Peoria District Dental Society Plan of Action

COVID-19

Key Players:

Local Dentists and Dental Specialists, Peoria Health Department and Corresponding Fulton and Tazewell County Health Department Dental Clinics and the OSF Dental Residency Program

Background:

The COVID-19 Pandemic could be spreading through The Peoria District within the next several weeks.  This will tax the community healthcare system and the focus will become treating the most severe cases.  On Tuesday, March 17th, at the request of the Illinois State Dental Society, the vast majority of dental offices across The Peoria District closed their offices to routine care in order to focus on emergent care with the goal to preserve Personal Protective Equipment (PPE) for treatment of their emergent patients and preserving “the limited supply of PPE so it can be used for urgent and more complex medical care that will be needed in our healthcare system.”1 The best way for our community to be on top of this situation is to work together.  In terms of dentistry, we NEED our private practitioners to continue to see emergent dental patients of record in their private practices to triage treatment needs for their patients.  The Oral Surgeons, Endodontists and Periodontists will be the second line of defense.  Since the prompt care facilities and hospitals will be focusing on urgent essential care including acute COVID-19 patients, keeping the urgent/emergent dental patients away from the emergency rooms of all hospitals is key.

Goal:

The goal of this collaboration during these unprecedented pandemic conditions of the COVID-19 is to provide emergency dental care to the patients of the Peoria District in a manner that allows for treatment in dental practices safely with appropriately equipped dental care providers. 

 

 

Plan of Action for Private Practices:

  • Cease all in-person dental treatment except for dental emergencies.
  • Triage the dental emergencies of your patients of record through any method you feel comfortable, with the goal of preservation of PPE. Have an emergency telephone number available for your patients to contact you for screening of their symptoms. Check your messages regularly to screen for patients that have not called your emergency line.
  • Referral Process
    • Phone the referral office first
    • E-mail any radiographic images prior to their visit, if possible
    • Include details of recent treatment provided or diagnosis of problems
    • Send all patient related demographic material
    • Ask the patient to fill out all paperwork online when possible

This will help reduce patient/staff contact and preserve PPE

  • Suggested methods of communication with your dental patient may include:
    • Telephone conversation
    • FaceTime conversations or Skype
    • Facebook Messenger video chat
    • Google Hangouts video
    • Texting3
    • Digital sharing of photo3
  • Use the ADA guide as a reference when deciding which patients, you feel are emergent2
  • Use the ADA COVID-19 Coding and Billing Interim guidance as a reference for communications3
  • Treat in your office any of the patients of record you feel need emergent dental care. Referrals can be sent to the specialist just as you would during normal office procedures. Keep in mind that antibiotics and pain relievers, draining an abscess and/or extraction may be the best course of action to alleviate pain for the near term while engaged in current efforts to slow this pandemic.
  • When possible, provide care without the use of aerosol creating equipment such as high-speed hand-piece, ultrasonic and sonic scalers, and the air/water syringe.
  • When treating patients in your office, screen patients prior to treatment for signs of COVID-19. Evaluate for a dry cough, difficulty breathing and/or febrile temperatures.
  • If you have a patient that exhibits signs of the virus, have them contact their physician, or Prompt Care/Urgent Care Facility, prior to going to the hospital.
    • COVID-19 Nurse Hotline at 833-OSF-KNOW
    • Clare, digital assistant, at osfhealthcare.org
  • Report the number of patients you treated in your dental office to your corresponding county Health Department, as this will show the number of patients which were kept out of the emergency room during this time of the pandemic.
  • If you are not treating any emergency patients in your practice for any reason, please consider notifying Kristan Creek, at the PDDS office at: kristan@pdds.org; please consider donation of your unused PPE for use in emergent cases. She will contact you if such a donation is needed.
  • The hospitals and other dental offices will be communicating with the Peoria District Dental Society any specific needs for PPE that can be provided by the dental community.

