Well, here in Australia today, on Monday March 23, our country has just started stage 1 of a lockdown strategy to slow down the spread of the Coronavirus COVID-19.
As of midday today following the Prime Minister’s announcement last night, all club, pubs sporting venues, churches, cinemas, gyms and casinos shut their doors.
Restaurants and cafes are also closed, but are allowed to serve takeaway.
The Australian Dental Association has released an updated Guidance on Dental Treatment during COVID-19 Pandemic
In that document, the Federal ADA has carefully outlined a process for the dental profession to move forward responsibly during this time.
Of primary importance is the direction to the profession that:
“Dentists should exercise clinical judgement to determine whether to provide care to patients in the context of:
- their specific dental needs
- their overall health
- the ability to provide dental care safely for patients and dental team members
- the current COVID-19 situation in your area
- the availability of Personal Protective Equipment (PPE)”
Primarily, in my opinion, the importance of whether to treat or not is determined by the patient’s overall health, and their specific dental need.
The document suggests we are in Operation Level 2 [Reduce] and the Services that can be performed are:
Some clinically necessary routine dental treatment using standard precautions for people who do not meet epidemiological/clinical criteria for COVID-19.
Urgent dental treatment using standard precautions for people who do not meet epidemiological or clinical criteria for COVID-19
Emergency dental treatment for:
- – patients with confirmed COVID-19*
- – suspected COVID-19 cases* who meet epidemiological/clinical criteria
* Manage as per ADA COVID-19 Guidelines
The document goes on to suggest that in Operation Level 2 [Reduce], the Services are Restricted Services:
Defer urgent dental treatment for suspected cases of COVID-19 who meet epidemiological/clinical criteria until COVID-19 status is confirmed.
Defer routine dental treatment that is considered to be non-urgent and will not impact on the dental or general health of the patient.
Also of great importance is this statement:
Dentists should exercise clinical judgement to determine whether to provide care to patients in the context of:
- the ability to provide dental care safely for patients and dental team members
Based on what we’ve seen in society with changes in behaviours and recommendations so far due to pandemic mathematics [such as crowd gatherings, safe distances, and touching], it would be apparent that the restrictions on dental practice WILL PROCEED to Level 3 [Restrict] and probably Level 4 [Eliminate].
Level 3 [Restrict]
Services that can be performed:
Only urgent dental treatment using standard precautions for people who do not meet epidemiological/clinical criteria for COVID-19
Emergency dental treatment for:
- – patients with confirmed COVID-19*
- – suspected COVID-19 cases* who meet epidemiological/clinical criteria
* Manage as per ADA COVID-19 Guidelines
Level 3 [Restrict]
Restricted services:
Defer routine dental treatment using standard precautions for people who do not meet epidemiological or clinical criteria for COVID-19.
Defer urgent dental treatment for suspected cases of COVID-19 who meet epidemiological or clinical criteria until COVID-19 status is confirmed
And finally:
Level 4 [Eliminate]
Services that can be performed:
Only urgent dental treatment using standard precautions for people who do not meet Emergency dental treatment for:
- – patients with confirmed COVID-19*
- – suspected COVID-19 cases* who meet epidemiological/clinical criteria
* Manage as per ADA COVID-19 Guidelines
Level 4 [Eliminate]
Restricted services:
Defer routine and urgent dental treatment using standard precautions for people who do not meet epidemiological or clinical criteria for COVID-19.
Defer urgent dental treatment for suspected cases of COVID-19 who meet epidemiological or clinical criteria until COVID-19 status is confirmed
Our biggest concern I believe at present is whether the window of opportunity of performing routine treatment on patients who do not meet epidemiological/clinical criteria for COVID-19 is worth the risk.
It is said that for every case of COVID-19 reported there are at least 10 cases of COVID-19 out there in society that are unreported and could be, what has been classed as an asymptomatic super-spreader
A super-spreader [of any disease] is described as someone able to infect others more easily.
Super-spreaders may not even become ill with the virus.
As a health care professional, and with a moral obligation to society, it is each dentist’s duty to assess the risks of each and every procedure they perform as to whether they cause increased possibility of the spread of Coronavirus, or not.
It is for this reason that the Federal ADA president has recommended:
“The ADA’s advice is that dental practices should immediately restrict dental treatment to non-aerosol generating procedures and consider the type of patients that receive treatment wherever possible (Level 2) restrictions”
ADA NSW President Kathleen Matthews has also recommended:
“ADA NSW is now recommending that dentists minimise the provision of routine dental treatment until 30 April 2020.”
And from ADA Queensland President Norah Ayad
“First and foremost, we must always prioritise the safety of the community and recognise our responsibility to reduce the risk of transmission and play a vital role in reducing the burden on the health system. Dentistry is an essential service however we must recognise that the full scope of dentistry is not. We are acutely aware of the level of concern in the dental community regarding the provision of dental treatment and possible associated risks to patients, practitioners and support staff.
Consistent with international guidelines the level as assessed by ADA puts current restrictions at Level 2.
Given the level of community transmission in Queensland, we recommend dentists start preparing to implement level 3 restrictions as the situation is rapidly evolving.”
It is my belief that further restrictions to dental practice and treatment are imminent.
At this stage, we as dentists need to do what we believe necessary to treat those screened patients who need treatment most urgently, with due consideration to NOT to be ignoring the channels of spread of the disease as well as due consideration to the safety of our patients and of our staff, by them using the recommended Personal Protective Equipment [PPE].
Under the current circumstances, patients are much safer in a dental practice than they would be in a hospital.
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For more up to date information, join Jayne Bandy and me on a LIVE webinar at 4pm AEST [Sydney time] today: