Update for Dental Licensees: Extension of Peacetime Emergency and Additional Guidance on Emergencies
Dear Licensees,
We wanted to provide you some updated guidance on treating your dental emergency patients.
I first wanted to clarify something with licensees. Dentistry is an essential healthcare service and nothing from the state or the Board has stated otherwise. Dentists and allied dental professionals are considered essential ambulatory healthcare workers. The limitation on dental services is due to safety considerations and PPE preservation.
Due to the recent extension of the peacetime order, through May 13, we understand that urgent dental needs are now becoming emergent and if left untreated, some dental infections can lead to life-threatening conditions or permanent dysfunction.
Dentists need to treat patients that they determine to have a condition needing emergency procedures such as acute dental or oral needs, including treatment for pain, swelling, trauma, or an abscess. Emergency procedures should be evaluated on a case-by-case basis to determine the appropriate and necessary timing of in-person treatment.
- Severe dental pain from pulpal inflammation.
- Symptomatic 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 crown cementation if the temporary crown is lost, broken or causing gingival irritation.
- Denture or partial denture delivery if the patient is not able to function due to lack of prosthesis.
- Treatment for orthodontic patients that have high risk of caries around orthodontic brackets, periodontal disease resulting in attachment loss and recession, or apical root resorption if delay of treatment continues. In orthodontics there are some forms of more “active” appliances (certain types of archwires, power chains, coil springs, etc.) that, if they go too long without evaluation and/or adjustment by the practitioner, could cause permanent dysfunction to the patient. The provider needs to determine the emergent needs.
- Extensive dental caries or defective restorations causing pain. Minimize aerosols as much as you can when performing procedures and consider minimally invasive techniques. If you have a hard tissue laser, please consider this for restorative procedures.
- Teeth that have had RCT initiated before or during the original peacetime emergency
These should be treated as minimally invasive as possible and using PPE’s that you have available. Please see previous guidance from the CDC regarding PPE and masks. Wear a mask and face shield or N95 mask if you have available.
This is certainly not all inclusive and is for example. The dentist will ultimately have to decide what constitutes an emergency based on the individual patient needs and their clinical expertise; considering threat to permanent dysfunction for the patient and by assessing the patient overall (systemic conditions, risk).
Additionally, please take the following measures when treating emergency patients:
- Use cell phone or tele-dental triage: Talk with the patient, determine their need to present to clinic, have the patient take a picture and text it to you. (HIPAA laws have been adjusted to respond to the pandemic- this is ok for you to do at this time)
- Have a detailed questionnaire and conversation with the patient before scheduling appointments. Prior to any procedure, ask the patient about flu-like symptoms, travel abroad for self, family, friends, and co-workers to permit a thorough evaluation of the patient. Ask them about sudden loss of smell or taste. Also ask them if they have had any contact with someone that tested positive or was possibly infected with the virus and not tested.
- Take the temperature of the patient at the outset of the appointment. Allied dental professionals are also allowed to do this, as it is a vital sign.
- Careful evaluation of the need for scheduling of ASA 2 & 3 patients.
- Use of 1% hydrogen peroxide rinse prior to examination of the oral cavity by the patient to reduce microbial load. There are also other possible rinses that can be effective or ozonated water that could be used if you have an alternative available.
- Use of rubber dam for isolation and high-volume suction to limit aerosol in treatment procedures. You may also consider adding point of source machines to your armamentarium that can remove some aerosols near the mouth as a handpiece is used. Check with your dental supplier to see what is available.
- Continue proper disinfection protocol between patients. Cavicide is on the list of products that kill viruses like Coronavirus. There are many others as well and you will want to consider what will be best for your practice.
- Disinfect and leave operatory vacant after use. If you have another patient coming, use another operatory and then go back to the other operatory as needed.
- Document in the record the reason for seeing the patient for emergency and why the procedure was deemed an emergency.
To prevent overcrowding of waiting areas or the possible spread of infection:
- Consider having patients wait in their cars instead of the waiting areas to prevent inadvertent spread of the virus. Call patient when surgical area is ready for treatment.
- Consider staggering appointment times to reduce waiting room exposure.
- Limit access to waiting room use to only patients. Accompanying individuals have to wait in their respective transportation.
- Remove all magazines, toys, etc. from waiting area to prevent contamination.
Guidance on treatment that doesn’t involve the use of PPE and the patient is not presenting in the clinic:
Dentists may deliver Invisalign patients their liners at this time via mail or pick-up. Dentists may deliver dentures via pick up if the patient is high risk and does not want to present clinically. Please provide detailed instructions to the patient. Also provide resources for over the counter products to help them adjust into their new prosthesis. If you have products in the clinic, please consider providing samples to the patient. Dentists may also deliver mouthguards or occlusal guards via mail or pick up. Delivery of sleep apnea devices would also be considered here.
As I mentioned in the last bulletin, our website is updated every other day under the COVID section and I encourage you to check the website periodically as well. https://mn.gov/boards/dentistry/current-licensee/resources/covid19/. The Board also has a page on Facebook and we have been sharing information there.
Please email any questions or comments to bridgett.anderson@state.mn.us.
Best,
Bridgett Anderson LDA, MBA
Executive Director
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