Plan of Action for Oral Surgery Offices

  • Adjust seating in waiting room areas to accommodate current recommendations for social distancing.
  • Limit individuals in recovery areas to essential nursing staff, the patient, and no more than ONE patient escort/family member.
  • Have all patients and accompanying caretakers or escorts wash hands upon arrival.
  • Maintain essential operations, even if limited, to allow for timely accessibility and care of patients requiring emergent and urgent surgical intervention.
  • Utilize telemedicine/phone consultations within 24 hours of an appointment to acquire pertinent patient data to allow for enhanced screening prior to patient arrival:
    1. Has patient or anyone in immediate family had symptoms of fever, coughing, wheezing, or difficulty breathing?
    2. Has the patient traveled out of state? Out of country?  If so, when and where?
  • Has the patient or anyone with whom they reside had contact with another person who has tested positive or is suspected of having COVID-19? If yes, when was last contact?  (If less than 14 days, patient should be rescheduled and treatment deferred until after a 14 day period of elapsed time with no fever or other symptoms).
  1. Emphasize that patient’s and/or their escorts may NOT have children accompany them to their appointment.
  • Defer essential non-urgent patient care for at risk populations (elderly over age 65, immunocompromised, cardiovascular disease, diabetics, etc.).
  • Have doctors and staff leave their cell phones outside of patient care areas and avoid handling except at designated breaks.
  • All staff and doctors should continue to follow standards of care for universal precautions and infection control protocols.
  • If doctors or staff develop symptoms or suspect contact with a COVID-19 patient within or outside of the workplace, follow the isolation and return to work criteria for healthcare providers as outlined by the CDC. 4

Plan of Action for the Peoria City/County Health Department Dental Clinic and corresponding Tazewell and Fulton County Health Department Dental Clinics  

  • The Peoria City/County Health Department will work with the Peoria District Dental Society in the procurement of PPE for emergency dental treatment by dental providers in the community according to the available supply.
  • Act as a clearing house for any data with Peoria District Dental Society, regarding the numbers of emergent dental patients seen in the community in private practice offices and dental clinics.
  • Coordinate emergency dental care referrals for Medicaid/uninsured patients of record with the OSF GPR program.
  • Work with the Peoria District Dental Society to maintain a list of member dentist providers in the community who are providing emergency dental care in their private offices.
  • The Peoria Health Department Dental Clinic will be providing emergency dental care for children on Medicaid, special needs children and adult patients of record. In addition, care will be provided for children on Medicaid and special needs adults not currently under the care of a dental provider.

Plan of Action for the local OSF GPR Dental Clinic at East Bluff and Forest Park OSF Buildings

  • The OSF Dentist Residents and their Attending Faculty Dentists will do all they can to avoid having patients go to the ER for dental pain. The “on-call” OSF Dentist Resident will be treating dental emergencies referred by the OSF emergency room or the hospital.   Emergency dental care will also be provided by the OSF GPR dentist residents and their attending OSF dentist faculty at the OSF East Bluff and Forest Park Dental Clinics for their patients of record.
  • The OSF Dentist residents will be treating dental emergencies for mostly adult Medicaid or uninsured patients of record but will also be providing emergency dental care for those Medicaid/uninsured children and special needs patients referred to them by the Peoria City/County Health Department Dental Clinic or their attending faculty in private practice.
  • Patients triaged without dental pain, infection or and/or swelling will most likely be deemed nonemergency dental care.

 

Plan of Action for the Division of Oral Health at the Illinois Department of Public Health

  • Aid in the procurement of appropriate PPE for the dental providers in the community.
  • Coordinate the communication between local, regional, and state agencies who will be beneficial to execute the plan.
  • Disseminate any information needed to help move the plan along.
  • Coordinate communication to other communities who may want to model this plan.

Plan of Action for the Peoria District Dental Society

  • Coordinate communication to the dentists in the community.
  • Maintain a list of providers who are treating patients in their office.
  • Coordinate coverage of solo practitioner dentists who become infected and cannot treat their own patients after notification to the PDDS.
  • Communicate with the Corresponding County Health Department the list of providers in the community available for care.
  • Work with the local hospital administrators to coordinate any procurement of PPE for the medical community as necessary.

