Dentistry is back. Kind of.
Pennsylvania Health Secretary Dr. Rachel Levine said during her daily COVID-19 news briefing Friday that she is releasing guidance that would permit some non-emergency dental practice to resume statewide – with one big caveat:
Levine said the new orders state that dentists must provide personal protective equipment to all participating staff in accordance with the federal Occupational Safety and Health Administration and Centers for Disease Control infection prevention guidelines, and the emphasis is to be on procedures that don’t produce heavy spray from a patient’s mouth.
Most dentists in the state have been providing care for dental emergencies only since mid-March, as Gov. Tom Wolf started ordering business closures to try to stop the spread of coronavirus.
Under the new guidance, a Health Department spokesman said Friday afternoon, practices could be expanded to cover things like orthodontic work or root canals, but not routine cleanings.
Levine said she is authorizing the changes now because, even though there is still no data available to assess the risk of COVID-19 transmission during dental procedures, “there is a better understanding of which procedures have increased risk of transmission and how to utilize personal protective equipment to reduce the risk.”
The Pennsylvania Dental Association issued a statement Friday that, in essence, said it was still reviewing the changes.
“Obviously, any easing of the prior DOH restrictions that limited dentistry in Pennsylvania to only emergent/urgent procedures is a welcome step in restoring access to care and easing the burden on dental practices brought on by the pandemic, ” the association said.
“However, the Pennsylvania Dental Association has concerns about the new guidance and is acting swiftly to delineate them clearly and proceed accordingly.”
There are some limits.
For example, the new rules state procedures that create a visible spray that contain large particle droplets of water should only be performed as a last resort and when clinically necessary, and “only if proper PPE, per OSHA guidance, is available for all dental care practitioners including dental hygienists.”
In addition, the department noted that it is not currently prioritizing dental practices for distribution of face masks, shields and other protective equipment, so dental practices are own their own to provide that to employees.
The state dental association voiced disappointment with decision, too, but said it is hopeful that ongoing dialogue with the state will lead to some further movement on that issue, “especially given that dentistry is reportedly now No. 4 on the Federal Emergency Management Agency priority list for PPE.”
There are some important conditions for patients, too.
The Health Department wants all patients screened for symptoms of COVID-19 like having a cough or a temperature over 100.4 degrees before arriving at the practice, and social distancing should be maintained while in the practice. Patients should wash or sanitize their hands frequently and wear a mask when not undergoing treatment.
Finally, Levine asked that tele-dentistry continue when possible as patients may be able to be treated virtually with antibiotics and pain medication.
Levine said the opening up of the dental rules is “designed to allow access to this important health care while ensuring that the patient and the dental team – the entire dental team – are protected while performing the treatment.”
The guidance states that ultimately it will be up to each dentist to determine whether, and how extensively, to pick up his or her practice based on their understanding of the incidence of COVID-19 cases in their community, the needs of their patients and staff, and the availability of necessary supplies.
“This isn’t a return to routine dentistry, but a way to ensure that patients who need care can obtain it safely, for both the patient and the entire dental team,”the secretary said.