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Identifying and Managing Emergent Dental Cases during COVID-19 Crisis

With the spread of COVID-19, patient safety has never been more important. In order to slow the spread of the virus and free up space for critical patients, hospitals have postponed many surgeries, including most dental surgeries. Many emergency dental surgeries are now being performed in dental offices.


For dentists, these new protocols have raised questions as to identification of emergency cases, and how to get these patients the dental care they need. These are the current guidelines for dental cases during COVID-19, based on policies from the Ohio Dental Board, Medical Board, and CDC:


How to identify emergency cases - patients show signs of the following:

  1. Severe dental pain from pulpal inflammation

  2. Pericoronitis or third-molar pain

  3. Abscess or localized bacterial infection resulting in localized pain and swelling

  4. Tooth fracture resulting in pain or causing soft tissue trauma

  5. Dental trauma with avulsion/luxation


How to identify whether in-office anesthesia is needed:

  1. The patient must be an emergency case as per the above symptoms.

  2. If pain is caused by a singular issue, the dentist should consider if it can be addressed under local anesthetic.

  3. Treatment has been attempted (i.e. with pain medications), but has failed to remedy the situation.


NOTE: To adhere to the mandate and justify need, the dentist should write a qualifying statement addressing the need for anesthesia and should cover the treatment plan, any failed attempts to treat the patient without general anesthesia, and the reason to address this issue now instead of later (post-COVID).



How to screen patients for COVID-19:

  1. Has the patient tested positive for COVID-19?

  2. Has anyone living at the same residence as the patient tested positive for COVID-19?

  3. Has there been any other recent contact with any other COVID-19 positive people?

  4. Has there been any contact with someone with COVID-19 symptoms in the last 30 days?

  5. Has the patient had any recent cough, cold, flu, fever, or similar symptoms in the last 30 days?

  6. Please list all locations the patient or others living in the patient’s home have visited within the last 30 days, outside of the patient’s home city.


Sterilization/PPE Procedures for Clinicians

  1. Enhance equipment cleaning procedures. All machines, monitors, and boxes used to transport equipment must be wiped down and sterilized.

  2. Recommended PPE for clinicians:

- Gloves

- Goggles

- Face Shields

- Gown

- Level 3 Surgery Masks

- K/N95 Masks - if available

3. Staff must be kept to the bare minimum required for the procedure

- Dental team staff: Dentist, dental assistant, front desk individual (if needed)

- Anesthesia team staff: Anesthesiologist, RN, Anesthesia Coordinator

4. Eliminate the waiting room

- Patients should remain outside (e.g. parked car), and call the office when they arrive.

- The office will call the patient once ready to have them come into the building for pre-op

(one parent can join the patient for this).

- The parent must then wait outside of the office (e.g. in their car) during the surgery.

- The office will call once the surgery is finished to have the parent come directly to the

recovery room to have their child discharged.


For more information, we suggest you see the formal ODA guidelines here.


SmileMD developed the process above as the need to treat emergency patients became apparent. In addition, we saw the need to help out the hospital systems by keeping these patients out of the ORs, thereby reducing them to exposure as well as allowing hospitals to preserve their PPE and OR space.


We know how critical this care is to the safety and well-being of patients. If your office is experiencing patients that seem to require emergency services, please feel free to reach out to us, and we can walk you through best practices we have seen from partner practices throughout the state.


See attached infographic on identifying emergent cases, and use the link below to schedule a consultation with us.


https://www.smilemdsedation.com/practices

SmileMD COVID-19 Infographic

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