Online ECHO Clinic | October 29, 2020
Presentation Title: Dental Operations During COVID-19
In this presentation, Dr. Sean Kelly, Dental Support Center Clinical Consultant at the Northwest Portland Area Indian Health Board and Dental Director for the Puyallup Tribal Health Authority, reviews current guidelines from the CDC, OSHA, IHS and the ADA for necessary planning and strategies for dental clinics operations, shares how to prioritize patient appointments based on staffing, supply levels, engineering/administrative controls and other factors amid the COVID-19 pandemic, and outlines the appropriate PPE for patient care with a focus on aerosol generating vs. non-aerosol generating procedures. Finally, Dr. Kelly shares survey results of where NW Tribe’s dental programs are at with operations.
Sean Kelly, DDS, MsC, is the Dental Clinical Consultant for the Northwest Portland Area Indian Health Board and Dental Director for Puyallup Tribal Health Authority.
Dental Operations During COVID-19 (We encourage you to read the notes for each slide which provides a narrative with additional information)
- Guidance for Dental Settings (CDC)
- Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic (CDC)
- Dentistry Workers and Employers (OSHA)
- Strategies for Optimizing the Supply of N95 Respirators (CDC)
- Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during Shortages (CDC)
- Implementing Filtering Facepiece Respirator (FFR) Reuse, Including Reuse after Decontamination, When There Are Known Shortages of N95 Respirators (CDC)
- Optimizing Personal Protective Equipment (PPE) Supplies (CDC)
- National Supply Service Center (IHS)
- Indian Health Service Federal, Tribal and Urban (I/T/U) Guidance to Accessing Medical Supplies and Personal Protective Equipment through the Strategic National Stockpile (IHS)
- Estimating COVID-19 prevalence and infection control practices among US dentists (JADA)
Questions and Answers
- I’ve heard discussion lately about the value (or not) of letting a room “rest” for a period of time between patients. Can you speak about whether this is recommended?
- Answer: From my findings there is no recommendation for a “rest” period as a part of routine dental healthcare delivery to all patients. For a patient with suspected or confirmed SARS-CoV-2 infection DHCP should delay entry into the operatory until a sufficient time has elapsed for enough air changes to remove potentially infectious particles. This therefore would require knowing the rate of air changes your ventilation system provides. Click here to review the information that addresses this topic.
- Thoughts on triaging patients. Would you recommend a limited Urgent Care walk in time vs. attempting to Schedule all patients? Most patients are homeless with limited transportation.
- Answer: Each dental program has unique challenges. The CDC does recommend limiting patient interaction through “social distancing”. Scheduling patients is one tool that will help alleviate the number of patients congregating in your waiting room or other public spaces. Where possible I suggest broadening the time you allow walk-ins. If you generally have a small window of time for walk-ins, look at the possibility of increasing the time so to have patients spread out during this period. Note that scheduling for urgent care, within reason, is a process. It takes time to condition a community to clinic protocol, but I highly recommend discouraging walk-ins and have patients call to schedule an urgent care appointment. This has several benefits to include pre-screening for COVD-19 symptoms as well as triaging over the phone, allowing one to better plan for the appointment. Click here to review the information that addresses this topic.
- What would it take for you to think that you need to start slowing down your clinic? Covid Prevalence? Hospital Capacity?
- Answer: Each dental program has individual challenges with regards to the resources available for patient care. This presentation addresses some of the issues, but not all of them. If you can safely deliver dental care, for patients and staff alike, then that should be our goal. To do this requires adequate PPE and to follow the most current guidelines. With that said my clinic has relied considerably upon the information provided by our local health department. As COVID-19 cases have surged of late, we have taken steps to reduce our clinical footprint. This unfortunately impacts our levels (types and number) of dental services. I realize too that programs have differing business models and the financial impact also needs to be considered. These are issues our administrators and tribal governing bodies need to address. There is no simple answer to this question other than to say we must prioritize patient care taking all recommendations into consideration. Click here to review the information that addresses this topic.