Early in march it had become apparent that any person who had been at the pacific dental conference in vancouver was at risk to have contracted the coronavirus (covid 19). By march 16, this had become enough of an issue that all members and staff who had attended the pdc were asked to self-isolate until march 22.
On st. Patrick’s day our office team was busily involved in our daily routine even tho we realized that challenges were on their way. We had already cancelled all hygiene services. At about noon we received the following notice from our provincial association: “effective immediately there is a mandatory suspension of all non-emergency treatment and services.” Dentists may continue to provide emergency services as outlined. At a minimum you must be available by telephone to address patients’ continuity of care.
Emergency dental treatment may include treatment of oral-facial trauma, significant infection, prolonged bleeding or pain which cannot be managed by over the counter medications. Pre-screening of patients by phone is strongly recommended. Your office voice mail and email messaging must include how a patient can contact you, including a telephone number. You must ensure that all calls or emails are returned in a timely way. It is not appropriate to refer your patients to an emergency room for a dental emergency when you can reasonably assess that patient in a dental setting. Over the telephone. Pharmacological care may be your first level of management.
On march 22 dental practices were notified that communication from the chief medical officer of alberta indicated that iincreased numbers of covid-19 positive patients are anticipated in coming weeks. As such, it is only a matter of time until we have a covid-19 positive patient with a dental emergency.
In dealing with actual dental emergency treatment of a covid-19 asymptomatic patient we are informed that aerosol generating procedures present the greatest risk for cross contamination. These procedures include use of high speed handpieces, ultrasonic devices, high volume suctions and air water syringes. These situations require use of enhanced personal protective equipment. (ppe) ppe’s include gowns and lab coats worn over regular clothing, gloves, high grade custom fitted n-95 surgical masks and protective eyewear or face shield. There is a strict protocol involved in the donning and removal of this equipment in order to reduce risk of contamination.
As of march 26, the definition of emergency dental treatment has been revised by the provincial association to include only oral-facial trauma, significant infections or prolongued bleeding or pain which cannot be managed by otc medication.
It is assumed that all dental emergencies of patients who test positive for the covid-19 virus must be handled in a hospital environment. At present we are 2 weeks into the government mandated office closure and there is no indication when this situation will conclude. To this end we encourage all individuals to observe all precautions as recommended by the medical professionals. It is my sincere wish that you may be well and that this current situation will be resolved soon.
Dr brian schow