By Anne Blythe
As North Carolina’s workforce is being encouraged to hunker down at home and telecommute, dentist offices across the state have been given leeway in how they respond to the COVID-19 pandemic.
The state Board of Dental Examiners, which oversees licensing and disciplinary actions for dentists in this state, posted a notice on its website last week with guidance for the more than 5,100 dentists and 6,100 hygienists across the state.
“The board recognizes that circumstances vary deeply within our state and no two dental practices are alike,” the notice states. “You as a dentist have the best information regarding your patients, your auxiliary personnel, and the community you serve.”
The board encouraged all practices to postpone any non-urgent care and elective care until at least the end of the month.
Dentists, hygienists and other oral health care workers are considered to be at higher risk for transmitting and contracting the infection. Not only are they in close proximity to their patients, but they also handle drills that use water to cool the bit as well as aerosol rinsing devices that can propel germs and droplets from inside the mouth into the air.
On March 18, the state dental board posted a new notice in response to a barrage of pleas calling for a full shutdown.
“The NC State Board of Dental Examiners has received numerous requests for the Board to mandate the closure of all NC dental offices in response to the coronavirus pandemic,” the post states. “However, the Dental Board lacks the authority to mandate the closure of dental offices. Notwithstanding certain federal authority, the authority to close North Carolina businesses resides with the Governor, certain state agencies, and county and local governments under the emergency powers of the state.”
None of those agencies to date has ordered a full shutdown.
“In the meantime, dentists, who strictly adhere to all sterilization and disinfection guidelines, should consider the continuation of emergency care to prevent dental patients from adding stress to hospitals, hospital emergency rooms, and urgent care facilities,” the March 18 notice states. “Likewise, rescheduling or postponing non-urgent, routine, and elective procedures is advised to lessen the risk of an inadvertent spread of the virus.”
The American Dental Association issued a recommendation on March 16 suggesting a three-week pause, longer than the North Carolina board’s guidelines initially suggested on delaying routine cleanings and non-urgent procedures.
“The ADA is deeply concerned for the health and well-being of the public and the dental team,” Chad P. Gehani, ADA president, said in a March 16 statement recommending a three-week postponement of elective procedures.
“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 departments.”
Board responds to rapid changes
Since the State Public Health Laboratory reported its first presumptive positive result for COVID-19 on March 3, the state has been in a constant state of flux, responding to quickly evolving events.
Gov. Roy Cooper declared a state of emergency on March 10 and then ordered that crowds be no larger than 100 people, while recommending gatherings be fewer than 50.
When he ordered the closing of bars and restaurants on March 17, the governor noted many establishments had not adhered to his guidance. He acknowledged the financial hardships that many businesses, households and individuals would have even as he pursued measures to blunt the impact of the contagious pathogen, especially if the situation goes on for a while.
Alec Parker, executive director of the N.C. Dental Society, said most of the offices across the state that he has heard from are not seeing patients for routine procedures such as cleanings and even in some cases not filling cavities.
Some, though, are continuing with urgent care. They’re doing so, in part, to help keep those people out of emergency rooms where they might otherwise land as the state tries to lighten routine hospital loads to make room for the swelling needs predicted to come with the COVID-19 pandemic.
As of midday Thursday, North Carolina had 93 people who tested positive for the infection, but those numbers are expected to rise as the ability to test has expanded and more results come in. Secretary of Health and Human Services Mandy Cohen said the state has had its first “community-acquired” case, a key indicator that the disease has started spreading silently among the population.
The state has not reported any COVID-19 related deaths.
Precautions advised, guidelines provided
Parker said the Dental Society is advising any practices that continue seeing patients to take temperatures of all staff in the office first thing in the morning, again at midday and at the close of the day.
Though there is no order forcing offices to do that, Parker said he thought dentists would take the precautions. Too much is at risk if they don’t, he said.
“Dentists are pretty compliant people,” Parker added.
Parker said his organization is aware that some of these decisions might have negative financial consequences for many practices and their employees but said there are a number of efforts in the works that could help bring some relief created by the loss in revenue and any needed reductions to employee hours.
Now that North Carolina has its first case believed to be spread to someone who had no known contacts with anyone who had tested positive, there likely will be more guidelines issued in the coming weeks.
The Dental Society has set up a web page where providers can get information and training notices as the pandemic continues.
The American Dental Association sent out guidelines for how oral health care providers should determine what constitutes a dental emergency and urgent dental care.
“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 diffuse soft tissue bacterial
infection with intra-oral or extra-oral swelling that potentially compromise the patient’s airway; and trauma involving facial bones, potentially
compromising the patient’s airway.”