By Anne Blythe
Now that dental offices across the state have started bringing in patients for routine cleanings, the state board responsible for making sure they provide a standard practice of care during this unprecedented time is wrestling with unique questions.
The North Carolina State Board of Dental Examiners held its monthly board meeting over Zoom on June 12 and discussed a range of issues related to cleaning teeth and providing oral health care with COVID-19 so prevalent across the state.
Through much of April and early May, many offices were closed except to offer emergency care.
For nearly a month now, many have been open under new recommendations and guidelines issued by the eight-member board in April. In the document, the board stopped short of codifying the measures for infection-control and personal protective equipment. Nonetheless, it states that “failure to follow heightened infection control, sterilization, and patient safety recommendations may be viewed as a failure to meet the standard of care necessary for offering treatment during the COVID-19 pandemic.”
The board now is struggling with how to handle complaints that come in from hygienists and other employees, as well as from patients worried that specific offices are being lax on infection-control measures.
Dentists and the hygienists who work alongside them have been described as workers in the very high exposure risk category for COVID-19 by the Centers for Disease Control and Prevention.
“The cases we have are from patients concerned about the interactions they had with an office,” said Catherine Watkins, secretary-treasurer of the state dental board and a Winston-Salem dentist. She declined to give specifics, though.
Bobby White, chief executive officer of the board, said investigators had not been going to offices during the pandemic to do routine inspections.
White and Merlin Young, the board president, have been discussing how to get personal protective equipment to investigators who would go to the practices where problems were reported.
Young, a dentist in Wendell, said he had equipment from his practice that he could get to the board if necessary, but he was worried about putting investigators in harm’s way.
“I don’t want them going into an active office because I don’t want them exposed,” Young said.
How to do safe inspections
Board members questioned whether going in after- hours would give a true picture of what is happening at a given practice.
“If you don’t go in during operations, you won’t be able to see the kind of screening process they have,” Watkins said.
During more typical times, the board follows a specific process when a complaint comes in. It would be assigned to an investigative panel, which would then recommend any corrective or punitive action to be addressed by the full board.
Economists quoted in a recent New York Times story said that dentists could be a key economic indicator to watch as the country moves through the pandemic. If their businesses come back after the pauses in March, April and May, the economists said, and the patients come with them, then that might bode well for the country and financial recovery.
But the patients will have to trust their dentists will take extra precautions, even if that means sometimes patients will be turned away.
Raleigh Wright, chief of staff for Lane & Associates Family Dentistry and board member, said all complaints that come to the dental board might not warrant an investigation. He relayed an experience at his office with a patient who was upset after being turned away from care at one of the practice’s 34 offices because the patient had a 101-degree temperature.
Watkins then went on to relate an experience at her practice, a large one with 129 employees and at least 16 dentists, some of whom are not working because of risk factors associated with the pandemic. A nurse who works in an environment where COVID-19 is a known risk was not stopped outside the front door, as she should have been, according to Watkins.
“In our personal office, we had a nurse who came in for a hygiene appointment, but she is directly involved every day with Novant, COVID-positive patients,” Watkins said. “She has not been required by Novant to have a screening test, and she made it up to our third floor.
“Our doctor and hygienist were very uncomfortable and asked her to leave until she could come back with a screening test that was negative. So that’s what we did on that individual case basis, but the lack of consistency is concerning to us personally and obviously to other people around the state.”
Trouble getting answers
There has been confusion among dentists and hygienists about what action they should take if they find out during a screening before a routine cleaning or other procedure that someone has been in contact with someone infected with COVID-19.
There also is a lack of uniformity on answers across the state for how an office should respond if someone who works there tests positive for the virus.
In chasing answers to some of the questions, Wright said he called the Centers for Disease Control and Prevention and was referred to the state Department of Health and Human Services, then to the county health departments.
“I was told that we are a decentralized health department and that means every county has their own set of requirements and recommendations,” Wright said. “I won’t say what county, but we were told that if one of our employees tested positive for COVID, they could return to work the next day as long as they wore a mask. And all the neighboring counties to that county said, ‘Absolutely not, they have to be quarantined for 14 days.’
“Every county has its own policies and rules.”
‘Some take this seriously and some are not’
Instead of sending investigators out immediately, the board decided that White would write a letter that goes out in an email blast to all dental providers in the state. Before launching a formal investigation they wanted to make sure dentists understood that concerns about safety at some offices had already come to the board’s attention and to encourage dentists to fix the problem.
“I just get the sense that dental offices are all over the board,” Watkins said. “Some take this really seriously and some are not. To keep from having more and more complaints, maybe we could let them police themselves a little bit if they knew we were actually looking at it and getting concerns.”
Buddy Wester, a Henderson dentist and board member who served as president at one point, suggested a carrot approach before following up with a stick for practices being loose with infection control. He outlined the kind of message he thought the executive director could send.
“I think that Bobby could write one of his fireside chat letters, such that you know ‘We’re here with you. We’re here for you, but be aware that if we get a complaint about infection control in your office by a patient, then we will have to investigate,’ not just ‘Well we’re going to start investigating,’” Wester suggested.
“Be sure to let them know that if there’s a complaint, a written complaint, we will have to start investigation. But he can put a lot of flowers in it. People will be singing kumbaya.”
Though the board has received complaints from hygienists about wanting their providers to supply disposable gowns, members agreed that such complaints were between the employee and employer and the Occupational Safety and Health Administration was a better place for those disputes to be aired.