Almost every industry has been hit hard by the effects of COVID-19, and the dental industry is no exception. While an increased emphasis on telehealth has been a notable byproduct of the current crisis, dental health care personnel (DHCP) are typically not able to work from home, making the widespread implementation of teledentistry a challenging proposition. Given the risk of spreading COVID-19 through the aerosols created during in-office examinations and cleanings, dentists who want to return to work while also keeping their patients and employees safe, face a new world and difficult decisions. This article highlights the current state of dental practice as America begins to reopen—exploring relevant guidance from federal agencies and possible challenges dental practices might face upon reopening.

CDC Guidelines 

While there is no way to completely stem the spread of COVID-19, the Centers for Disease Control and Prevention (CDC) has issued non-binding guidelines specifically for dental settings. The guidelines are meant to decrease the spread of COVID-19, spelling out steps that offices can take to minimize patient and employee exposure. The CDC’s recommendations are made up of measures like:

• Screening patients multiple times before treatment
• Rearranging waiting rooms
• Updating ventilation systems
• Following strict personal protective equipment (PPE) strategies
• Having DHCP stay at home if they believe they have been exposed to COVID-19
•  Cleaning patient areas thoroughly between visits

OSHA Guidance 

The Occupational Safety and Health Administration (OSHA) has also released non-binding guidance that describes how dental settings can best protect employees from exposure to COVID-19. OSHA warns that conducting aerosol-generating procedures on patients that do not appear to be sick puts employees at a high risk of being exposed to COVID-19. The OSHA guidelines begin with the broad statement that “all elective dental procedures” should be postponed. While this statement may recommend an overly cautious approach in light of recent state guidance (TN guidance & GA guidance), it is indicative of the overall concern that OSHA and other federal agencies have in balancing the safety of the workforce and patient population versus the economic and patient care benefits to reopening. 

If patients are being seen in-office, OSHA recommends a number of safeguards including:

• Avoiding instruments that generate aerosols
• Wearing N95 masks while performing aerosol generating procedures
• Setting up directional airflows from staff work areas into patient treatment areas
• Using teledentistry for non-emergency situations

Recommendations 

Complying with the guidance released by both the CDC and OSHA may seem like a heavy burden to bear for dental practices, particularly when faced with other economic and practice-related challenges. However, it is important to remember that both sets of suggestions are non-binding. Further, while there is a concern that OSHA’s guidelines could open dental practices up to general duty violations by establishing an unreasonably high standard of care, OSHA, for example, has stated that it will use its discretion and avoid disciplining any dental practices that are making a good faith effort to comply with their recommended guidelines. Keeping this in mind, dental practices may be well served to view this guidance as the recommended framework for establishing its policies and procedures in reopening its in-office care to ensure that they are making a good faith effort to keep patients and employees safe.

Next Steps for Dental Practices

COVID-19 has changed how dental practices must act for the short term and likely for the long term as well. However, there are resources that dental settings can use for guidance as they begin to reopen. Ultimately, it is our opinion that, if dental practices can show good faith efforts in attempting to reopen their offices in compliance with the available state and federal resources (such as the above-cited OSHA and CDC guidance), then the risk of liability, whether patient or workforce-related, can be mitigated and allow practices to focus on treating their patients during this challenging period. 

In addition to these health and safety considerations for reopening, we realize dental practices are facing many financial and contractual challenges, as it may relate to paying employees, applying for and best utilizing loans, maintaining real estate commitments, and more.