures.
Q: While performing this necessary treatment, what steps do dental professionals need to protect themselves and their patients?
A: To protect themselves and their patients from infection during treatment procedures, dental professionals should take the following steps:
- Implement full contact and respiratory precautions by using gowns, gloves, masks, face shield protection, and goggles.
- Change gloves often and wash hands frequently.
- Routinely sanitize surfaces and equipment.
- Sterilize instruments between patient visits.
- Frequently clean and disinfect public areas, including door handles, bathrooms, chairs, and front desks.
- Implement safe work practices including keeping your hands away from your face, limiting surface touches, changing gloves when torn or heavily contaminated, and performing hand hygiene.
Q: PPE shortages are a growing concern. How can dental practices best manage limited or even absent supplies?
A: An inability to use appropriate PPE such as N-95 masks places the practitioner and staff at risk for aerosols created by dental procedures. Workarounds are risky and not recommended in the dental office should an emergency procedure need to be done on a patient suspected of having the virus.
Teledentistry consultations by patients with practitioners for recommended antibiotics and prescribed analgesics will alleviate some emergency need until PPE supplies can be secured.
Q: Do you have any other comments about the impact the virus will have on dentistry?
A: As a critical part of the healthcare industry, dentistry is doing its part to mitigate the spread of COVID-19. The situation is continuing to change and evolve rapidly. By postponing elective procedures and non-emergency appointments, dentists can help prevent the spread of the infection and focus on patients who need emergency treatment.
With hospitals and emergency rooms overloaded, dental and endodontist offices remain open for dental emergencies for those suffering from extreme tooth pain or other oral health-related emergencies such as those that might require root canal treatment. To help reduce the number of emergency room and urgent care admitted patients, it’s important that patients contact an endodontist office first for all dental-related emergencies.
Q: Where can dentists go for more information about managing treatment during the outbreak?
A: For more information on recommendations on managing treatment during the coronavirus outbreak, visit the website of your local state authorities as well as:
- The Center for Disease Control and Prevention’s webpage
- The ADA’s Coronavirus Center for Dentists
- The AAE’s COVID-19 resource page
Dr. Krell received his DDS and MS degrees from the University of Iowa and his MA degree in sociology-anthropology from the United States International University in San Diego, California. He has been an endodontist for 37 years. He was a full-time educator for eight years at the University of Iowa and was in private practice with Endodontics PC in West Des Moines, Iowa, for 29 years until he retired on December 31, 2017. He is still an adjunct clinical professor in the Department of Endodontics at the University of Iowa College of Dentistry. He is a Diplomate of the American Board of Endodontics, as well as a past president and past director. He is a past president of AAEF (now the Foundation for Endodontics) and is presently a Foundation Trustee and president of the American Association of Endodontists.