PDDS Consensus Statement

The consensus of PPDS leadership is that the term ’emergent’ has been employed as the current defining criteria for dental care.  Our society feels strongly that such a limiting criteria is too shortsighted to constitute a valid long-term strategy and the following considerations and consequences need to be voiced to state and national leadership with organized dentistry at the helm acting to educate those outside our profession and aid in better defining the standards of care given the current pandemic.  While strictly limiting dental practices to emergent care only for a short duration may be appropriate to help flatten the curve, long term limitation of practice as we are seeing recommended in states like Florida and Oregon has the potential for significant deleterious consequences.  The elimination of hygiene is particularly worrisome as it serves as the primary screening tool for dental offices.  Early detection of oral cancer, detection of treatable caries prior to pulpitis, and improved periodontal health (which is well established in multiple studies to reduce risk of heart disease, improve diabetic control, and have a positive impact on the immune system) are directly correlated to maintaining consistent dental hygiene services in the dental practice.  With prolonged cessation of these services, it is inevitable that the society will see a substantial increase in urgent/emergent oral health issues.  The increase could be overwhelming enough to tax hospital emergency facilities at a time where avoiding such is paramount.  Additionally, more instances of severe dental infections due to lack of preventative services, will inevitably lead to higher consumption of antibiotics, many of which will also see an increased consumption due to utilization for prevention of opportunistic pulmonary infections in the acutely symptomatic COVID-19 population.  Lastly, the emerging disparity in recommendations between states and municipalities has the potential to unnecessarily increase interstate and regional travel for the purpose of obtaining dental care.  Compounded, all of these concerns could lead to some of the very problems our current guidelines are seeking to avoid.

Therefore, we strongly encourage the ADA and organized dentistry to recommend dentists resume routine dental care following the current twenty-one day restriction, with the following recommendations:

  1. Telephone screenings within 24 hours of appointments.
  2. Defer treatment of patients with suspicious symptoms and/or fever until they are symptom free for 14 days.
  3. Defer treatment on at-risk patients (Elderly over age 65 and patients with co-morbidities such as cardiopulmonary disease and the immunocompromised).
  4. Strict adherence to current standards of isolation and infection control protocol (PPE, rubber dam, high speed suction, disinfection of all operatory surfaces, and equipment sterilization).
  5. Social distance practices in waiting room….spacing of chairs, etc.

Resources:

CDC Information for Healthcare Professionals

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

https://www2.illinois.gov/Documents/ExecOrders/2020/ExecutiveOrder-2020-10.pdf

Peoria District Dental Society: 309-444-4443 and kristan@pdds.org

Peoria County Health Department: 309-679-6000

Fulton County Health Department: 309-647-1134

Mason County Health Department: 309-210-0110

Tazewell County Health Department: 309-925-5511

Woodford County Health Department: 309-467-3064

Stark County Health Department: 309-852-0197

 

References:

  1. https://www.isds.org/news-details/2020/03/16/isds-issues-recommendations-for-dental-offices-regarding-covid-19
  2. https://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_COVID19_Dental_Emergency_DDS.pdf?_ga=2.250269573.2003345993.1584634508-1239058311.1502377212
  3. https://success.ada.org/~/media/CPS/Files/COVID/ADA_COVID_Coding_and_Billing_Guidance.pdf
  4. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html

Reviewers and Contributors:

Dr. Daniel Lovell, PDDS President; Dr. Michael Danner, Past PDDS President; Dr. Christopher J Couri, Past PDDS President; Dr. Nathan Schroeder, Past PDDS President Dr. Fabian Hosein, Past PDDS President; Dr. Paul Amodeo, OSF GPR Director; Dr. Susan Bishop, PCCHD Dental Clinic Director and Past PDDS President; Dr. Jamie L. Smith, PDDS President-Elect; Kristan Creek, PDDS Executive Director

Peoria District Dental Society has been encouraging the improvement of public dental health since 1914.

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