Ensuring Safe Access to Oral Healthcare During COVID-19
June 24, 2020 | Janet Oputa, Alexandra Kearly, Dylan Leach
June is Oral Health Month, and it’s important to remember that dental care and the oral health workforce have also been tremendously impacted by the COVID-19 pandemic. In the midst of stay at home orders, nationwide closures, and related employment loss, people have largely put their oral health on the back burner.
In March, the Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) released guidance recommending dental practices to prioritize emergency visits and postpone non-emergency care to mitigate the spread of COVID-19. The U.S. Department of Labor reported that in March, all but three percent of dental practices in the country closed for routine care, and in April, 503,000 dental practice jobs were lost.
Dental Practice COVID-19 Considerations
As states begin to relax physical distancing restrictions, many dental practices are taking steps toward resuming non-emergency dental care. To increase protection for the oral health workforce, CDC issued recent guidance that includes recommendations on sterilization and disinfection, personal protective equipment (PPE), and caring for patients with and without COVID-19. The CDC guidance suggests that dental practices continue monitoring local case prevalence and stay informed by consulting regularly with state and territorial health agencies (S/THAs) and other local health agencies.
States have been implementing measures to preserve PPE by prioritizing use for medical facilities caring for COVID-19 patients. Many dental practices donated their PPE to local hospitals in the early weeks of the pandemic. Subsequently, dental facilities have been encouraged to track their supply of PPE, preserve scarce PPE for oral health workers engaging in direct patient care, and communicate with dental supply distributors, local public health partners and local healthcare coalitions to identify sources for additional supplies.
In addition, The ADA released detailed guidance on returning to work and outlined recommendations to ensure safety for patients and staff during dental visits. Staff may perform temperature checks, ask patients to wear masks, and wipe down surfaces touched by patients during visits. Staff are advised to perform strong disinfectant cleanings after patient appointments and reduce aerosols—which are airborne particles that contain viruses or bacteria—by hand scaling technique when cleaning teeth, using high velocity suction, and using dental dams whenever possible.
State Policy Actions
S/THAs have also followed suit in providing guidance for dental practices resuming care. For example, the California Department of Public Health released guidance for dental offices resuming deferred and preventive dental care. The guidance outlines suggestions on using PPE, conducting screening and testing, using visual signs to provide instruction on personal hygiene, limiting aerosol-generating procedures, adopting infection control measures, and others. The guidance also urges practices to prioritize emergency and urgent care and adopt considerations for providing preventive treatment so long as community transmission remains low and there is sufficient PPE in the region.
The ADA defines teledentistry as the “use of telehealth systems and methodologies in dentistry.” The Association of State and Territorial Dental Directors (ASTDD) offers additional information and considerations for state and territorial health agencies interested in adopting teledentistry during and beyond the COVID-19 pandemic. With significant dental practice closures and reduced non-emergency care, many states have adopted policies to expand access to oral healthcare and maintain continuity of oral health services through teledentistry. As of April 2020, at least 22 states have published statements promoting the use of teledentisty.
State Policy Actions
States have begun using teledentistry as both a tool to triage and screen patients to determine if an in-person visit is necessary, and to continue providing necessary preventive oral health services. This has spurred interest in adopting state policies to define and establish requirements for teledentistry.
For example, Virginia enacted 2020 legislation that establishes requirements for teledentistry, including the types of oral health professionals permitted to conduct services. Many state Medicaid agencies have expanded access to teledentistry through guidance that temporarily expands the types of services eligible for reimbursement. For example, Maryland issued March guidance allowing Medicaid coverage of teledentistry screening and evaluation services. West Virginia issued guidance in April to the same affect, also allowing for telephonic services to be covered. North Carolina issued guidance confirming the types of teledentistry services covered under Medicaid, and temporarily encouraging dentists to prioritize teledentistry for emergent and urgent care needs. Finally, Nevada’s Board of Dental Examiners issued guidance stating that teledentistry is within scope of current regulations and confirming that practitioners may practice teledentistry.
In times of a health crisis, states have opted to expand provider scope of practice so healthcare professionals can provide necessary services, such as administering vaccines. During the 2009 H1N1 Influenza Pandemic, several states adopted policies allowing oral health professionals to administer the H1N1 vaccine. Looking ahead, dentists could play a role in curbing the COVID-19 pandemic by administering a potential COVID-19 vaccine once available.
State Policy Actions
Illinois enacted 2014 legislation that allows dentists to administer certain vaccines to adults upon completion of state-defined training. The legislation requires dentists administering vaccines to coordinate care with a patient’s primary care physician and report patient data to the state immunization data registry. During the 2009 H1N1 outbreak, New York issued an executive order allowing dentists and dental hygienists to administer seasonal and H1N1 flu vaccines under certain circumstances. Oregon also enacted 2019 legislation authorizing dentists to administer vaccines to any established patient.
To protect the oral health workforce during the COVID-19 pandemic, dental practices should remain informed on the spread of COVID-19 and follow federal and state safety recommendations on reopening to reduce the risk of transmission for staff and patients. States should consider expanding the scope of practice for licensed dentists to administer future COVID-19 vaccines as well as other immunizations to aid in outbreak prevention and control. Lastly, states should consider adopting teledentistry policies to support patient triage services, increase access to oral healthcare for underserved communities, and improve oral health outcomes for all.
The development of this document is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UD3OA22890.